February 8, 2017

Cranial Sacral Therapy also known as craniopathy or cranial osteopathy is a holistic therapy that involves the manipulation of the skull bones (the cranium) and the sacrum to relieve pain and a variety of other conditions like chronic pain, emotional trauma, physical disability, pediatric trauma, and emotional stress and numerous ailments , including cancer. It is a gentle healing modality that uses very light touch to impact physical, neurological, and energetic structures in the body.

CST is a gentle, hands-on method of evaluating and enhancing the functioning of a physiological body system called the craniosacral system. Cranio-sacral therapy treats the whole person. It does not focus on symptoms although it is often the symptoms that bring us for treatment initially. This therapy stems from osteopathy, which is an approach that emphasizes the role of the musculoskeletal system in health and disease.

What is Craniosacral System?

The three layer of membranes that surround the brain and spinal cord (meninges) including the cerebral spinal fluid constitute the craniosacral system. The tissues extend through the bones to the skull, face and mouth (the cranium) and then down to the tailbone (the sacrum). This system protects the brain and the spinal cord as a shock absorber, and also serves to facilitate the electro-chemical conduction of nerves signal.

CST Process

Cranio-Sacral treatment is most often carried out with the patient lying down, fully clothed, in a quiet and peaceful environment. Treatment involves a very gentle touch of the practitioner’s hands. This light contact may be taken up on the Cranium, the Sacrum, the feet, the trunk, or any other part of the body as appropriate. Treatment is generally experienced as a profound relaxation which may pervade the whole person, physically, mentally and emotionally, often accompanied by a feeling of lightness and ease.

The gentle approach of CST is entirely non-invasive. The subtle interaction of the two systems – brought together by this light contact – stimulates and enhances self healing mechanisms within the body to respond, release and open up to a more balanced healthy state.

The practitioner notes what he or she perceives at selected points on the body and in the craniosacral system (the membranes and cerebrospinal fluid that surround and protect the brain and spinal cord), as well as the client’s attitude and intentions. The goal of craniosacral therapy is to help get rid of restrictions in this system to improve the functioning of the central nervous system.

CST is used for following conditions

Cranial osteopathy is used for a wide range of problems in both children and adults including –

  • Constipation
  • Iirritable Bowel Syndrome
  • Seizures
  • Scoliosis
  • Migraine headaches
  • Disturbed sleep cycles
  • Asthma
  • Neck pain
  • Sinus infections
  • TMJ syndrome
  • Ménière’s disease
  • Ear problems

And for children with – Attention Deficit Hyperactivity Disorder (ADHD), who have experienced birth trauma or head trauma.

The American Cancer Society notes that while cranial osteopathy therapy has not been shown scientifically to be a treatment for cancer, it can help patients feel more relaxed by helping to relieve stress and tension.

Benefits of CST

Cranial sacral therapy seeks to restore the natural position of the bones and can decrease  stress from chronic injuries as well as provide relief from migraine headaches, neck and back pain, temporomandibular joint disorder (the inflammation of the joint that connects the lower jaw to the skull) and more.

Approximately 28 million Americans suffer from migraine headaches. Often, migraines are triggered or exacerbated by stress and poor sleep. Researchers found that participants who received bodywork like Cranial Sacral Therapy had better quality sleep and fewer migraines than participants who didn’t. Effects even lasted up to three weeks after therapy ended.

Cranio-Sacral Therapy treats people rather than conditions. It is primarily concerned with establishing a healthy, balanced underlying state which enables the body’s own healing mechanisms to operate at optimum level, and therefore to restore health.

Cranio-Sacral Therapy works on many different levels and influences many different structures within the body. It influences the musculo-skeletal system, the nervous system, the cardio-vascular system, the immune system, the organs, the connective tissues, the fluids and the energy systems of the body.

The whole person – Cranio-Sacral Integration is not merely treating the body. It recognises that body, mind and feelings are absolutely and inextricably intertwined. It therefore engages with every aspect of our being – physical, mental, emotional, spiritual. So its effects are profound and widespread and can be effective over a very wide range of circumstances and conditions. Cranio-Sacral Integration is not treating conditions; it is treating people; it is treating the whole person and everything about the person at a fundamental and profound level. In doing so it can enable the body to address whatever symptoms, conditions or disturbances that particular individual may be experiencing.

Wide Application – Consequently, the applications of Cranio-Sacral Therapy are very wide – from simple aches and pains to the most complex chronic or persistent issues. It can also be valuable in helping to resolve intransigent and persistent conditions that have not responded to other forms of treatment.

It has a significant part to play in addressing the far-reaching and potentially life-determining consequences of severe trauma and shock – whether due to severe car accidents, mugging, rape, sexual abuse, childhood abuse, birth, war, or any other cause – engaging with both the physical and psycho-emotional effects of trauma.

Cranio-Sacral Therapy is concerned with enhancing health, strength and vitality at the very core of our being, thereby stimulating the body’s own natural potential, helping the body to eradicate the root of any problem. It is concerned with integrating all the body’s resources to function at their optimum level.

Who can benefit?

Cranio-Sacral Integration can be of benefit at any age – for babies, children, adults, the elderly, in pregnancy, in birth, in sickness or in health.

It has often been found to be helpful –

For Babies –

  • for the many common symptoms affecting so many babies in early life
  • helping babies to sleep better and to become more settled
  • for more serious issues, including the widespread effects of Birth Trauma

For children –

  • for the many knocks and falls which they encounter
  • to aid recovery from persistent illness
  • and for more serious issues

For Pregnant Women –

  • to assist in enabling an easier, smoother, more natural birth
  • with less need for intervention
  • to encourage a more comfortable pregnancy
  • to create the optimum environment for the baby

For Adults –

  • For numerous range of issues

For Old people –

  • To maintain good health and wellbeing

For Everyone –

  • who wishes to improve their underlying state of health and wellbeing
  • and to create a greater sense of ease clarity and health in their life

By complementing the body’s natural healing processes, CST is used as a preventive health measure for its ability to bolster resistance to disease, and is effective for a wide range of medical problems associated with pain and dysfunction.

 

Posted in MUSCULOSKELETAL
February 8, 2017

Costochondritis, also called Tietze’s Syndrome is an inflammation of the cartilage that attaches the inner end of the upper ribs to the flat bone in the middle of the chest (known as the sternum). Cartilage is a type of tissue that helps form many important body structures. For example, the ears are mostly made of cartilage.

Cartilages attach the ribs to the breastbone (sternum) and the sternum to the collarbones (clavicles). The joints between the ribs and the cartilages are called the costochondral joints. Those between the cartilages and the breastbone are called costosternal joints. Those between the sternum and the clavicles are called the sternoclavicular joints. The prefix ‘costo’ simply means related to the ribs. ‘Chondr-‘ means related to the cartilage and ‘-itis’ is the medical ending (suffix) that means inflammation. In costochondritis, there is inflammation in either the costochondral, costosternal or sternoclavicular joints (or a combination). This causes pain and tenderness, that tends to be worse with movement and pressure.

Most patients with costochondritis experience pain over the front of the chest (the area of the sternum). Costochondritis should only be diagnosed after excluding other more serious problems such as heart disease. Costochondritis pain is usually worsened by activity or exercise. Often the pain is worsened when taking a deep breath due to stretches of the inflamed cartilage. Pressing on the area can be extremely painful for the patient. Because of the many nerves that branch away from the chest, pain may be experienced in the shoulder or arms as well.

When called Tietze’s Syndrome, the pain from costochondritis is accompanied by redness and or swelling in the areas most tender.

Causes

The cause of costochondritis may be unknown, or it may be caused by any of the following –

Chest injury – An injury to your chest may cause costochondritis.

Strain – Activities that strain your chest wall muscles can lead to costochondritis. This includes hard coughing. Strain can also occur while you are playing sports with repeated arm movements, such as rowing, weightlifting, and volleyball.

Infection – Lung or chest infections can increase your risk of costochondritis.

Inflammatory diseases – Diseases that cause swelling around your joints, such as rheumatoid arthritis, increase your risk of costochondritis.

Risk Factors

There is no particular person more at risk of costochondritis than another. It does tend to affect younger people, especially teenagers and young adults. It can affect children. People performing repetitive movements that strain the chest wall, particularly if they are not used to it, might be considered more at risk of getting this condition. People with fibromyalgia tend to develop costochondritis more often than others. Fibromyalgia is a long-term (chronic) condition that causes widespread body pains and fatigue. (See separate leaflet called Fibromyalgia for more information.)

  • Race – A study indicates Hispanics may have an increased prevalence of costochondritis, but most studies do not mention race as a factor.
  • Sex – Studies of chest pain in children demonstrate that males and females are affected equally. There are no recent studies evaluating the effect of gender in costochondritis.
  • Age – No data support an association between age and costochondritis; the condition is well described in children of all ages, including infants.
  • Injury – A blow to the chest
  • Physical strain – Heavy lifting and/or strenuous exercise
  • Arthritis – In some people, costochondritis has been linked to specific problems, such as osteoarthritis, rheumatoid arthritis and ankylosing spondylitis.
  • Joint infection – The rib joint itself can become infected by viruses, bacteria or fungi. Examples include tuberculosis, syphilis and aspergillosis.
  • Tumours – Non-cancerous and cancerous tumours also can cause costochondritis. Cancer may travel to the joint from another part of the body, such as the breast, thyroid or lung.

Symptoms

The main symptoms of costochondritis are pain and tenderness at the junction of the ribs and the breastbone. The pain increases with movement and deep breathing, and decreases with rest and quiet breathing. Pressure placed directly on the affected area will also cause significant pain.

The pain can vary in intensity but is often severe. It is often described as sharp, aching or pressure-like in nature. It is usually located on the front of the chest, but can radiate to the back, abdomen, arm or shoulder.

The pain usually occurs on only one side of the chest, most commonly the left, but can affect both sides of the chest at the same time.  Symptoms of costochondritis usually last for between one and three weeks.

Costochondritis is similar to a condition called Tietze syndrome, which affects the same area. However, with Tietze syndrome there is swelling as well as the pain and tenderness. Swelling is not a symptom of costochondritis.

Treatment

Medications

  • Acetaminophen – This medicine decreases pain. Acetaminophen is available without a doctor’s order. Ask how much to take and how often to take it. Follow directions. Acetaminophen can cause liver damage if not taken correctly.
  • NSAIDs , such as ibuprofen, help decrease swelling, pain, and fever. This medicine is available with or without a doctor’s order. NSAIDs can cause stomach bleeding or kidney problems in certain people. If you take blood thinner medicine, always ask if NSAIDs are safe for you. Always read the medicine label and follow directions. Do not give these medicines to children under 6 months of age without direction from your child’s healthcare provider.

Other Treatment

Rest – Affected person may need to rest and avoid painful movements and activities. Do not carry objects, such as a purse or backpack, if this causes pain. Avoid activities such as weightlifting until your pain decreases or goes away.

Heat – Heat helps decrease pain in some patients.

Ice – Ice helps decrease swelling and pain. Ice may also help prevent tissue damage. Use an ice pack, or put crushed ice in a plastic bag. Cover it with a towel and place it on the painful area for 15 to 20 minutes every hour or as directed.

Stretching exercises – Gentle stretching may help your symptoms.

Alternative Treatment

Acupuncture is a well known Chinese technique used to alleviate pain, especially bone and joint pains. Acupuncture is very useful in repeated episodes of costochondritis.

