FAQ Category: General

Shingles is caused by one of the many herpes viruses. It is also known as herpes zoster. It starts as a painful skin rash with blisters — usually along a nerve pathway on one side of the body. The rash usually heals within two to four weeks.

But some people have continued nerve pain for much longer — sometimes months or years. This condition is called postherpetic neuralgia. Over time this pain may go away. Sometimes it is replaced with numbness.

There is a live vaccine available now (Zostavax) for adults age 60 and older. It is used as a preventative measure to avoid shingles and especially postherpetic pain. There’s some research that shows increased intake of fruits and vegetables acts as a natural preventitive for this painful condition.

But once it’s here, treatment depends on how quickly the diagnosis is made. In the acute (early) phase, anti-viral medications may help with the symptoms. They can reduce the severity and duration of herpes zoster with minimal side effects. But for those who develop post-herpetic pain, a different strategy is needed.

That’s where products like Capsaicin come into play. Capsaicin is the active component of chili peppers. Capsaicin works well as a counter-irritant. It produces a burning sensation that irritates the skin enough to grab the attention of the nervous system, masking the underlying oost-herpetic pain. With long enough use of Capsaicin, neurons are depleted of neurotransmitters, the chemical messengers that deliver pain messages. The result is a reduced sensation of pain. The neurons do recover when the Capsaisin is no longer used.

Chronic neuropathic pain of this type may require a combination of approaches. There are some medications that can help. Some patients have experienced success with other forms of pain management such as biofeedback, meditation, hypnosis, Reiki, BodyTalk, or acupuncture. If you have been using the cream for many weeks with no success, it’s time to head back to your physician for a recheck and reevaluation of the treatment options available to you.

Fracture belt refers to the higher number of fractures observed in a geographical region. Several studies have been done looking at specific types of fractures (e.g., wrist, ankle).

One study of Medicare patients (over age 65) showed a much higher rate of ankle fractures in North Carolina compared with California. Another similar study (again using the national Medicare database) found a similar higher rate of wrist fractures in patients from the eastern portion of the United States, specifically the northeastern section of the United States.

Several factors may be linked with this pattern of distribution. For example, weather conditions in that area with more ice and snow than in other places could be an important regional difference. Limited exposure to sunlight resulting in higher levels of osteoporosis and lack of water with fluoride in it could contribute to the higher level of osteoporosis-linked fractures. And possibly more involvement in sports activities may affect the rate of falls and subsequent fractures.

Studies on this problem are fairly limited. Most of the data has come from Medicare records rather than large randomized trials. Medicare has a fairly shallow depth of information collected. It does not include how fractures occurred, type of fracture, results of treatment, or even the functional status of the patient. So although we can identify the locations of fracture belts, the whys and wherefores remain unknown for the most part.

Physical therapists are often called upon to help determine when an older adult is ready to go home after being in the hospital. Or when it’s time to move from an independent living situation to an assisted living or skilled nursing care facility. These judgments are made with the assistance of standardized tests that measure physical performance.

For example, tests such as the Mini-Mental State Examination (MMSE), Physical Activity Scale for the Elderly (PASE), and the Six-Minute Walk Test (6MWT) might provide helpful information.

The PASE is a self-reported survey. It is usually filled out by people still living at home. The person taking the test answers questions about him or herself regarding exercise activity, work or volunteer activities, and daily household-related activity. The 6MWT requires the person to walk for six-minutes on a flat surface. Distance covered in that amount of time is recorded. Blood pressure, heart rate, and ratings of perceived exertion (e.g., no fatigue, moderate fatigue, most fatigue ever experienced) may also be collected.

After completing these tests, a special device called the StepWatch Activity Monitor (SAM) can be attached to the ankle. The SAM is used to count the total number of steps each person takes over a period of time. The device is designed to be used with people who have different walking patterns, speeds, and limps. It can be used by anyone with an assistive device such as a walker or cane. And the SAM can be used in water for those who participate in a pool-exercise program of any kind.

All of these results don’t equal a crystal ball. They just provide an ability to predict function based on normal values for healthy adults of the same age. Most rehab teams take other factors into consideration as well, such as the patient’s general health and presence of other disabling conditions (e.g., heart disease, diabetes, high blood pressure). The patient’s home environment is usually also evaluated for any barriers to independence and continued recovery.