Glucosamine is naturally found in the cartilage of joints. Glucosamine sulfate is also found in the synovial fluid that surrounds all joints. Glucosamine supplements have shown the most promise in the treatment of osteoarthritis of the knee, but some feel it may have some benefit in the treatment of costochondritis.

Omega 3s – It is vitally important for a strong immune system and fighting inflammation.

An anti-inflammatory diet is recommended comprising of healthy and wholesome foods.  Salmon, sardines, herring, anchovies, flaxseed, hempseed and walnuts are a great source of anti-inflammatory Omega 3s. In addition, other anti-inflammatory fats include extra-virgin olive oil, avocado oil, flaxseed oil, hempseed oil and walnut oil.

Turmeric – A great natural pain reliever as well as being anti-inflammatory. Turmeric contains Curcumin and Curcuminoids which act in the same way as prescribed NSAIDs (non-steroidal anti-inflammatory drugs). Turmeric needs to be supplemented to reap the full benefits but can also be used topically and added to food.

Burdock Root – Burdock contains anti-inflammatory fatty oils and is great as a natural pain reliever.

Aloe Vera – Aloe Vera boosts the immune system and energy levels, providing the body with the right agents to restore and repair itself.

Refined carbohydrates are pro-inflammatory.

Vitamin D is integral for bone health, and severe deficiency can cause rickets in children and osteomalacia in adults. Although osteomalacia can cause severe generalized bone pain, there are only a few case reports of chest pain associated with vitamin D deficiency.

Noni fruit acts as an anti-inflammatory and is an excellent natural remedy for Costochondritis.  We have had reports from customers who have experienced rapid relief from Costochondritis in just a few days.  Two traditional names for Noni have been ‘painkiller tree’ and ‘headache’ tree. Research has show that noni is completely safe, and does not exhibit any toxic effects.

Serrapeptase also has anti-inflammatory properties and has had wide clinical use, spanning over twenty-five years throughout Europe and Asia.  It is a viable, natural alternative to salicylates, ibuprofen and the more potent NSAIDs. Unlike these drugs, Serrapeptase is a naturally occurring, physiologic agent with no inhibitory effects on prostaglandins and is devoid of gastrointestinal side effects.  Serrapeptase would also then be indicated as a natural remedy for Costochondritis.

 

Reference –

https://www.southerncross.co.nz/AboutTheGroup/HealthResources/MedicalLibrary/tabid/178/vw/1/ItemID/190/Costochondritis-causes-symptoms-treatment.aspx

http://www.healthdirect.gov.au/costochondritis

http://emedicine.medscape.com/article/808554-overview

http://www.netdoctor.co.uk/conditions/aches-and-pains/a2864/costochondritis-tietzes-syndrome/

http://myheartsisters.org/2013/12/26/chest-pain-costochondritis/

http://patient.info/health/costochondritis

http://www.nhs.uk/conditions/Tietzes-syndrome/pages/introduction.aspx

http://www.healthline.com/health/costochondritis#Overview1

http://www.webmd.com/pain-management/costochondritis?print=true

https://www.nlm.nih.gov/medlineplus/ency/article/000164.htm

http://www.mayoclinic.org/diseases-conditions/costochondritis/basics/definition/con-20024454

http://www.emedicinehealth.com/costochondritis/article_em.htm

https://umm.edu/health/medical/ency/articles/costochondritis

http://www.regenerativenutrition.com/natural-supplements-cure-costochondritis.asp

http://hubpages.com/health/Costochondritis-treatment

 

 

Posted in MUSCULOSKELETAL
February 8, 2017

Complex regional pain syndrome (CRPS) is a condition of intense burning pain, stiffness, swelling, and discoloration that most often affects the hand. Arms, legs, and feet can also be affected by CRPS. It is caused by damage to, or malfunction of, the peripheral and central nervous systems.

The central nervous system is composed of the brain and spinal cord, and the peripheral nervous system involves nerve signaling from the brain and spinal cord to the rest of the body.  CRPS is characterized by prolonged or excessive pain and mild or dramatic changes in skin color, temperature, and/or swelling in the affected area.

CRPS symptoms vary in severity and duration. Studies of the incidence and prevalence of the disease show that most cases are mild and individuals recover gradually with time. In more severe cases, individuals may not recover and may have long-term disability.

Types of CRPS

There are two types of CRPS –

  • CRPS Type 1 – Used to be known as reflex sympathetic dystrophy, Sudeck’s atrophy, reflex neurovascular dystrophy, or algoneurodystrophy. No damage has occurred. It is triggered by an apparent trivial injury, such as a fractured or sprained ankle.
  • CRPS Type 2 – Used to be known as causalgia. This is triggered by a more serious injury, such as a broken bone or some surgical operation. It may also be caused by a serious infection. In all cases there is clear evidence that nerve damage has occurred.

Anyone can get CRPS. It can strike at any age and affects both men and women, although it is much more common in women. The average age of affected individuals is about age 40. CRPS is rare in the elderly. Children do not get it before age 5 and only very rarely before age 10, but it is not uncommon in teenagers.

Causes

The exact cause of CRPS is unknown but may result from irritated and damaged nerves of the sympathetic nervous system. Even relatively minor trauma to a body part may lead to CRPS.

The sympathetic nervous system is a division of the autonomic nervous system (ANS) which controls unconscious bodily functions including digestion, regular beating of the heart, blood flow, sweating and salivation.  In CRPS dysfunctional sympathetic nerves are thought to send inappropriate messages to the brain. These interfere with normal messages regarding sensation, temperature and blood flow.

A number of different events can trigger the condition. These include –

  • Trauma (injury)
  • Surgery
  • Some forms of arthritis
  • Heart disease
  • Stroke
  • Nerve entrapment conditions
  • Shingles
  • Shoulder problems
  • Breast cancer

CRPS also occurs in some people with fibromyalgia.  A common nerve entrapment condition that can trigger CRPS is carpal tunnel syndrome.  In approximately one third of all cases, no trigger can be identified.

Symptoms

CRPS can affect the nerves, skin, muscles, blood vessels and bones simultaneously. Symptoms can be gradual or rapid in onset and can vary in severity. They normally occur in three stages: acute, dystrophic and atrophic.  Signs and symptoms occurring in these three stages may include –

  • Stage 1 of CRPS – Typically lasts from 1 to 3 months. There is a severe, burning pain in one of the limbs. There may be muscle spasms (involuntary muscle contractions), joint stiffness and fast-growing hair and nails. Skin color and temperature may also change as blood vessels in the area are affected.
    • Burning pain
    • Swelling of an extremity
    • Vasospasm (constriction of blood vessels) affecting skin colour and temperature.
    • Excessive sweating
    • Tenderness.
  • Stage 2 of CRPS – Usually lasts for 3 to 6 months. Pain in the affected limb, hand or foot may get worse, as may alterations in skin texture and color. Muscle tone may weaken. Inflammation and stiffness may worsen.
    • Intensified pain
    • Shiny skin
    • Thickened skin
    • Contracture development (tightening and shortening of muscles)
    • Diminished swelling.
  • Stage 3 of CRPS – Changes that have occurred so far are usually irreversible at this stage. There will be significant loss of muscle tone in the affected limb, bones may have become contorted, while the joints have become stiffer. The patient will likely find it very hard to use the affected limb. Patients who receive prompt treatment for CRPS early on are very unlikely to ever reach this stage.
    • Skin changes become irreversible
    • Significant osteoporosis can be shown on x-ray
    • Thinning of the fatty layers under the skin
    • Restricted movement due to contractures
    • Pain unyielding and may have spread to other areas of body

Other possible signs and symptoms include –

  • Changes in skin temperature – the skin may be sweaty on some occasions, and cold and clammy in others.
  • Changes in skin color – there may be blotches or streaks on the skin. It may range in color from very pale to pink. Sometimes the affected area of skin may take on a blue tinge.
  • Skin texture – the skin may sometimes seem thin and shiny.
  • Nails and hair – hair and nails may grow at unusual speeds (too slow or too fast).
  • Joints – the affected joint(s) may be painful, stiff and inflamed.
  • Mobility – the patient may find it harder to move the affected limb or part of limb.

Complications

  • Muscle atrophy (muscle withers) – if a limb is not used for any reason, which in this case would be pain, the muscles begin to waste.
  • Contracture – the hand, fingers or foot, depending on which area is affected, may contract into a fixed position as the muscles gradually tighten.
  • CRPS may spread – CRPS symptoms may spread to the opposite limb, hand or foot (mirror-image type), to a distant part of the body (independent type), or to a nearby site (continuity type).

Treatment

Medications – Doctors often try medication first. Because each person responds differently to medication, your doctor may try a variety of doses and drugs. Medications range from over-the-counter pain relievers, such as aspirin, acetaminophen and anti-inflammatory steroids to stronger pain medicines. These may include –

  • NDSAIDs (nonsteroidal anti-inflammatory drugs) – OTC (over-the-counter, no prescription required) NSAIDs such as ibuprofen, naproxen sodium or aspirin may relieve pain and inflammation.
  • Antidepressants – such as amitriptyline may be prescribed for neuropathic pain (pain caused by a damaged nerve). Should not be taken by those with a history of heart disease. Side effects may include drowsiness, dry mouth, blurred vision, constipation and problems urinating. Individuals who feel drowsy should not drive or operate heavy machinery.
  • Anticonvulsants – these were originally designed for epilepsy treatment. As side effects may include loss of coordination, drowsiness, dizziness and fatigue, patients may have to refrain from driving or operating heavy machinery.
  • Corticosteroids – such as prednisone may reduce inflammation.
  • Bone-loss medications – such as alendronate (Fosamax) and calcitonin (Miacalcin) may also be prescribed.
  • Opioid medications (opiates) – Opioids (opiates) are a class of drugs that are commonly prescribed for their analgesic or pain-killing, properties.
  • Sympathetic nerve-blocking drugs – an anesthetic may be injected, blocking the nerve fibers in the affected nerves.
  • Topical analgesics – topical means “applied onto the skin”. Several types of creams, such a lidocaine, or a combination of ketamine, clonidine and amitriptyline may reduce hypersensitivity.

Surgical Treatment – If nonsurgical treatment fails, there are surgical procedures that may help reduce symptoms.

  • Spinal cord stimulator – Tiny electrodes are implanted along your spine and deliver mild electric impulses to the affected nerves.
  • Pain pump implantation – A small device that delivers pain medication to the spinal cord is implanted near the abdomen.

Physiotherapy attempts to build or recondition muscles – allowing the person to move more normally and with less pain. The doctor may recommend passive physical therapy, such as massage and applying heat/cold, or active therapies, such as exercise.

Medical Devices – Medical devices, such as neurostimulators or drug pumps (intrathecal drug delivery systems), are surgically placed devices that modulate pain signals before they reach the brain.

Alternative Treatment

Nutritional supplements – Vitamins, minerals, and added antioxidants may be recommended by a nutritional specialist. These supplements are thought to improve and strengthen the immune system, which may in turn have a positive influence on CRPS symptoms.

Omega-3 Fatty Acids – Fatty acids are essential nutrients derived from dietary intake of fats. They are an important source of energy for the body, and serve a variety of other biologic functions. Conversely, excessive levels of omega-6 PUFAs, such as arachidonic acid, are associated with inflammatory activities, an effect that can be offset by the simultaneous consumption of omega-3 PUFAs.

Gamma linolenic acid (GLA) is a plant-derived omega-6 most abundant in seeds of an Eastern flower known as borage. GLA plays an important role in modulating inflammation throughout the body, especially when incorporated into the membranes of immune system cells.

B Vitamins – Vitamins B1 (thiamine), B6 (pyridoxine), and B12 (cyanocobalamin/ methylcobalamin) are not only beneficial for managing pain that may result from a vitamin B deficiency, but are also effective (alone or in combination) with other conventional medications for various painful diseases.

Vitamin C – Vitamin C (ascorbic acid), a versatile antioxidant, may act as another natural shield against pain. Accumulating evidence indicates that free radicals play a role in the exaggeration of pain hypersensitivity.

Vitamin D – Vitamin D is a prohormone version of an important hormone called 1,25-dihydroxycholecalciferol or 1,25-dihydroxy vitamin D, also known as calcitriol (Dusso 2005). Vitamin D, once converted into calcitriol, inhibits inflammation by regulating some of the genes responsible for producing pro-inflammatory mediators.

Proanthocyanidins – Proanthocyanidins (tannins) belong to a group of chemical compounds called “flavonoids”, which provide a variety of beneficial functions for humans (e.g., their well-known antioxidant and anti-inflammatory affect). Grape seed is an especially rich source of proanthocyanidins, which have been associated with symptom reduction in a variety of painful diseases.

Melatonin is a naturally occurring hormone that is synthesized by the pineal gland and regulated by the environmental light/dark cycle. Melatonin can reduce pain through its beneficial effect on sleep, as well as its analgesic properties. It is also a potent antioxidant, and has been shown to reduce the pain associated with a variety of chronically painful conditions.

Methylsulfonylmethane – Methylsulfonylmethane (MSM) is an organic sulfur-containing compound. Among its many beneficial functions, MSM has been shown to display anti-inflammatory and antioxidant properties and pain management.

Acupuncture or acupressure – These treatments utilize thin needles to relieve pressure points in the affected area.

 

Reference –

http://painhealth.csse.uwa.edu.au/pain-condition-complex-regional-pain-syndrome.html

https://www.rcplondon.ac.uk/guidelines-policy/pain-complex-regional-pain-syndrome

http://www.cincinnatichildrens.org/health/c/rsd/

http://www.bodyinmind.org/what-is-complex-regional-pain-syndrome-in-plain-english/

http://rsds.org/wp-content/uploads/2015/02/deMosM_SturkenboomMCJM_HuygenFJPM.pdf\

https://www.southerncross.co.nz/AboutTheGroup/HealthResources/MedicalLibrary/tabid/178/vw/1/ItemID/193/Complex-regional-pain-syndrome-CRPS.aspx

http://familydoctor.org/familydoctor/en/diseases-conditions/complex-regional-pain-syndrome.html

http://orthoinfo.aaos.org/topic.cfm?topic=a00021

 

 

Posted in MUSCULOSKELETAL
February 8, 2017

Claudication is a common condition in which pain occurs in the legs with exercise. The pain is the result of a reduction in the blood flow to the muscles of the legs.

Claudication is defined as reproducible ischemic muscle pain, is one of the most common manifestations of peripheral arterial occlusive disease (PAOD) caused by atherosclerosis. Claudication occurs during physical activity and is relieved after a short rest. Atherosclerosis is the hardening and narrowing of the arteries over time through the buildup of fatty deposits, called plaque, along the artery walls. As plaques grow, they increasingly block the flow of blood through the arteries. Pain develops because of inadequate blood flow.

Claudication may occur in one or both legs, depending on where the blockage occurs. The pain is brought on by walking or exercise and disappears with rest. Claudication can range from being a mild nuisance to a disabling limitation. Claudication generally occurs when walking the same distance. With progressive vessel disease, the initial claudication distance (that distance at which a person first experiences pain when walking) may decrease or the person may no longer be able to walk.

About 9 million Americans, about 12 percent of the population, experience occasional claudication. Of those who are age 70 or more, about 20 percent are affected. About 25 percent of people who have hardening of the arteries (arteriosclerosis) in the legs experience claudication.

Causes

Claudication is pain caused by too little blood flow, usually during exercise. Sometimes called intermittent claudication, this condition generally affects the blood vessels in the legs, but claudication can affect the arms, too. Claudication is a symptom of PAD, which is caused by atherosclerosis.

Risk factors for claudication are the same as those for atherosclerosis, and include –

  • Smoking
  • Diabetes
  • Overweight
  • Sedentary lifestyle
  • High cholesterol
  • High blood pressure
  • Family history of atherosclerosis or claudication
  • Older age (55 for men, 60 for women)
  • Having a family history of heart or vascular disease.

Symptoms

Typical symptoms of claudication include –

  • Pain, a burning feeling, or a tired sensation in the legs and buttocks while walking
  • Shiny, hairless, blotchy foot skin that may get sores
  • Paleness in the limb when elevated and reddened when lowered
  • Cold feet
  • Impotence in men
  • Leg pain that occurs at night when in bed
  • Pain that occurs at rest may be a sign of increasing severity of arterial disease in the leg(s)

The symptoms related to claudication may look like other medical conditions or problems. Always consult your doctor for a diagnosis.

Treatment

  • Smoking cessation
  • Regular exercise, which is essential for patients with mild-to-moderate PAD
  • Heart-healthy diet, low in saturated fat, to reduce unhealthy cholesterol levels
  • Medications to help control high blood pressure and cholesterol. Other drugs that may help include antiplatelet medications to prevent blood clots.
  • In severe cases, procedures may be needed to open blocked blood vessels.

Angioplasty (stretching the artery where it is narrowed with a balloon) may help to improve walking distance for some people. Overall it is less effective in the longer term than simple exercise. Angioplasty is usually limited to narrowings or short complete blockages (usually less than 10cm) in the artery.

Bypass surgery is usually reserved for longer blockages of the artery, when the symptoms are significantly worse. There may be very short distance claudication, pain at rest, ulceration of the skin in the foot, or even gangrene in the foot or toes.

Alternative Treatment

L-carnitine appears to be of some benefit in intermittent claudication. Although it does not increase blood flow, carnitine appears to increase walking distance by improving energy utilization in the muscles.

Inositol hexaniacinate, a special form of vitamin B 3, appears to be helpful for intermittent claudication.

Mesoglycan is a substance found in many tissues in the body, including the joints, intestines, and the lining of blood vessels.

Ginkgo is an effective supplement for claudication.

Grape seed extract – Grapes, including the fruit, leaves and seeds, have been used medicinally since the time of the ancient Greeks. Grape seed extract is rich in oligomeric proanthocyanidins, antioxidants that integrative practitioners in Europe use to treat varicose veins, chronic leg ulcers and other symptoms of PAD.

Hesperidin – This flavonoid is found in unripe citrus fruits, such as oranges, grapefruits, lemons and tangerines.

Horse chestnut seed extract – The seeds, leaves, bark and flowers of this tree, which is native to Europe, have been used for centuries in herbal medicine.

Policosanol – This is a natural cholesterol-lowering compound made primarily from the wax of cane sugar. Comparative studies show that policosanol treats intermittent claudication as effectively as the prescription blood thinner ticlopidine (Ticlid) and more effectively than the cholesterol-lowering statin lovastatin (Mevacor).

Acupuncture – This practice involves the insertion of tiny needles into specific areas of the body. This is said to unblock the body’s flow of energy, promote healing and reduce pain.

Massage – Massage therapy can help to relax tense muscles and reduce the pain of spinal stenosis.

Pilates – This form of exercise serves to strengthen the muscles in the back and abdominals. Stronger muscles can provide the neck and back with better support, which may help to ease the symptoms of spinal stenosis.

 

Reference –

http://familydoctor.org/familydoctor/en/diseases-conditions/peripheral-arterial-disease-and-claudication.html

http://www.circulationfoundation.org.uk/help-advice/peripheral-arterial-disease/intermittent-claudication/

https://www.ucdmc.ucdavis.edu/vascular/diseases/claudication.html

http://www.ncbi.nlm.nih.gov/books/NBK235/

http://emedicine.medscape.com/article/460178-overview

http://www.cecity.com/wsu/claudication/

http://www.hopkinsmedicine.org/healthlibrary/conditions/cardiovascular_diseases/claudication_85,P08251/

https://stanfordhealthcare.org/medical-conditions/blood-heart-circulation/claudication.html

http://www.mc.vanderbilt.edu/documents/GSR/files/Intermittent%20Claudication%20ppt.pdf

 

Posted in MUSCULOSKELETAL
February 8, 2017

Chronic pain is a persistent pain that adversely affects your well-being, level of function, and quality of life. It can be the result of an injury or infection, or there may be an ongoing cause of pain. It is an ongoing or recurrent pain lasting longer than the time of normal healing for an illness or injury, or more than 3 to 6 months.

Chronic pain is a disease of the central nervous system.  It is defined as “pain without apparent biological value that has persisted beyond normal tissue healing time”  It is also defined as pain that either persists beyond the point that healing would be expected to be complete (usually taken as 3-6 months) or that occurs in disease processes in which healing does not take place. The pain may be continuous or intermittent. Chronic pain can be experienced by those who do not have evidence of tissue damage or biological reason for pain.

Some forms of chronic pain can be linked to an identifiable cause, like degenerative disc disease, spinal stenosis, or spondylolisthesis. Other forms of pain have no known or understood cause, such as fibromyalgia or neuropathic pain (nerve pain). Fighting chronic pain is a lifelong struggle for many.

Chronic pain is not simply a physical problem. It is often associated with severe and extensive psychological, social and economic factors. Apart from poor general physical health and disability there may also be depression, unemployment, and family stress. Many of these factors interact, and the whole picture needs to be be considered when managing individual patients. The impact of chronic pain on patients’ lives varies from minor restrictions to complete loss of independence.

Types of Chronic Pain

Nociceptive pain is caused by damage to body tissue and usually described as a sharp, aching, or throbbing pain. This kind of pain can be due to benign pathology; or by tumors or cancer cells that are growing larger and crowding other body parts near the cancer site. Nociceptive pain may also be caused by cancer spreading to the bones, muscles, or joints, or that causes the blockage of an organ or blood vessels.

Neuropathic pain occurs when there is actual nerve damage. Nerves connect the spinal cord to the rest of the body and allow the brain to communicate with the skin, muscles and internal organs. Nutritional imbalance, alcoholism, toxins, infections or auto-immunity can all damage this pathway and cause pain. Neuropathic pain can also be caused by a cancer tumor pressing on a nerve or a group of nerves. People often describe this pain as a burning or heavy sensation, or numbness along the path of the affected nerve.

Causes

Anyone can develop chronic pain, although it most commonly affects older adults and people with health conditions like diabetes, arthritis, or back problems. Persistent pain is not a normal part of ageing and treatment for it should be sought.

Chronic pain cannot be prevented in every case. However, early, aggressive treatment of sudden and severe pain may reduce the odds of it developing into chronic pain.

The amount of pain that different people experience as a result of apparently identical injuries can vary a great deal. One person may suffer greatly, while another does not even need minor pain relievers. Sometimes a seemingly minor injury, perhaps just a paper cut, can lead to severe and persistent pain. We don’t know why this happens – some people just appear to be predisposed to pain, while others seem to be immune. These individual differences may reflect upbringing or cultural traditions. However, there are more and more indications that pain response may be affected by our genes. And we have no control over our genes.