The family does have a valuable place in the decision-making process. If you did not speak up at the meeting but have concerns now, it’s not too late to contact the rehab team leader. This is usually the case worker or social worker, but may also be the physician, physical or occupational therapist, or a rehab manager. Perhaps your father would benefit from a transition from rehab center to a step-down facility or assisted living situation before going home. There are always options that can be explored.

Many seniors find the services, design, and setting of assisted living situations works very well to help them get back on their feet. The physical environment is set up to get them moving. It’s usually a short walk to the dining hall, recreational area, mail room, etc. Taking short walks many times throughout the day has been shown in many studies to be a very effective form of rehab, therapy, and maintenance exercise all rolled into one.

Seniors find that with the increased physical activity, they eat better, sleep better, and feel better. Results like your aunt has experienced is a true testimony as to the benefit of living in a retirement community.

The environment is designed to meet the needs of older adults with some physical limitations. Short bouts of walking activity at the person’s own pace carried out daily and consistently over time seem to be the key to achieving higher physical function. The result is to minimize the impact of physical limitations on daily function for these seniors. That could mean improved quality of life with fewer health problems and greater independence.

Perhaps there would be a way to combine a few sleepovers at your home but with most days and nights remaining at the center where she is doing so well. Before making any kind of decisions, arrange a meeting with the staff at the facility where your aunt is currently living. They may be able to help you gain the perspective you need for a decision of this type. They may be able to suggest some ways to help your aunt see the value of staying where so many services are available.

Joint laxity or looseness is one factor that might contribute to chronic joint injuries or sprains. And that’s something you can be born with. Inherited conditions (e.g., Marfan’s syndrome) involving collagen fibers that make up the soft tissues are a more remote possibility.

But there are other possible factors contributing to chronic joint injury such as impaired balance, problems with proprioception (joint sense of position) or muscle imbalances/weakness. Usually there is a reason behind the reason.

In other words, a specific reason why someone might have muscle weakness or impaired proprioception. Before starting on they exercise program, it’s wise to look for all possible avenues to restore a normal, natural balance of muscle strength, motor control, movement, proprioception, and kinesthesia (awareness of movement).

You may not be able to solve this on your own. A visit to your primary care physician might be in order. He or she can direct you to someone more specific if needed (e.g., rheumatologist, orthopedic surgeon, neurologist). If there’s a problem with muscle insufficiency, altered motor control, or joint proprioception, a physical therapist can help you find the right rehab protocol and exercises to restore normal function.

At age 13, she has a few years yet to train. Avoiding injuries during this phase should be the focus of any discussion regarding her gymnastics. Taking dance classes, tumbling, yoga, and t’ai chi are all part of today’s gymnast’s daily training schedule. Working hard, taking appropriate rest breaks, and training smart is what it’s all about these days.

If your daughter is under the supervision of a senior gymnastics instructor, she is probably getting advice and direction about what to do to prepare herself for a life in the circus arts. There are even a few schools around the country that specialize in this sort of thing. Depending on where you live, it may be a good idea to take advantage of something like this.

The truth is that Cirque du Soleil performers have a low rate of injury — lower than other athletes, including competitive gymnasts. There are certain types of injuries that occur such as shoulder injuries, rib and foot fractures, and hip/groin strains.

For all circus artists, work schedules are reviewed and managed to avoid excessive workload without adequate rest periods. All Cirque du Soleil performers are encouraged to report any and all injuries, no matter how minor. Quickly addressing the problem, providing appropriate rehab, and restoring strength and conditioning are key factors to successfully minimizing the impact of injuries.

Many of the performers in today’s modern circuses like Cirque du Soleil have years of training in dance and gymnastics as well as acrosport. Acrosport is a term used to describe the tumbling, aerial, and acrobatic movements made through space in the circus arts.

These circus artists are highly conditioned athletes who participate in daily strengthening and flexibility programs. Compared with other sports on the field and on the court, the circus arts are associated with a much lower injury rate. But they do hurt themselves from time to time.

A recent survey of injuries among Cirque du Soleil acrobats and nonacrobats (e.g., musicians) showed that the most common types of injuries include sprains, strains, fractures, and ligament or muscle tears. Running on and off the stage actually generates the largest proportion of injuries in both musicians and nonmusicians alike.