Chronic pain often sets the stage for a complex set of physical and psycho-social changes that are an integral part of the chronic pain problem. These ancillary effects, which add greatly to the pain patient’s burden, can include:

  • Immobility and consequent wasting of muscle, joints, etc.
  • Depression of the immune system and increased susceptibility to disease.
  • Disturbed sleep.
  • Poor appetite and nutrition.
  • Dependence on medication.
  • Over-dependence on family and other caregivers.
  • Repeated and/or inappropriate use of professional healthcare services.
  • Poor performance on the job or inability to work.
  • Introspective isolation from friends, family and society.
  • Anxiety and/or fear.
  • Bitterness, frustration, depression, and even suicide.

With so many possible causes, the precise cause of chronic pain can be hard to pinpoint. While pain may start with a disease or injury, it can persist because of stress, emotional problems, improper treatment, or persistent abnormal pain signals in the body. Chronic pain can even occur without any previous injury, illness or known cause.

Symptoms

The symptoms of chronic pain include –

  • Mild to severe pain that does not go away.
  • Pain that may be described as shooting, burning, aching, or electrical.
  • Feeling of discomfort, soreness, tightness, or stiffness.

Pain is not a symptom that exists alone. Other problems associated with pain include –

  • Fatigue.
  • Sleeplessness.
  • Withdrawal from activity and increased need to rest.
  • Weakened immune system
  • Changes in mood including hopelessness, fear, depression, irritability, anxiety, and stress.
  • Disability

Treatment

Medications – Some general categories for medications used for chronic pain are –

  • Anti-depressants – They can block the brain from receiving pain messages, so they are a reasonable option for chronic pain sufferers. It’s also thought that anti-depressants may increase the amount of endorphins in the body, and endorphins are a natural pain suppressant. Anti-depressants may be prescribed as part of a comprehensive treatment plan that seeks to help you deal with all components of chronic pain.
  • Muscle relaxants – If the chronic pain is caused by muscle sprain, strain, spasm, or tension, the patient may take a muscle relaxant. This medication may help give pain relief you needed, so that the person can work on strengthening the muscles through physical therapy and exercise.
  • Neuropathic agents – For chronic pain caused by nerve problems (neuropathic pain), doctors may prescribe neuropathic agents. They specifically target the nerves, and they change the way that the brain receives and interprets pain messages.
  • Non-steroidal anti-inflammatory drugs (NSAIDS) – NSAIDs fight inflammation, just as steroids do, but they do it without any steroids. They work by blocking certain enzymes in the body—the ones that help create inflammation.
  • Opioids (Narcotics) – In the most extreme cases, and only under careful supervision, the doctor may also prescribe an opioid, such as morphine or codeine. Opioids are also called narcotics. They work by attaching to opioid receptors on the surface of the brain, spinal cord, and gastrointestinal cells. They then can block pain messages from getting to the brain. Opioids also change the brain’s interpretation of pain by affecting the way that pain signals are transmitted.
  • Pain relievers – Prescription-strength pain relievers—also called pain killers or analgesics—do just what their name implies: they relieve pain. They don’t reduce inflammation. Instead, pain relievers work by blocking the brain from receiving pain signals from the nerves. If the nerve cells can’t transmit pain messages as they normally do, then the brain won’t be aware of the pain, and the patient either won’t feel it or won’t feel it as severely. Most pain relievers belong to one of the above categories (opioids, NSAID, etc.).
  • Steroid medications – Steroids are very strong anti-inflammatory medications. They stop the body from producing the chemical that cause inflammation, so they’re used for chronic pain patients with an inflammatory condition, such as arthritis.

Alternative Treatment

EPA, an omega-3 fatty acid in fish oil, is a potent anti-inflammatory. It works in a manner similar to NSAIDs, only better. Rather than dampening the production of prostaglandins across the board, it suppresses only those that cause pain and inflammation. And because inflammation is a primary cause of pain, fish oil is a great therapy for discomfort of any kind.

Glucosamine simply provides the body with the raw materials needed for cartilage regeneration. Glucosamine has been studied in scores of clinical trials.

Chondroitin sulfate is an ingredient in many joint formulas, and it appears to work well in combination with glucosamine. It inhibits enzymes that break down cartilage. It also attracts and holds water, which is very important, as water gives cartilage its resiliency and cushioning effects.

The amino acid d-phenylalanine (DPA) slows the action of the enzymes—particularly carboxypeptidase A or endorphinase and enkephalinase—that degrade the endorphins. The enzymatic degradation of endorphins and enkepinalins is a constant, somewhat indiscriminate, process. Slowing down this endorphin-reducing mechanism can diminish pain within twenty-four hours.

Calcium is critical to maintaining bone density. Many RA medications can contribute to bone loss, and inactivity from inflammation and pain can further deteriorate bone health. A calcium-rich diet along with a supplement can be an important part of treatment.

Quercetin, a plant-based flavonoid is responsible for giving many flowers, fruits, and vegetables their color. Quercetin has potent antioxidant and anti-inflammatory properties, and may benefit those with RA.

Vitamin D can contribute to the onset and progressive symptoms of RA. The vitamin significantly contributes to joint and bone health. Vitamin D is “an active steroid hormone that binds to receptors in a host of vulnerable tissues—including the joints affected by arthritis.”

White Willow Bark has a long history as an effective therapy for pain relief. In fact, aspirin was originally derived from the bark of this tree, although today’s synthesized version contains only one of its components.

Curcumin is the active ingredient in turmeric (Curcuma longa), the yellow-orange spice in curry. It has perhaps the strongest anti-inflammatory activity of all the medicinal herbs and has been compared to NSAIDs in terms of efficacy. Curcumin is also showing promise as a protector against degenerative disorders of the brain.

Bromelain is an enzyme from pineapple that acts on prostaglandin pathways to reduce pain and inflammation.

Boswellia, an extract from the Boswellia serrata tree, comes from ancient India. Studies suggest that patients with both osteoarthritis and rheumatoid arthritis have noted significant improvement boswellia.

DMSO (dimethyl sulfoxide) is a sulfur compound that is an excellent therapy for inflammatory conditions. This remarkable substance can be used orally, intravenously, or topically. Most patients with arthritis find topical application the most convenient.

MSM (methylsulfonylmethane) has many of the same properties as DMSO, minus the smell. Its potent anti-inflammatory actions blocks the pain response in nerve fibers.

Cayenne pepper (Capsicum frutescens) has been used therapeutically for centuries. Capsaicin works by depleting substance P, a neuropeptide produced by the nerves that carry pain sensation (the “p” stands for pain). Skin ointments containing capsaicin have been shown to significantly relieve arthritis pain.

Physical exercises and practicesMusculoskeletal pain, joint pain, and lower-back painBy strengthening muscles supporting joints, improving alignment, and releasing endorphins• Physical therapy: Specialized movements to strengthen weak areas of the body, often through resistance training

  • Yoga – An Indian practice of meditative stretching and posing
  • Pilates – A resistance regimen that strengthens core muscles
  • Tai chi: – A slow, flowing Chinese practice that improves balance
  • Feldenkrais – A therapy that builds efficiency of movement

 

Reference –

http://www.nps.org.au/conditions/nervous-system-problems/pain/for-individuals/pain-conditions/chronic-pain

http://www.aci.health.nsw.gov.au/chronic-pain/for-everyone/introduction-to-pain

http://www.medtronic.com/patients/chronic-pain/about/

http://www.medtronic.com/patients/chronic-pain/about/

http://www.health.com/health/chronic-pain/

http://www.medicinenet.com/chronic_pain/page2.htm

http://www.webmd.com/pain-management/guide/pain-types-and-classifications

http://www.webmd.com/pain-management/guide/pain-types-and-classificationshttps://www.asra.com/page/45/types-of-chronic-pain

http://pain.about.com/od/typesofchronicpain/ss/pain_classifications.htm

http://www.spine-health.com/conditions/chronic-pain

http://www.arthritis.org/living-with-arthritis/pain-management/chronic-pain/

http://www.rehab.research.va.gov/jour/07/44/2/pdf/tan.pdf

http://www.rehab.research.va.gov/jour/07/44/2/pdf/tan.pdf

http://www.aarp.org/health/alternative-medicine/info-11-2008/drug_free_remedies_chronic_pain.html

 

Posted in MUSCULOSKELETAL
February 8, 2017

Chronic Exertional Compartment Syndrome, commonly known as Compartment syndrome is a painful condition that occurs when pressure within the muscles builds to dangerous levels. This pressure can decrease blood flow, which prevents nourishment and oxygen from reaching nerve and muscle cells.

Anyone can develop chronic exertional compartment syndrome, but it’s more common in athletes who participate in sports that involve repetitive impact exercise, such as running and fast walking. Chronic exertional compartment syndrome is sometimes called chronic compartment syndrome or exercise-induced compartment syndrome.

CECS syndrome refers to exercise induced leg pain resulting from muscle ‘swelling’ and an increase in pressure in a compartment of the lower leg. The muscles in the lower leg are divided into a number of separate compartments by ‘sleeves’ of thick, inelastic connective tissue. When a person exercises, blood flow is increased to this compartment and the contained muscles increase in volume (swell). When there is not enough room within the compartment for this increased muscle volume, compartmental pressure rises. This can interfere with the blood flow to the muscles and nerves in the compartment, causing pain. Factors that may contribute to compartment syndrome include an increase in the size and volume of the muscles within the compartment, unaccustomed strenuous exercise, or progressive tightening of the surrounding connective tissue ‘sleeve’.

Men and women athletes are equally affected by the problem.  Athletes often get CECS in both legs. It is more common in running sports, basketball, gymnastics, soccer, field hockey, and dance.  Compartment syndrome most often occurs in the anterior (front) compartment of the lower leg (calf). It can also occur in other compartments in the leg, as well as in the arms, hands, feet, and buttocks.

Causes

The pain in CECS has been thought to derive from the same pathologic processes that cause pain in acute compartment syndrome—that is, compromise of the vascular supply, which leads to myoneural ischemia. Various mechanisms have been suggested as to the cause of this tissue ischemia, including arterial spasm, capillary obstruction, arteriovenous collapse, or venous outflow obstruction.

The pain and swelling of chronic compartment syndrome is caused by exercise. Athletes who participate in activities with repetitive motions, such as running, biking, or swimming, are more likely to develop chronic compartment syndrome. This is usually relieved by discontinuing the exercise, and is usually not dangerous.

A history of severe injury can cause scar tissue or injury to the compartment sleeve. Weight gain can also be associated with increasing compartment pressures. Drugs such as anabolic steroids can cause the muscle to increase in size but the compartment does not increase to accommodate it. Supplements such as creatine might cause swelling of the muscle. Training errors including excessive training frequency, type of exercise and poor running mechanics are also associated with fatigue and swelling of the muscle, increasing compartment pressure.

The risk factors include –

  • Chronic compartment syndrome most often occurs in athletes aged under 40 years but can occur at any age.
  • Most at risk are those who exercise with repetitive motions or activity.
  • Sporting activities with particular risk include running, football, cycling, tennis and gymnastics.
  • Excessive training increases the risk.

Symptoms

The most common sensation when a person has compartment syndrome is pain along the lower leg. This is commonly felt from the outside of the front edge of the shin (tibia). It may include-  aching, tight, cramping or squeezing pain.

Symptoms may also include –

  • Numbness
  • Difficulty moving the foot
  • Visible muscle bulging

Treatment

Nonsurgical treatment – Physical therapy, orthotics (inserts for shoes), and anti-inflammatory medicines are sometimes suggested. They have had questionable results for relieving symptoms.