Fortunately, injuries tend to be minor and are easily treated. Most of the performers don’t even have to change their act or sit out a performance while healing. Sports rehab is offered right away (even back stage during performances) by physical therapists and athletic trainers.

Homeopathy is a well-respected form of alternative care for chronic conditions like allergies, back pain, migraines, and arthritis. It is practiced around the world, including some countries where it is the first-line of treatment, not just used when traditional medicine fails to help.

Homeopathy treats an illness with heavily diluted preparations that are thought to cause effects similar to the disease’s symptoms. It was first reported on by a German physician Samuel Hahnemann back in 1796. The homeopathic substances are referred to as remedies rather than drugs.

Homeopathic treatment takes into consideration the whole patient — mind and body, not just the person’s symptoms. The homeopathic treatment of the whole patient (with all signs and symptoms) is referred to as classic homeopathy.

Paying attention to all aspects of the person (not just the fact that they are having back pain) means that the remedies vary from patient to patient. Anyone with any type of low back pain from trauma, arthritis, disc degeneration, or other physical (and even psychologic) causes can benefit from a homeopathic approach.

If you are sure your mother isn’t suffering painful symptoms from a fracture, infection, or tumor, then there may be no reason to discourage her — especially if she feels homeopathic treatment is helping without using medications that can have adverse side effects.

If your brother lives in the same area as your mother, it may be helpful if he escorted her to the appointments with the homeopathic specialist. In this way, he could ask questions and learn a bit more about this approach. As with all nontraditional, alternative types of treatment, the first goal of every practitioner is to do no harm. Most likely, your mother won’t be hurt in any way by this approach. And it sounds like she has already experienced some success with homeopathic care.

Giant cell tumors of the sacrum are uncommon. They are usually benign but they can grow very large putting pressure on the nearby nerves and other soft tissues. Sometimes they do become malignant and metastasize to the lungs. Giant cell tumors occur more often in Chinese people (up to 20% of the population are affected) compared to Caucasians in Western countries. The reason for this is unknown.

The tumor most frequently involves the ends of long tubular bones in skeletally mature adults between the ages of 20 and 55 years of age. Sixty percent occur around the knee; 10% to 12% involve the distal radius (bone in the forearm). The bones of the hand and wrist and spine (vertebrae) are rarely affected. Giant cell tumors are the second most frequent primary bone-involved tumor in the sacrum.

Symptoms depend on the location but include pain on weight bearing with pathologic fracture may be the presenting clinical feature when tumors occur in the weight-bearing bones. Sacral tumors may present with low back pain radiating to one or both of the legs. Abdominal discomfort and bowel and bladder symptoms may be present.

Optimal treatment is a matter of considerable discussion and debate. Decisions about treatment may vary in a country like China depending on availability of medical services. Radiation, surgery, or both are effective but they are not without significant side effects and complications. Recurrence (tumor grows back) is common and has been reported in one-third to almost one-half of patients surgically treated.

Bone graft substitutes are made from animal collagen tissue. When used to help promote bone growth, these therapeutic proteins can help speed up the bone formation and healing process. But because they come from outside the body, the immune system may set up a defense against them. This means the body forms antibodies to the proteins.

These antibodies could cause potential harm to a developing fetus. There could be cross-reactivity reactions. The antibodies could cross the placenta (protective barrier between mother and child). Since no studies have been done (or will be done) to see the effect of these antibodies on the in utero (in the uterus) development, these substances cannot be deemed safe during pregnancy.

Even if a woman receiving bone graft substitutes is not pregnant, there’s no way to predict whether she might get pregnant while these antibodies are circulating in her system. And we don’t have long-term studies yet to show what happens to these antibodies over time. It’s possible with the passage of time, there could be delayed adverse effects of this treatment.

So for now, it’s easier and safer to say that the use of bone graft substitute is not advised during pregnancy or in women with childbearing ability.

Studies show that running is one of the most common causes of leg injuries in all athletes. In fact, it’s estimated that up to 70 per cent of distance runners experience an overuse running injury during any 12-month period of time. As you have discovered, the knee is affected most often. Injuries to the foot and ankle take a close second.

Patellofemoral pain syndrome, iliotibial band syndrome, plantar fasciitis, Achilles tendinitis, and shin splints are just a few of the more common problems reported. Taking a look at your training schedule is always a good idea. Shoe wear can be equally important.

But a recent study on the cause of overuse running injuries reported two main reasons for overuse running injuries: abnormal foot pronation mechanics and weak hip-stabilizer muscles. Abnormal foot position called pronation describes an ankle that is angled inward and a foot that is flat (collapsed arch).

With a flattened arch, when the foot strikes the ground, the (flat) arch absorbs some of the shock that the heel would normally absorb in a foot and ankle that has a more normal alignment. If this misalignment occurs over and over with each stride, it can lead to foot pain as well as knee pain.
Some runners develop pain up the front of the lower leg (shins) as a result of this transfer of energy on impact. This condition is called shin splints.

Studies have shown that a small amount of foot pronation during mid-stance (when weight is on the foot) works to the runner’s advantage. But too much for too long in the stance cycle and problems develop. If the foot and ankle don’t roll back away from the pronated position, there isn’t a rigid enough column of support to allow for toe-off in the propulsion cycle. The tibia (lower leg bone) tries to compensate by rotating. The risk of injury goes up with the large twisting force placed on the lower leg.

The second common risk factor in overuse running injuries of the knee involves the hip-stabilizing
muscles. Weakness of the gluteus medius and other muscles that control hip internal rotation and abduction (moving the leg away from the body) play a big role in knee injuries.

When these muscles don’t stabilize the hip, the leg pulls into internal rotation. As the foot hits the ground, too much internal rotation increases the force placed on the arch and midfoot. The result is to transfer load through the foot and ankle up the lower leg to the knee. Multiple studies have shown the relationship of weak hip muscles to knee injuries. Even a small loss of hip abduction and external rotation due to weakness can affect the biomechanics of the lower leg.

Normally, as the hip moves toward the midline, the iliotibial band functions as a passive restraint system to hold the leg in a more neutral position. The iliotibial band is a long fibrous band of connective tissue along the outside of the hip. It goes from the pelvis to the tibia (lower leg bone).

Some of the hip muscles join together with the iliotibial band. When a runner with weak hip stabilizers runs, the iliotibial band gets overworked and they can end up with knee pain and/or iliotibial band syndrome (ITBS). ITBS is a painful lateral thigh from friction of the band against the muscle, bursa, and bone.

Runners can be screened for these problems and start on a special rehab program before injuries develop from overtraining. If this theory is correct, rehab should reduce the large number of knee injuries that occur in runners.

The World Health Organization, the American Heart Association, and the American Cancer Society have all published guidelines for healthy living designed to reduce your risk of diabetes, heart disease, cancer, and many other adverse health conditions.

These include quitting smoking (or other tobacco use), eating five one-half cup servings of fruits and vegetables each day, and getting at least 30 minutes of moderate physical activity and exercise every day if possible (for sure, at least five days a week). It may help if we start with what is defined as physical activity and exercise.

Participation in leisure activities, lifting and carrying activities, and domestic- or school-related activities counts toward the daily requirement. The value of activity can be measured using a concept called metabolic equivalents (METs).

Metabolic equivalent values are a standard way to measure intensity of an activity. One MET is defined as the amount of energy used while sitting quietly. Activity intensity can be labeled as light, moderate, and vigorous.

Light intensity is usually defined as any activity performed between two and four METs. Moderate intensity is a MET value of four up to 6.5. Anything with a MET value greater than 6.5 is considered a vigorous activity. Sometimes METs are labeled differently depending on the person’s age. For example, metabolic equivalent measures used for adults over 55 years of age are divided into light (less than three METs), moderate (three to five METs), and vigorous (more than five METs).

Using these guidelines, it is possible to look at all kinds of physical activities like gardening, bicycling, walking, and doing odd jobs. Specific sports such as golf, weight-lifting, speed skating, tennis, and football can also be included, but it doesn’t sound like you are participating in this type of highly competitive exercise.

If you keep a daily log of physical activity and exercise for a couple of days up to a week, you might be very surprised by how much exercise and activity you are already getting. With a little intention, you could probably bump that up a bit. A 10-minute walk around the block, going up and down your stairs, or even vacuuming more often contribute to the exercise bank you need to stay healthy.