Surgical treatment – If conservative measures fail, surgery may be an option. Similar to the surgery for acute compartment syndrome, the operation is designed to open the fascia so that there is more room for the muscles to swell. Although surgery is highly effective for most people, it’s not without risk. Complications of the surgery can include infection, permanent nerve damage, numbness and scarring.

Weight Loss – When a person gains weight the muscle has to work harder and there is potentially more mass in the compartment which increases pressure. Keeping weight as low as is appropriate is often helpful. Some athletes experience symptoms only after returning to running after a layoff and any increases in weight during this layoff may be a factor in increasing compartment pressure resulting in pain.

Flexibility training – If a muscle group is tight, the muscles that pull in the opposite direction have to work harder than normal.

Biomechanical assessment and correction – Assessment and correction of your biomechanics may potentially be very useful.

Alternative Treatment

Arginine – It acutely improve exercise capacity.  Its chronic effect results from the stimulation of muscle protein synthesis and thus, anabolism (the synthesis in living organisms of more complex substances (e.g., living tissue) from simpler ones together with the storage of energy) of muscle protein.

Branched-Chain Amino Acids (BCCAs) – BCCAs are an important source of energy in prolonged endurance exercise.  Supplementation is proposed to increase endurance in long tennis matches, soccer, marathons, long-distance swimming, and cycling activities.  BCAA supplementation may contribute to increased body fat loss and maintenance of a high level of exercise performance.

Chromium – Chromium is a trace mineral that is used for weight loss and for enhancement of glycemic control in the treatment of diabetes.  It has been proposed for the treatment of hyperlipidemia (an excess quantity of lipid in the blood) and hypercholesterolemia (an excess of cholesterol in the blood).

Creatine – Creatine is probably the most often used and the most researched supplement taken by athletes.

Vitamin C – Vitamin C is a powerful antioxidant which concentrates preferentially in leucocytes and attenuates reperfusion-induced muscle injury.

 

Reference –

http://www.medscape.com/viewarticle/405772

http://www.runnersworld.com/tag/compartment-syndrome

http://www.grastontechnique.com/file/sites%7C*%7C86%7C*%7CStudentDiscount%7C*%7CStudentEdge2012-optimized.pdf

http://orthoinfo.aaos.org/topic.cfm?topic=a00204

http://www.sportsinjurybulletin.com/archive/compartment-syndrome.html#

http://www.bmj.com/content/346/bmj.f33

http://www.medicinenet.com/compartment_syndrome/article.htm

http://www.mayoclinic.org/diseases-conditions/chronic-exertional-compartment-syndrome/basics/causes/con-20026471

 

Posted in MUSCULOSKELETAL
February 8, 2017

Charcot Marie Tooth disease (CMT) also known as Chacot-Marie-Tooth hereditary neuropathy, peroneal muscular atrophy, and hereditary motor and sensory neuropathy, is a group of disorders that affect the peripheral nerves — the nerves that carry messages between the brain and muscles throughout the body. It is named after the three doctors who described it in 1886: Jean Martin Charcot and Pierre Marie in Paris, and Howard Henry Tooth in Cambridge, England. Charcot-Marie-Tooth disease is also sometimes referred to as hereditary motor and sensory neuropathy (HMSN) or peroneal muscular atrophy.

CMT is one of the most common inherited neurological disorders, affecting approximately 1 in 2,500 people in the United States. A typical feature includes weakness of the foot and lower leg muscles, which may result in foot drop and a high-stepped gait with frequent tripping or falls. Foot deformities, such as high arches and hammertoes (a condition in which the middle joint of a toe bends upwards), are also characteristic due to weakness of the small muscles in the feet. In addition, the lower legs may take on an “inverted champagne bottle” appearance due to the loss of muscle bulk. Later in the disease, weakness and muscle atrophy may occur in the hands, resulting in difficulty with fine motor skills. Some patients experience pain, which can range from mild to severe.

The periphery nerves – the ones affected – are located outside the main central nervous system. Periphery nerves control muscles, as well as relaying data from our arms and legs to our brain, which allow us to sense touch. The building block of the nervous system is the nerve cell, or neuron. Neurons from the brain or spinal cord send electrical impulses down nerve fibres from the spinal cord to the muscles. The nerve fibres, which are like fibres in an electrical cable, are called ‘axons’. Axons are protected by an insulating material called myelin. Each axon is covered in a sheath of myelin, which keeps the axon healthy and helps electrical impulses travel quickly down nerve fibres.

CMT either interferes with the production of proteins that make up the myelin sheath, or else affects the structure or function of the axon. Neuropathies that affect myelin are known as ‘demyelinating’ neuropathies. Those that affect primarily the nerve fibres are called ‘axonal’ neuropathies. The result of both is that affected nerves cannot work properly to control movement or sensation.

Causes

Nerve Damage – A nerve cell communicates information to distant targets by sending electrical signals down a long, thin part of the cell called the axon. In order to increase the speed at which these electrical signals travel, the axon is insulated by myelin, which is produced by another type of cell called the Schwann cell. Myelin twists around the axon like a jelly-roll cake and prevents the loss of  electrical signals. Without an intact axon and myelin sheath, peripheral nerve cells are unable to activate target muscles or relay sensory information from the limbs back to the brain.

Genetic Factors – CMT is caused by mutations in genes that produce proteins involved in the structure and function of either the peripheral nerve axon or the myelin sheath. Although different proteins are abnormal in different forms of CMT disease, all of the mutations affect the normal function of the peripheral nerves. Consequently, these nerves slowly degenerate and lose the ability to communicate with their distant targets. The degeneration of motor nerves results in muscle weakness and atrophy in the extremities (arms, legs, hands, or feet), and in some cases the degeneration of sensory nerves results in a reduced ability to feel heat, cold, and pain.

The gene mutations in CMT disease are usually inherited. Each of us normally possesses two copies of every gene, one inherited from each parent. Some forms of CMT are inherited in an autosomal dominant fashion, which means that only one copy of the abnormal gene is needed to cause the disease. Other forms of CMT are inherited in an autosomal recessive fashion, which means that both copies of the abnormal gene must be present to cause the disease. Still other forms of CMT are inherited in an X-linked fashion, which means that the abnormal gene is located on the X chromosome. The X and Y chromosomes determine an individual’s sex. Individuals with two X chromosomes are female and individuals with one X and one Y chromosome are male.

Types of CMT

There are various types of CMT:

  • CMT 1 – the genes involved in myelin sheath production are faulty. The myelin sheath gradually wastes away. Approximately one third of all CMT cases are of this type.
  • CMT 2 – Approximately 17% of all CMT cases. The defect is in the axon itself.
  • CMT 3 – Also known as Dejerine-Sottas disease. This is a rare type of CMT. The myelin sheath is affected. The patient experiences severe muscle weakness and his/sense of touch is also affected severely. Children with CMT 3 may have noticeable symptoms.
  • CMT 4 – also affects the myelin sheath. CMT 4 is rare. Experts believe several different genetic processes are involved in the development of CMT 4, but they are not sure which genes. Symptoms generally appear during childhood. Wheelchairs are commonly required by patients with CMT 4.
  • CMT X – this type of CMT is caused by an X-chromosome mutation. This type of CMT is more commonly diagnosed in male patients. If female patients have CMT X, symptoms will be very mild. Approximately one tenth of all CMT cases in the UK are of this type.

Symptoms

CMT is a highly variable condition, even between members of the same family so the symptoms described here may not apply to all people with CMT.

In the most common types of CMT, symptoms usually begin before the age of 20 years and the typical symptoms are –

  • Weakness and wasting of muscle in the lower legs and feet
  • High arches in the feet (known medically as pes cavus) and curled toes
  • Foot drop (inability to hold foot horizontal)
  • Numbness in the feet
  • Difficulty with balance
  • Hand weakness and numbness, often appearing as much as ten years after foot and leg problems
  • Fatigue as a result of the extra effort required to perform daily activities.

Common Symptoms

  • Foot deformity (very high arched foot/feet)
  • Difficulty lifting foot at the ankle (foot drop)
  • Curled toes (known as hammer toes)
  • Loss of lower leg muscle, which leads to skinny calves
  • Numbness or burning sensation in the feet or hands
  • “Slapping” when walking (feet hit the floor hard when walking)
  • Weakness of the hips, legs, or feet
  • Leg and hand cramps
  • Loss of balance, tripping, and falling
  • Difficulty grasping and holding objects and opening jars and bottles

The muscles that support the foot while walking are among the first to be affected by CMT so the first noticeable signs are often difficulty in walking because of problems picking up the feet. The toes drop as the foot is lifted, causing a tendency to trip and an awkward walking style. Children with CMT may be described as clumsy or not good at sport before any other symptoms are noticed.

High arched feet can lead to instability of the foot and ankle, with twisting of the ankles becoming very common. Curled or hammer toes are a very common symptom and can result in pain from ill-fitting shoes.

Pain is often a feature of CMT, and is usually a result of poor walking putting additional stress on the knees, hips, back and even shoulders and neck. More rarely, the damaged nerves themselves cause pain, known as neuropathic pain. Some people with CMT experience tremor in both the arms and legs. Severe tremor and CMT is given the name ‘Roussy-Levy Syndrome’.

Symptoms can progress noticeably at the time of the growth spurt associated with puberty.

Some very rare symptoms of CMT include; curvature of the spine (scoliosis) and speech, swallowing and breathing difficulties, particularly when lying flat in bed at night.

Complications

  • Breathing – if the nerves that control the diaphragm are affected the patient may feel out of breath.
  • Depression – the mental stresses, anxieties and frustrations of living with a progressive disease, such as CMT, can eventually raise the risk of developing depression.
  • CBT (cognitive behavioral therapy) – CBT has been shown to help patients with CMT cope better. CBT trains the patient to react differently to his/her condition.

Treatment

Although there is no cure for CMT, therapies can treat the symptoms. The development of a comprehensive treatment plan with a health care team can help people with CMT lead an active life.  Treatment plans generally involve one or more of the following:

Physical and occupational therapy – Therapists work to improve muscle strength and stamina and to help people complete tasks of daily living.

Braces and other orthopedic devices – Custom shoes or shoe inserts (foot orthoses) help to improve walking ability – Leg braces prevent ankle sprains and improve walking ability.

Surgery – For some people, surgery can help prevent or reverse foot and joint deformities.

  • Osteotomy – used to correct severe flat feet. The surgeon either repositions or removes bones in the foot. After the operation the foot will be in plaster for a number of weeks.
  • Arthrodesis – used to correct flat feet, relieve joint pain, and correct heel deformities. The three main joints in the back of the feet are fused, resulting in a stronger foot, better shape, and often less pain. After surgery the foot will be placed in a cast for a number of weeks. It can take up to 10 months before the foot recovers completely.
  • Planter fascia release – inflamed tendons can cause continuous heel pain. Part of the tendon is surgically removed, while the remaining tendon is repositioned. The patient’s foot will be in a cast for about 3 weeks.

Pain management – Pain-killing drugs may be prescribed for people who have severe pain. Joint and muscle pain – resulting from stresses that are placed on parts of the body because of CMT.

NSAIDs (non-steroidal anti-inflammatory drugs), such as ibuprofen, can help reduce joint and muscle pain –

  • Neuropathic pain – caused by damaged nerves (less common).
  • NSAIDs can sometimes help alleviate the symptoms of neuropathic pain.
  • TCAs (tricyclic antidepressants) – if NSAIDs are not effective, the patient may be prescribed a TCA. TCAs, although originally designed to treat patients with depression, are also effective in alleviating neuropathic pain symptoms.