What’s the ideal level of physical activity? The World Health Organization says that everyone should engage in physical activity and exercise for at least 30 minutes five days out of the week. This can be done in small segments (five or 10 minutes at a time) or it can be done all in one half hour period of time.

Less than this and you are labeled sedentary (inactive). More than this and you might actually increase your risk for injury and low back pain. A recent study from The Netherlands confirmed that too little or too much activity can be a risk factor for low back pain.

Some studies have already shown that high physical loads (e.g., twisting, bending, lifting, extreme sports) are linked with episodes of low back pain. Others point out the effect of being too sedentary (inactive) as a possible risk factor. So that leaves us with the question: how much activity is the right amount to promote a healthy back?

It turns out that the relationship between physical activity and low back pain looks like a U-shape. At one end (the upper left side of the U), total inactivity and high risk of low back pain go together. In the middle (the bottom of the U-shape), low to moderate intensity of activity is paired with low risk of back pain. And at the far end (the upper right side of the U-shape) reflects how maximum activity results in a high risk of back pain.

This U-shaped relationship seemed to hold true more for women than for men. The reason(s) for this remain unknown. Type of activity also made a difference. Anyone involved in sports activities had a lower risk of developing low back pain. The authors suggest that back loading forces are different for sports activities and this dynamic may account for the reduced risk of chronic low back pain.

Too much exercise (too often, too long, too intense) can result in the type of injuries you are observing in your co-workers. It can also compound the problem if they are also restricting calories in order to lose weight. As Ben Franklin once said, Moderation in all things. When it comes to exercise, this seems to really hold true.

Even in urban areas, gunshot wounds are not your everyday, ordinary problems. But they do occur with some regularity in the United States. In fact, there are a reported 80,000 nonfatal gunshot wounds every year. The average EMT, orthopedic surgeon, and other health care professionals won’t see a steady flow of these patients, but still must be prepared for any that do show up.

Orthopedic surgeons from the Henry Ford Hospital in Detroit, Michigan have put together an instructional course with a review of musculoskeletal injuries from gunshot wounds. In particular, joint injuries affecting the shoulder, wrist, hip, and ankle are discussed. A separate section is included with a discussion of long-bone fractures affecting the humerus (upper arm bone), forearm, femur (thigh bone), and tibia (lower leg bone).

Of course, your role as the EMT is different from that of the surgeon. You will be stabilizing the fracture site for patient transport and responding to any immediate threat to life and limb. The surgeon will be cleaning up and removing all debris from the wound. The joint will be carefully inspected before stabilizing the bone fracture. Bullets and bullet fragments must be removed to prevent lead toxicity from developing. Any foreign body left in the joint can interfere with normal joint mechanical movement. Over time, this can lead to arthritis.

The extent of damage may be determined by the type of gunshot wound (low- versus high-velocity). Low-velocity gunshot wounds occur when the speed of the bullet is less than 1.5 meters per second. The amount of energy transferred to and through the body at the time of impact determines whether the gunshot wound is a low- or high-velocity injury. Soft tissue defects caused by high-energy gunshot wounds may be severe enough to need skin grafts.

Complications of gunshot wounds are many and varied. Infection, the formation of a fistula (pocket of blood and/or pus), fractures that don’t heal, and loss of blood circulation resulting in osteonecrosis (death of bone) are the main concerns early on. Anyone with a significant positive health history for diabetes, heart disease, peripheral vascular disease, or alcohol abuse is at increased risk for delayed wound healing and impaired recovery.

Nerve injuries take a long time to heal. Recovery is slow as the nerve regenerates. Unstable fractures that don’t heal increase the risk of a second surgery later on. In some cases, amputation becomes the final treatment required. This is especially likely when blood vessels have been damaged and blood loss to the area causes necrosis (death of soft tissues).

The authors offer details about each type of bone fracture and what to expect. Common patterns of soft tissue involvement for each fracture type are discussed. Treatment approaches such as open vs- closed surgery, internal vs. external fixation, and wound care for war wounds are also discussed at length.

You may be able to glean ideas from the information presented that will help you focus your triage and stabilization procedures. Anything that can be done out on the field to reduce the risk of infection is a huge step in the right direction.