Alternative Treatment

Coenzyme Q10 has already been studied in other diseases which involve deterioration of nerve cells. Coenzyme Q10 supplementation is safe and beneficial in a relatively small group of patients with Charcot-Marie-Tooth disease.

Creatine is one of the main symptoms of Charcot-Marie-Tooth disease muscle weakness and the supplement Creatine can help to improve muscle performance and help to treat myopathies.  Evidence suggests that Creatine can help to improve muscle strength and is very well tolerated.

Alpha Lipoic Acid has proven to help protect the nerves from the toxic chemicals throughout the body and can help to ease the burning and numbness sensations that often accompany Charcot-Marie-Tooth disease.

Vitamin C  supplement can be very effective for helping to treat balance and physical performance issues in those who suffer from Charcot-Marie-Tooth disease. Studies also show that Vitamin C may help with prevention the disease progression and can help to promote normal myelination in the nerves.

Meditation – Techniques include specific postures, focused attention, or an open attitude toward distractions.  People use meditation to increase calmness and relaxation, improve psychological balance, cope with illness, or enhance overall health and well-being.

Yoga – Various styles of yoga are used for healthy bone purposes.  Yoga typically combines physical postures, breathing techniques, and meditation or relaxation.   People use yoga as part of a general health regimen, and also for variety of health conditions.

Acupuncture – This is a family of procedures involving the stimulation of specific points on the body using a variety of techniques, such as penetrating the skin with needles that are then manipulated by hand or by electrical stimulation.

Cayenne is very healing, will equalize the blood pressure and increase stimulation. It also has calcium to help the body rebuild.

Curcumin – Abnormal activation of nuclear factor kappa B (NF-kappaB) probably plays an important role in the pathogenesis of CMT.

 

Reference –

http://www.aanem.org/Patients/Disorders/Charcot-Marie-Tooth-Disease

https://www.uihealthcare.org/charcot-marie-tooth-disease/

https://my.clevelandclinic.org/health/diseases_conditions/hic_Charcot-Marie-Tooth_Disorder

http://www.medicalnewstoday.com/articles/172056.php

http://www.mda.org.au/Disorders/Peripheral/CMT.asp

http://www.gpnotebook.co.uk/simplepage.cfm?ID=-1241120765

https://www.cmt.org.au/

http://www.healthline.com/health/charcot-marie-tooth-disease

http://patient.info/doctor/charcot-marie-tooth-disease

http://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/peripheral_nerve/conditions/charcot_marie_tooth_disease.html

http://www.webmd.com/brain/charcot-marie-tooth-disease

 

Posted in MUSCULOSKELETAL
February 8, 2017

Cervical Spondylosis or Cervical Osteoarthritis is a physical condition caused by the wear and tear of bones and cartilage in the neck (cervical vertebra) region.  It is a common cause of chronic neck pain.

Cervical Spondylosis is a degenerative disorder at the level of the cervical spine. It can be described as the result of degeneration of the intervertebral discs or the corpus vertebrae in the cervical region. Possible characteristics are Degenerative Disc Disease, the formation of osteophytes, facet and uncovertebral joint arthritis, ossification of the posterior longitudinal ligament, hypertrophy of the ligamentum flavum, spinal stenosis. In some cases this degeneration also leads to a posterior protrusion of the annulus fibers of the intervertebral disc. This protrusion can cause compression of nerve roots, which in turn can lead to pain, motor disturbances such as muscle weakness, and sensory disturbances. As the spondylosis progresses there may be even interference with the blood supply to the spinal cord where the vertebral canal is narrowest. However, in some people, the nearby muscles, ligaments, or nerves may become irritated or ‘pressed on’ by the degenerative changes. So, cervical spondylosis often causes no problems but can be a cause of neck pain, particularly in older people.

The cervical spine is made up of small circular bones (vertebrae) stacked on top of each other. Between each vertebrae is an intervertebral disc which acts like a shock absorber and allows flexibility of the spine. Muscles and ligaments run between, and are attached to, the vertebrae. Nerves from the spinal cord pass between the vertebrae going to the shoulder, neck, arm, and upper chest.

Causes

Cervical spondylosis arises from degenerative changes that occur in the spine as a person ages. These changes are normal and they occur in everyone. In fact, nearly half of all people middle-aged and older have worn disks that do not cause painful symptoms. The following are causes –

  • Cervical Stenosis is a condition when the disc degenerates, the normal relationships of the bones are lost and there is a condition of instability- one vertebra moving in an abnormal manner in relation to the next vertebra. In an attempt to stabilize, new bone grows outward – osteophytes. Osteophytes can be found near the disc spaces and around the facet joints. If they grow in areas where nerves or the spinal cord are nearby, they can impinge or compress these structures. This can cause pain, numbness, tingling, or weakness to varying degrees. If significant enough to cause nerve dysfunction, it is known as cervical stenosis.
  • Cervical Disc Herniation is more or so like the disc prolapse/herniation in the lower back. In the process of sustaining increased mechanical loads, the outer aspect of the disc, known as the annulus becomes stressed and with time, small tears can form in it. The gel center, known as the nucleus, can be ejected from the disc through an annular tear. This is called a disc herniation. If the disc herniates in the direction of the spinal cord or nerve root, it can cause neurologic compromise. Disc herniations in the cervical spine can be serious. If significant enough, they can cause paralysis of both the upper and lower extremities, though this is extremely rare.
  • In most cases, a patient complains of neck pain associated with radiating pain to one arm. This is caused by compression of a nerve root. With time some herniated discs resolves or shrinks. Sometimes, disc herniations can persist, causing prolonged symptoms and neurologic problems, which may lead to surgical considerations.

What are the Risk Factors?

Age is the most common risk factor for cervical spondylosis. The condition is extremely common in patients who are middle-aged and older.

Other factors that may increase your risk for developing cervical spondylosis and neck pain include –

  • Genetics—a family history of neck pain and spondylosis
  • Smoking—clearly linked to increased neck pain
  • Occupation—jobs with lots of repetitive neck motion and overhead work
  • Depression or anxiety
  • Previous injury or trauma to the neck

Symptoms

For most people, cervical spondylosis causes no symptoms. When symptoms do occur, they typically include pain and stiffness in the neck. This pain can range from mild to severe. It is sometimes worsened by looking up or looking down for a long time, or by activities in which the neck is held in the same position for a prolonged period of time—such as driving or reading a book. The pain usually improves with rest or lying down.

Other symptoms may include –

  • Headaches
  • Grinding or popping noise or sensation when you turn your neck
  • In some cases, cervical spondylosis results in a narrowing of the space needed for the spinal cord or nerve roots. If this occurs, your symptoms may include numbness and weakness in the arms, hands, and fingers
  • Trouble walking, loss of balance, or weakness in the hands or legs
  • Muscle spasms in the neck and shoulders

The pain may get worse –

  • After standing or sitting
  • At night
  • When a person sneezes, coughs, or laughs
  • When a person bends the neck backwards or walk more than a few yards

Less common symptoms are –

  • Loss of balance
  • Loss of control over the bladder or bowels (if there is pressure on the spinal cord)

Treatment

Medications – During the first phase of treatment, your doctor may prescribe several medications to be used together to address both pain and inflammation

  • Acetaminophen – Mild pain is often relieved with acetaminophen.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) – Often prescribed with acetaminophen, NSAIDs such as ibuprofen and naproxen are considered first-line medications for neck pain. They relieve both pain and swelling and may be prescribed for a number of weeks, depending on your specific symptoms. Other types of pain medication can be considered if you have serious contraindications to NSAIDs or if your pain is not well controlled.
  • Muscle relaxants – Medications such as cyclobenzaprine or carisoprodol can be used to treat painful muscle spasms.

Blockers –

  • Cervical epidural block – In this procedure, steroid and anesthetic medicine is injected into the space next to the covering of the spinal cord (“epidural” space). This procedure is typically used for neck and/or arm pain that may be due to a cervical disk herniation, also known as radiculopathy or a “pinched nerve.”
  • Cervical facet joint block – In this procedure, steroid and anesthetic medicine is injected into the capsule of the facet joint. The facet joints are located in the back of the neck and provide stability and movement. These joints can develop arthritic changes that may contribute to neck pain.
  • Medial branch block and radiofrequency ablation – This procedure is used in some cases of chronic neck pain. It can be used to both diagnose and treat a painful joint. During the diagnosis portion of the procedure, the nerve that supplies the facet joint is blocked with a local anesthetic.

Surgery – Surgery is not commonly recommended for cervical spondylosis and neck pain unless the doctor determines that –

  • A spinal nerve is being pinched by a herniated disk or bone (cervical radiculopathy), or
  • The spinal cord is being compressed (cervical spondylotic myelopathy)

Soft cervical collar – This is a padded ring that wraps around the neck and is held in place with Velcro.

Ice, heat, and other modalities – The doctor may recommend careful use of ice, heat, massage, and other local therapies to help relieve symptoms.

Physical therapy – Physical therapy is usually the first nonsurgical treatment that the doctor will recommend. Specific exercises can help relieve pain, as well as strengthen and stretch weakened or strained muscles. In some cases, physical therapy may include posture therapy or the use of traction to gently stretch the joints and muscles of the neck.

Alternative Treatment

5-HTP (5-hydroxytryptophan) is the precursor of the neurotransmitter serotonin. It is obtained commercially from the seeds of the plant Griffonia simplicifolia. There is a small amount of research evaluating the use of 5-HTP for fibromyalgia, and early evidence suggests that 5-HTP may reduce the number of tender points, anxiety, and intensity of pain and may improve sleep, fatigue, and morning stiffness.

DHEA (dehydroepiandrosterone), the majority of clinical trials investigating the effect of DHEA for systemic lupus erythematosus (SLE) support its use as an adjunct treatment.

Omega-3 fatty acids, fish oil, alpha-linolenic acid – Multiple randomized controlled trials report improvements in rheumatoid arthritis, including morning stiffness and joint tenderness, with the regular intake of fish oil supplements for up to three months. Benefits have been reported as additive with anti-inflammatory medications such as NSAIDs (like ibuprofen or aspirin).

S-adenosyl-L-methionine (SAMe) is a naturally occurring molecule that is found in humans. SAMe is present in almost every tissue and fluid in the body, and has been studied extensively in the treatment of osteoarthritis. SAMe reduces the pain associated with osteoarthritis and is well tolerated in this patient population.

Proteins,Calcium and vitamin D – Proteins and Vitamin C are necessary for the development of a healthy bone metrix. Vitamin D, calcium, phosphorous and the essential trace minerals are essential for healthy bones.

Glucosamine– Several human studies and animal experiments report benefits of glucosamine in treating osteoarthritis of various joints of the body, although the evidence is less plentiful than that for knee osteoarthritis. Some of these benefits include pain relief, possibly due to an anti-inflammatory effect of glucosamine, and improved joint function.

Alpinia, also known as Chinese ginger, has been studied in combination with another ginger species for the treatment of cervical sondylosis.

Beta-carotene is a member of the carotenoids, which are highly pigmented (red, orange, yellow), fat-soluble compounds naturally present in many fruits, grains, oils, and vegetables (green plants, carrots, sweet potatoes, squash, spinach, apricots, and green peppers). Beta-carotene supplementation does not appear to prevent cervical spondylosis, but it may slow progression of the disease.

Boron is a trace element, which is found throughout the global environment. Based on human population research, individuals who eat foods rich in boron (including green vegetables, fruits, and nuts) appear to have fewer joint disorders.

Boswellia has been noted in animal and laboratory studies to possess anti-inflammatory properties. Based on these observations, boswellia has been suggested as a potential treatment for rheumatoid arthritis and cervical spondylosis.

Chiropractic is a healthcare discipline that focuses on the relationship between musculoskeletal structure (primarily the spine) and body function (as coordinated by the nervous system), and how this relationship affects the preservation and restoration of health.

Chlorophyll – Diets high in chlorophyll have been hypothesized to modify intestinal flora resulting in improved management of immune disorders including rheumatoid arthritis and other related disorders.

DMSO (dimethyl sulfoxide) – Applying DMSO to the skin may help treat CS.

Niacin – Vitamin B3 is made up of niacin (nicotinic acid) and its amide, niacinamide, may be useful in the treatment of cervical spondylosis.

Probiotics – In limited study, Lactobacillus GG was associated with improved subjective well-being, as well as reduced symptoms of rheumatoid arthritis and other related disorders.

Selenium supplementation has been studied in spondylosis patients with mixed results. Additional research is necessary before a clear conclusion can be drawn.

Chondroitin sulfate, a component of shark cartilage, has been shown to benefit patients with spondylosis.

Methylsulfonylmethane, or MSM, is a form of organic sulfur that occurs naturally in a variety of fruits, vegetables, grains, and animals. MSM is a normal oxidation product of dimethyl sulfoxide (DMSO).

Transcutaneous electrical nerve stimulation (TENS) is a non-invasive technique in which a low-voltage electrical current is delivered through wires from a small power unit to electrodes located on the skin. Electrodes are temporarily attached with paste in various patterns, depending on the specific condition and treatment goals.

Rose hips have traditionally been used by herbalists as an anti-inflammatory and antiarthritic agent.

Devil’s claw (Harpagophytum procumbens) originates from the Kalahari and Savannah desert regions of South and Southeast Africa. There is increasing scientific evidence suggesting that devil’s claw is safe and beneficial for the short-term treatment of pain related to degenerative joint disease.

Chondroitin – Multiple clinical trials have examined the use of oral chondroitin in patients with osteoarthritis of the knee and other joints (spine, hips, and finger joints).

Acupuncture is commonly used throughout the world. According to Chinese medicine theory, the human body contains a network of energy pathways through which vital energy, called chi, circulates. These pathways contain specific “points” that function like gates, allowing chi to flow through the body. Needles are inserted into these points to regulate the flow of chi.

Yoga is a natural and side-effect free remedy for Cervical Spondylosis. A regular practice of this ancient science leads to a flexible body, calm mind and a positive attitude towards life.

 

Reference –

https://www.rimed.org/medhealthri/2012-04/2012-04-105.pdf

http://www.worldscientific.com/worldscibooks/10.1142/3175

http://www.aafp.org/afp/2000/0901/p1064.html

http://www.homoeopathyclinic.com/articles/diseases/cervicals.pdf

http://www.artofliving.org/in-en/yoga/health-and-wellness/cervical-spondylosis-yoga

http://www.cervical-spondylosis.com/

http://www.emedicinehealth.com/spondylosis/article_em.htm

http://www.physio-pedia.com/Cervical_Spondylosis

http://patient.info/health/cervical-spondylosis

http://www.msdmanuals.com/professional/neurologic-disorders/spinal-cord-disorders/cervical-spondylosis-and-spondylotic-cervical-myelopathy

 

Posted in MUSCULOSKELETAL
February 8, 2017

Bones play an important structural role in the body. They provide mobility, support and protection for  the body and acts as a warehouse for essential minerals. Although some people think of bones as hard and lifeless, they are actually living, growing tissue. They are alive and constantly changing, with new bone being made and old bone lost throughout our lives. In adults, the entire skeleton is completely replaced every seven to ten years. Bones continue to grow in strength until our mid twenties, at which point bone density reaches its peak. Bones are made up of three major components that make them flexible and strong –

  • Collagen, a protein that gives bones a flexible framework
  • Calcium-phosphate mineral complexes that make bones hard and strong
  • Living bone cells that remove and replace weakened sections of bone

Healthy bones are critical to overall health, and behaviors that promote health and disease prevention also are key to maintaining a strong and healthy skeleton. These behaviors include, for example, getting regular exercise, eating a balanced diet, not smoking, preventing falls and injuries, and drinking alcohol only in moderation. Encouraging bone health is important in helping to stem the rate and risk of osteoporosis, the most common bone disease, which currently afflicts 10 million Americans over the age of 50.

What is Osteoporosis? Osteoporosis is a chronic, debilitating disease whereby the density and quality of bone are reduced. The bones become porous and fragile, the skeleton weakens, and the risk of fractures greatly increases. The loss of bone occurs “silently” and progressively, often without symptoms until the first fracture occurs, most commonly at the wrist, spine and hip. Approximately one out of three women over 50 will have a fracture due to osteoporosis as will one out of five men over 50. Although osteoporosis typically manifests itself later in life, the roots of the disease may stretch back to early childhood and reflect a lifetime of risks and behaviors.

Other bone diseases affect the lives of many Americans and their families. Nearly 1.5 million people in the United States may have Paget’s disease, the second most common bone disease.

What is Paget’s disease? Paget’s disease is characterized by pain, skeletal deformities, increased risk for multiple fractures, and other complications such as hearing loss. Osteogenesis imperfecta is a genetic disorder that causes brittle bones that break easily. Estimates of the numbers of individuals in the United States with this disorder range from 25,000 to 50,000 – exact numbers are difficult to calculate because milder forms of the disease may go undetected.

Although these, and other rare bone diseases, may affect fewer individuals than other conditions, their importance is far reaching. It’s effects on bone health has increased the potential and importance to address bone loss, fragility, or disease.

The importance of bone health is already far greater than is widely recognized. An estimated 1.5 million people suffer an osteoporosis-related fracture each year, and over their life times, half of all women and one-quarter of all men can expect to join their ranks. Among people age 65 and older, unintentional falls account for 87% of all fractures treated in emergency departments.

Factors Affecting Bone Health

  • Gender, Size & Age Women have less bone tissue than men. If a woman’s period is absent for long stretches of time prior to menopause, she can be at increased risk for osteoporosis – and menopause itself corresponds to dramatic bone loss as estrogen decreases. In men, lower testosterone can cause lower bone mass. Also age play a role in weakened bones, as bones thin and weaken with increasing age. Maintaining a healthy body weight is important for bone health throughout life. Being underweight raises the risk of fracture and bone loss. Weight loss is associated with bone loss as well, although adequate diet and physical activity may reduce this loss.
  • Genetics – If a person is of Caucasian or Asian descent, he/she is at a greatest risk for osteoporosis. A parent or sibling with osteoporosis or a history of fracture is a risk factor.
  • Physical Activity – Physical activity is important for bone health throughout life. It helps to increase or preserve bone mass and to reduce the risk of falling. All types of physical activity can contribute to bone health, albeit in different ways.
  • Fractures – Fractures are commonly caused by falls, and thus fall prevention offers another opportunity to protect bones, particularly in those over age 60. Several specific approaches have demonstrated benefits, including muscle strengthening and balance retraining, professional home hazard assessment and modification, and stopping or reducing psychotropic medications.
  • Reproductive Problems – Reproductive issues can affect bone health. Pregnancy and lactation generally do not harm the skeleton of healthy adult women. Amenorrhea (cessation of menstrual periods) after the onset of puberty and before menopause is a very serious threat to bone health and needs to be attended to by individuals and their health care providers.
  • Calcium – Calcium has been singled out as a major public health concern today because it is critically important to bone health and the average American consumes levels of calcium that are far below the amount recommended for optimal bone health. A diet low in calcium contributes to diminished bone density, early bone loss and an increased risk of fractures.
  • Vitamin Deficiency – In children, severe vitamin D deficiency results in delayed growth and bone deformities known as rickets, and in adults, a similar condition called osteomalacia (a ‘softening’ of the bones, due to the poor mineralization). Milder degrees of vitamin D inadequacy can lead to a higher risk of osteoporosis, and an increased likelihood of falling in older adults whose muscles are weakened by a lack of the vitamin.
  • Lifestyle – Smoking can reduce bone mass and increase fracture risk and should be avoided for a variety of health reasons. Heavy alcohol use has been associated with reduced bone mass and increased fracture risk.
  • Heavy Metals – The main threats to human health from heavy metals are associated with exposure to lead, cadmium, mercury and arsenic. Metal exposure lowers bone density in the arms (the area that was tested). The overall bone density of affected person is significantly lower than the healthy person.
  • Hormones – Too much thyroid hormone can cause bone loss. In women, bone loss increases dramatically at menopause due to dropping estrogen levels.
  • Eating Disorders – People who have anorexia or bulimia are at risk of bone loss. In addition, stomach surgery (gastrectomy), weight-loss surgery and conditions such as Crohn’s disease, celiac disease and Cushing’s disease can affect your body’s ability to absorb calcium. Caffeine increases the loss of calcium from the body; however, the negative effects can be offset by adequate calcium intake.
  • Medications – Damaging to bone over long-term usage – prednisone, cortisone, prednisolone and dexamethasone (corticosteroids).
  • Medical Conditions – Conditions like – Inflammatory Bowel Disease, Celiac Disease, Glucocorticoids, Anorexia nervosa have adverse effects on bone health.

Keeping Bones Healthy

Calcium Supplements – Calcium is a major building-block of the bone tissue. The human skeleton houses 99 per cent of our body’s calcium stores. The calcium in the bones also acts as a ‘reservoir’ for maintaining calcium levels in the blood, which are essential for healthy nerve and muscle functioning. Calcium requirements are high during teenage years with the rapid growth of the skeleton, and during this time, the body’s efficiency in absorbing calcium from food increases.

Vitamin D & Homocysteine – Vitamin D plays a key role in assisting calcium absorption from food, ensuring the correct renewal and mineralization of bone tissue, and promoting a healthy immune system and muscles. studies suggest that high blood levels of the amino acid homocysteine may be linked to lower bone density and higher risk of hip fracture in older persons. Vitamins B6 and B12, as well as folic acid, play a role in changing homocysteine into other amino acids for use by the body, so it is possible that they might play a protective role in osteoporosis. Further research is needed to test whether supplementation with these B vitamins might reduce fracture risk.

Vitamin A – The role of vitamin A in osteoporosis risk is controversial. Vitamin A is present as a compound called retinol in foods of animal origin, such as liver and other offal, fish liver oils, dairy foods and egg yolk. Some plant foods contain a precursor of vitamin A, a group of compounds called carotenoids.

Zinc – This mineral is required for bone tissue renewal and mineralization. Severe deficiency is usually associated with calorie and protein malnutrition, and contributes to impaired bone growth in children. Milder degrees of zinc deficiency have been reported in the elderly and could potentially contribute to poor bone status.

Magnesium – Magnesium plays an important role in forming bone mineral. Magnesium deficiency is rare in generally well-nourished populations. The elderly could potentially be at risk of mild magnesium deficiency, as magnesium absorption decreases and renal excretion increases with age, and also because certain medications promote magnesium loss in the urine.