Yes, you’ve heard about the recent recalls on baby food, pet food, and peanut butter. But there has been a less widely publicized recall on allograft (donated) bone as well. The Centers for Disease Control (CDC) and the Food and Drug Administration (FDA) report almost 60,000 allograft tissue samples were recalled over the last 15 years. All of those were musculoskeletal tissue specimens.

Allograft tissues have been recalled from more than 60 tissue banks. The recalls were on a variety of tissues (e.g., heart valves, corneas, veins) but mostly musculoskeletal. In fact, 96.5 per cent of all allograft tissue recalled comes from musculoskeletal tissues. The reasons for recall included improper recovery from the donor, poor donor selection, and positive blood tests for diseases or bacterial infections that could be passed to the recipient.

Only one case of viral disease transmission (HIV) from allograft bone in a spine fusion patient has ever been reported. Antibody testing has been available since 1985, so the risk of HIV transmission has been eliminated.

Sometimes it is impossible to trace the infection to its source — whether that’s from the allograft or something else. And if it’s from the allograft, how did that happen? It could have been a problem during the donor screening process, during actual recovery of the donor tissue, or an error in serologic (blood) testing of the donor tissue. Other areas of consideration include methods and safety in transporting, delivering, and implanting the donor tissue.

Since 1993, there have been government regulations in place to safeguard donor tissue. Safety rules, on-site inspections of tissue banks, and reporting of adverse effects of allograft tissue are now in place. All donor tissue must be tested for hepatitis and HIV. In addition, hospitals and surgery centers are required to follow a standard method for handling all donor tissues.

Surgeons are also responsible for following all safety measures as these relate to allograft tissue. That’s probably why your neighbor is aware of this problem. For example, the surgeon must know where the tissue came from (e.g., morgue, operating room, funeral home) and make sure the recovery facility is practicing all recommended steps in assuring safety of the donor tissue. This includes proper donor screening and valid methods of tissue sterilization. Both of these steps are important in reducing the risk of donor tissue contamination.

They are advised to deal only with tissue banks that have been inspected by the Food and Drug Administration and/or are accredited by the American Association of Tissue Banks (not all are). And they must be prepared to report their concerns or any adverse events that occur.

Since 1993, there have been government regulations in place to safeguard donor tissue. Safety rules, on-site inspections of tissue banks, and reporting of adverse effects of allograft tissue are now in place. All donor tissue must be tested for hepatitis and HIV. In addition, hospitals and surgery centers are required to follow a standard method for handling all donor tissues. Potential donors are screened very carefully before being accepted.

Only one case of human immunodeficiency virus (HIV, the cause of AIDS) from allograft bone in a spine fusion patient has ever been reported. Antibody testing has been available since 1985, so the risk of HIV transmission has been eliminated.

Given the fact that there is only one known case of infection transmission among patients who received allograft (donor) bone during spinal surgery, the use of these tissues has been reported as safe. The fact that not all tissue banks are regulated and inspected does raise the concern for improper or even illegal means of obtaining, processing, and distributing donor tissue.

Check with your surgeon about any concerns you may have. Surgeons are responsible for following all safety measures as these relate to allograft tissue. For example, they must know where the tissue came from (e.g., morgue, operating room, funeral home) and make sure the recovery facility is practicing all recommended steps in assuring safety of the donor tissue. This includes proper donor screening and valid methods of tissue sterilization. Both of these steps are important in reducing the risk of donor tissue contamination.

They are advised to deal only with tissue banks that have been inspected by the Food and Drug Administration and/or are accredited by the American Association of Tissue Banks (not all are). And they must be prepared to report their concerns or any adverse events that occur.

Osteochondritis dissecans (OCD) is a bone defect in a joint (usually the knee). A fragment of cartilage or cartilage with a piece of bone attached to it comes loose and can become a free-floating body inside the joint. The cause of OCD varies from patient to patient. The most common causes are repetitive microtrauma (most common in athletes), inflammation, loss of blood supply, and abnormalities in bone formation.

Treatment depends on the severity of the condition. And the degree of severity depends on how large the fragment is and whether or not it has detached causing a hole in the bone where it came from. A mild (grade I) case of OCD means there’s a lesion but the frayed piece of cartilage is stable. In other words, it is still attached to the bone. During arthroscopic exam, the surgeon cannot move the fragment away from the bone. With a stage II lesion, the cartilage is starting to show some signs of separation between the cartilage and the bone.

Stage III lesions are partially detached. An MRI can be used to see just how attached (or detached) the fragment is. And with a stage IV lesion (the subject of this study), the fragment has come loose, leaving a crater or hole in the bone. This hole is referred to as a grade IV defect. The loose fragment of cartilage usually has a piece of the underlying bone still attached.

You didn’t mention any pain or problems at this time. Usually osteochondritis dissecans affects teens and young adults involved in sports activities. So you’re not likely to develop this same problem now that you are in your 30s. But you may experience some increased pain, stiffness, and loss of motion if osteoarthritis develops.

Your results are somewhat dependent on the severity of the lesion and the treatment provided at the time of diagnosis. Studies show that the long-term prognosis is best for younger patients with mild lesions. They are treated nonoperatively with modified activities and by keeping weight off the affected knee.

But even with surgery to repair the defect, the long-term results can be very favorable. Patients report being able to do everyday activities without any pain or difficulty. Participating in competitive sports may not be as easy due to pain and stiffness.

It does make intuitive sense that keeping muscles warm would prevent injuries. Loss of body heat with cooling and chilling of the skin and underlying muscle could cause a muscle to cramp upor suffer a minor strain or sprain. But whether or not thermal shorts really make a difference hasn’t been tested fully yet.

One study looking at the effect of keeping the muscles warm with thermal shorts showed that although players who didn’t wear the shorts were more likely to be injured, the rate wasn’t statistically significant. Players who wore the shorts once in a while seemed to have a higher rate of hamstring injury. But this could have been a coincidence or linked with something else (an unknown factor).

The evidence so far seems to suggest that maintaining a proper biomechanical balance between opposing muscles and establishing a strong core (muscles of the back and trunk) may be the best prevention strategy. This is especially true for muscles of the lower extremities.

Today, more and more efforts are being directed toward patient education for chronic conditions such as arthritis. Reducing the burden of arthritis and preventing further disability requires a better understanding of the disease and its natural course.

This knowledge may help people manage their own condition. Weight loss, physical activity, and exercise are extremely important for anyone with musculoskeletal disorders, but especially those who suffer from any joint problems such as arthritis.

Research has shown that these simple measures taken by patients can reduce pain, swelling, and stiffness. At the same time, these efforts help protect the joints, which can delay the need for joint replacement.

Joint replacements don’t last forever. Sometimes, people wear out the first implant requiring a second. Each time surgery is done, more of the bone is destroyed in the process. The involved leg may become shorter than the other leg. This can create an awkward gait (walking) pattern that leads to other problems such as back pain.

The more that can be done as soon as the diagnosis is made, the better. Even with delays in diagnosis or delays in appropriate treatment, people can benefit from the new information we now have about the importance of self-care.

Family support is very important in the management of chronic diseases such as arthritis. Your interest in your father’s condition is a wonderful part of that support mechanism. Take the time to ask him what he’s learning in these classes. Share in the discovery of new information. It may help you and other family members avoid developing the same joint problems in years to come.

Almost 30 million adults in the United States have diagnosed osteoarthritis (OA) in one or more joints. With another 1.3 million affected by rheumatoid arthritis that makes arthritis the second most common musculoskeletal disease in America.

It’s actually a little more complex than that. There are more than 100 diseases that fall under the category of arthritis and other related conditions or AORC. Besides osteoarthritis and rheumatoid arthritis, there are conditions such as gout, lupus, psoriatic arthritis, ankylosing spondylitis, and many others.

All added together, one-fifth of the adult population in the United States has some form of arthritis. That’s almost 50 million people. And it’s not just older adults who are affected. Two-thirds of these individuals are under the age of 65. Men and women are both affected, although women tend to be the larger group of patients diagnosed with arthritis of some type.

There are several factors for the phenomenon you are noticing and describing. First, Americans today are living longer than previous generations. And they are more active. These two reasons alone are enough to explain what appears to be an unprecedented increase in the prevalence of arthritis. Prevalence refers to how many people on any given day have this disease.

Researchers are actively striving to find an answer to the problem of arthritis and other related conditions. Identifying risk factors that could be modified (changed) to prevent or delay the onset of arthritis is the first goal. Second to that, finding medications or other forms of treatment that don’t involve surgery that can help is another focus of scientists.