Vitamin K – Vitamin K is required for the correct mineralization of bone. Some evidence suggests low vitamin K levels lead to low bone density and increased risk of fracture in the elderly, but more studies are needed to prove if increasing vitamin K intake would help to prevent or treat osteoporosis

Protein – Adequate dietary protein is essential for optimal bone mass gain during childhood and adolescence, and preserving bone mass with ageing. Insufficient protein intake is common in the elderly and is more severe in hip fracture patients than in the general ageing population. Protein under nutrition also robs the muscles of mass and strength, heightening the risk of falls and fractures, and it contributes to poor recovery in patients who have had a fracture.

 

Reference –

http://www.betterbones.com/osteoporosis/natural-approach-to-bone-health.aspx

http://nof.org/learn/prevention

http://www.caltrate.ca/keeping-bones-healthy

http://www.emedicinehealth.com/what_is_bone_loss/page3_em.htm#what_causes_bone_loss

http://www.progressivehealth.com/toxic-cadmium-damaging-bones.htm

http://bmb.oxfordjournals.org/content/68/1/167.full

http://www.ncbi.nlm.nih.gov/books/NBK45503/

http://www.caltrate.ca/what-affects-bone-health

http://www.iofbonehealth.org/sites/default/files/PDFs/good_nutrition_for_healthy_bones.pdf

https://jeanhailes.org.au/health-a-z/bone-health

 

Posted in MUSCULOSKELETAL
February 8, 2017

Ankylosing spondylitis is a type of arthritis of the spine. It causes inflammation between your vertebrae, which are the bones that make up your spine, and in the joints between your spine and pelvis. In some people, it can affect other joints. Its name comes from the Greek words “ankylos,” meaning stiffening of a joint, and “spondylo,” meaning vertebra. Spondylitis refers to inflammation of the spine or one or more of the adjacent structures of the vertebrae.

The condition is grouped into a set of overlapping arthritis disorders that doctors call the spondyloarthritides or spondylarthritis. In addition to ankylosing spondylitis, this classification includes other types of spondylitis caused by syndromes such as inflammatory bowel disease and psoriasis. Although these disorders have similarities, they also have features that distinguish them from one another. The hallmark of ankylosing spondylitis is “sacroiliitis,” or inflammation of the sacroiliac (SI) joints, where the spine joins the pelvis. AS affect joints outside of the spine, like the shoulders, ribs, hips, knees, and feet. It can also affect entheses, which are sites where the tendons and ligaments attach to the bones. It is possible that it can affect other organs, such as the eyes, bowel, and—more rarely—the heart and lungs. In the most severe cases, long-term inflammation leads to calcification that causes two or more bones of the spine to fuse. Fusion can also stiffen the rib cage, resulting in restricted lung capacity and function.

In the most severe cases, long-term inflammation leads to calcification that causes two or more bones of the spine to fuse. Fusion can also stiffen the rib cage, resulting in restricted lung capacity and function. Around 1% of the adult population is affected by spondylarthritis, with an estimated 1.7 million Americans aged 20-69 years thought to have the condtion.

Causes

The cause of AS is multifactorial, as in many autoimmune diseases, and based on genetic factors, such as the very strong genetic influences of HLA-B27 and environmental factors, such as bacterial infections.

Genetic Factors – Research has shown that more than 9 out of 10 people with AS carry a particular gene known as human leukocyte antigen B27 (HLA-B27).

Having this gene does not necessarily mean you will develop AS. It is estimated that 8 in every 100 people in the general population have the HLA-B27 gene, but most do not have AS.

It is thought that having this gene may make you more vulnerable to developing AS, and the condition is triggered by one or more environmental factors – although it is not known what these are.

Testing for this gene may be carried out if AS is suspected. However, this test is not a very reliable method of diagnosing the condition because some people can have the HLA-B27 gene but not have ankylosing spondylitis. AS can run in families, and the HLA-B27 gene can be inherited from another family member.

Environmental Factors – Apart from genetic factors, environmental factors also seem to play a role in the multifactorial causes of AS. The innate immunity could be disturbed, like in some polymorphisms of the TLR4 and CD14 genes, and make individuals prone to abnormal reactions after bacterial infections. The pathogenetic role of bacteria can be illustrated by the onset of another subtype of SpA, reactive arthritis. In this disease the symptoms manifest after bacterial infections, especially gastrointestinal (with Salmonella, Shigella, Yersinia or Campylobacter) or urogenital (with Chlamydia trachomatis).

Symptoms

Three main symptoms characterize ankylosing spondylitis:2

  • Pain
  • Stiffness
  • Loss of mobility.

Pain is the main symptom of ankylosing spondylitis, especially in the lower back and buttock areas in the early stages of the disease.2 Read on to the next section about diagnosis to find out the typical onset and character of pain in ankylosing spondylitis, and how it differs from other causes of back pain.

Although lower back pain is a key symptom of ankylosing spondylitis, the inflammation is not confined to the lumbar spine – it is systemic – meaning that pain can also arise in other parts of the body.

  • In other joints (arthritis and synovitis symptoms)
  • In the neck (upper – cervical – spine)
  • At the top of the shin bone in the lower leg
  • Behind the heel of the foot (inflammation – enthesitis – in the Achilles tendon)
  • Under the heel of the foot
  • In the chest (which can restrict breathing).

People with ankylosing spondylitis may also experience fatigue – a feeling of being tired and having low energy most of the time.

Tendons and ligaments in various parts of the body (in addition to those attached to the bones (vertebrae) of the lower spine) may become inflamed and painful where they attach to bones. Common examples are the Achilles tendon where it attaches to the heel, and where chest muscles attach to the ribs.

Uveitis affects about 1 in 3 people with AS from time to time. Tell a doctor urgently if you have AS and develop a painful or red eye. If you develop uveitis, treatment with eye drops should be started as soon as possible after eye symptoms begin. Treatment of uveitis is usually successful. However, if not treated quickly there can be permanent loss of vision in the eye (partial or complete).

Associated diseases

Some other conditions develop more commonly than normal in people who have AS. For example, people with AS have a greater than average chance of developing ulcerative colitis, Crohn’s disease, psoriasis, osteoporosis, lung fibrosis, cardiovascular disease (see later) and heart valve problems.

Treatment

Conventional treatment – The following two main approaches are typically used in the management of ankylosing spondylitis.

  • Painkillers and other drugs to reduce pain and inflammation
  • Physical therapy and exercises to maintain movement and posture.

Surgery is used only rarely, in severe cases to correct great deformity – for example, when the spine is bent over too far – or to replace a joint, such as in hip replacement.

  • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) – These drugs relieve pain and inflammation, and are commonly used to treat ankylosing spondylitis. Aspirin, ibuprofen, and naproxen are examples of NSAIDs.1 All NSAIDs work similarly by blocking substances called prostaglandins that contribute to inflammation and pain. However, each NSAID is a different chemical, and each has a slightly different effect on the body. Side effects of NSAIDs include stomach problems; skin rashes; high blood pressure; fluid retention; and liver, kidney, and heart problems.
  • Corticosteroids – These strong inflammation-fighting drugs are similar to the cortisone made by our bodies. If NSAIDs alone do not control inflammation in people with ankylosing spondylitis, doctors may inject corticosteroids directly into the affected joints to bring quick, but temporary relief. Injections may be given to the sacroiliac joint, hip joint, or knee joint, but are not given in the spine.
  • Disease-Modifying Antirheumatic Drugs (DMARDs) – These drugs work in different ways to control the disease process of ankylosing spondylitis. The most commonly used DMARDs for ankylosing spondylitis are sulfasalazine and methotrexate.
  • Biologic Agents – These new class of medications are genetically engineered to block proteins involved in the body’s inflammatory response. Four biologics—adalimumab, etanercept, golimumab, and infliximab—are approved by the Food and Drug Administration (FDA) for treating ankylosing spondylitis. All four work by suppressing a protein called tumor necrosis factor-alpha (TNF-α), and are often effective for relieving symptoms when NSAIDs or other treatments are not. These drugs are taken by intravenous infusion or injection. 

Physical Therapy – Physical therapy for ankylosing spondylitis can help to prevent symptoms and is tailored to individuals’ needs. In general, physical therapists will devise a program including exercises directed at the joints or that promote extension and mobility of the spine. Range-of-motion and stretching exercises can help maintain flexibility in the joints and preserve good posture. Proper sleep and walking positions and abdominal and back exercises can help maintain the upright posture.

Surgery – Most people with ankylosing spondylitis don’t need surgery. However, the doctor may recommend surgery if the patient has severe pain or joint damage, or if the hip joint is so damaged that it needs to be replaced.

Alternative Treatment

Supplements

Cod Liver Oil – Cod liver oil is an important omega-3 fat supplement. This supplement helps relieve inflammation in the entire body and reduces the pain and progression of the condition.

Vitamin D – Vitamin D is an important vitamin that helps maintain good bone health. As such, a daily vitamin D supplement will help maintain the strength of the bones and prevent unusual growth.

Potassium – Potassium deficiency is one of the suspected causes of inflammatory conditions in the body. As such, a daily potassium supplement can help relieve general inflammation as well as treat ankylosis.

Probiotics – These should be a mainstay in any inflammatory condition. They can normalize the bowel flora and replace the bad bacteria with good intestinal microflora. Studies specific to their benefits in ankylosing spondylitis have been mixed, but they do have an effect on immune system modulation and are often included in any anti-inflammatory regimen.

Wobenzyme N – This is an enzyme supplement that is used in the treatment of inflammation and pain. Enzymes in this supplement include bromelain (from pineapple) and papain (from papaya).

Turmeric – It is a great anti-oxidant that can reduce inflammation and pain.

Tart Cherry Formula – Specifically Montmorency tart cherry extract is excellent for decreasing pain and inflammation.

Magnesium – Magnesium deficiency can promote inflammation and pain. For sore muscle and/or joints, the use of Magnesium gel or oil applied directly to the area can promote healing and reduce inflammation and increase joint and muscle mobility and flexibility.

Morinda citrifolia (Noni) – This is a tropical plant from East Asia that has been used for many years. It has anti-inflammatory properties and can help in the treatment of pain.

Complementary Treatent

Warm Soaks – A warm bath or shower is a natural way to relieve the pain and stiffness of ankylosing spondylitis.

Acupuncture – This ancient technique that involves inserting thin needles through the skin may stimulate your body’s natural pain relievers.

Message – Massage therapy, when performed by a therapist accustomed to working with ankylosing spondylitis.

Transcutaneous electrical nerve stimulation (TENS) – TENS involves passing an electric current through the skin. It may work on the same principle as acupuncture — by bringing about the release of the body’s natural pain relievers.

 

Reference

http://www.coloradoarthritis.com/ankylosing-spondylitis-englewood.html

http://www.arthritisireland.ie/go/information/booklets/ankylosing_spondylitis

http://www.efpia.eu/diseases/110/59/Ankylosing-Spondylitis

http://www.efpia.eu/diseases/110/59/Ankylosing-Spondylitis

http://www.nhs.uk/Conditions/Ankylosing-spondylitis/Pages/Symptoms.aspx

http://patient.info/health/ankylosing-spondylitis-leaflet

http://www.webmd.com/back-pain/guide/ankylosing-spondylitis

http://www.mayoclinic.org/diseases-conditions/ankylosing-spondylitis/basics/definition/con-20019766

http://www.niams.nih.gov/Health_Info/Ankylosing_Spondylitis/

http://www.arthritis.org.nz/wp-content/uploads/2011/07/4506_art_AS_newImages_4-0.pdf

 

 

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