FAQ Category: General

There is a genetic link in the causation of osteoarthritis. Twin studies have been used to prove this. You didn’t say if you and your brother are identical or fraternal twins. This seems to make a difference.

Identical twins are twice as likely to show an increased rate of hip arthritis as fraternal twins. The rate is much higher in female twins.

Even if you weren’t twins, your risk of developing OA is higher just being siblings. A 1997 study of sibling risk showed that brothers and sisters of patients who had a total hip replacement were twice as likely to have a hip replacement themselves. Not only that, but their risk of a knee replacement was five times higher.

You ask a very good question and one that many adults with arthritis face every day. Sometimes poor balance leads to falls but many times arthritis sufferers can’t avoid obstacles because they are too busy avoiding the painful limb.

The first step is to get control of your pain. You need a management program that may include good nutrition, exercise, and medication. Talk to your doctor about the right medications and nutrition for you. See a physical therapist for a strength-training program that includes exercises to improve your balance.

Once you have the pain under control you will be able to advance your balance training and exercise program. Practicing balance is helpful when you face sudden challenges or obstacles. Work toward managing things like getting in and out of the tub or walking on grass.

The risk of falling can increase for anyone (especially older adults) taking certain drugs. Many medications have side effects that can cause dizziness or lightheadedness.

High blood pressure. Heart disease. Allergies. Insomnia. Too much stomach acid. Depression. These are just a few of the conditions treated with medications that are linked with falls.

aking multiple over-the-counter or prescribed medications along with alcohol or cough suppressants can be dangerous. Medications for insomnia or sleep disturbance and painkillers are two more to add to the list.

The best way to approach this problem may be to arrange an appointment for you and your father with his physician. Take all of his medications with you and ask the doctor to review them. His doctor can also rule out other possible causes of falls and get to the bottom of the problem before something serious happens from a fall.

Falls are, in fact, a cause of death in 10,000 people 65 years and older in the United States every year. Falls also account for 87 percent of all fractures in this same age group.

There is much that can be done to change this. The first step is to identify risk factors. Reducing those risk factors comes next. Poor vision, poor lighting, household clutter, painful joints, and muscle weakness are just a few risk factors. Poor health, fatigue, and some medications are additional risk factors.

Some things can be done right away to help. Others take more time. For example, remove any barriers to freedom of movement. This might include piles of magazines and newspapers. Throw rugs in doorways can easily trip the person who can’t lift a painful, arthritic limb. Make sure there are nightlights for dark hallways and the bathroom.

n exercise program to stay fit is essential. Strength and balance are keys to avoiding falls. The right exercise program can help a person recover quickly when caught off balance.

inally, make sure there isn’t a medical problem causing these falls. Dizziness leading to falls can occur from sudden changes in blood pressure or dehydration. Falling can be the first sign of neurologic problems.

It’s not clear what circumstances surround your husband’s use of the LBPP chamber. Is he part of a study held by doctors? Will he be evaluated before, during, and after using this device?

The LBPP chamber was designed for use with astronauts in weightless conditions. It takes
the workload off the lower half of the body. Under this kind of exercise, the heart rate
goes down. The result is less demand or workload on the heart.

The pressure around the legs inside the chamber helps the blood flow back to the heart.
This also reduces stress on the heart. This type of exercise unit could actually be a
very good device for older adults who are severely deconditioned or who have heart
disease.

Simply stated, the Hawthorne effect is an increase in worker productivity when an interest is shown in the work and worker.

The idea came about as a result of a study at the Hawthorne Plant Western Electric Company in Illinois in the late 1920s. The workers got more done each day when they were given attention by the management. Work conditions such as pay, light levels, and rest
breaks were changed and then returned to normal. With each change workers produced more.

he experiment started a whole field of study now known as Industrial Psychology. The same concept seems to apply in medicine. If a patient expects to get better, he or she will have a better outcome. If patients are offered a new treatment, they have a faster recovery compared to patients getting the “old” method of treatment.

The strength of bones is measured by their mass or thickness. Greater mass or high bone density means the bones are less likely to fracture. Bone mineral density (BMD) can be measured two ways. The first and easiest is done on the heel or finger. This is probably the type of test you and your friend had done.

The second is by X-rays called dual energy X-ray absorptiometry or DEXA. Either test gives a T-score to describe the thickness of the bone (BMD). Normal is a T-score above -1.0. Low bone density starts with a T-score between -1.0 and -2.5.

A T-score below -2.5 indicates osteoporosis or weak bones. You and your friend are both in the “normal” range. Your score is slightly better than your friend’s. The scores are only for the bone tested. Different bones can have different densities. A normal score in
one bone doesn’t mean all other bones are the same.

Less than four in 100 patients (four percent) suffer from hoarseness after thyroid surgery today. This is down from around 20 percent in the 1950s and 60s. The reason for this change? Surgeons have learned how to avoid damage to the recurrent laryngeal nerve (RLN).

Thyroid surgery used to pull on the nerve or cut off its blood supply. The result was hoarseness, difficulty swallowing, and even inhaling and choking on food.

Today the surgeon finds the nerve and protects it from damage during the thyroid removal. The experience of the surgeon is still a key factor. The operation is more difficult if a
tumor is wrapped around the thyroid or involves the nerve.

It’s true that exercise helps reduce pain and swelling caused by osteoarthritis (OA). How
this works remains a topic of much debate in the scientific world. One theory is that exercise increases the strength of the muscles around a joint. This in turn helps take the load off the joint.

Exercise may also fine-tune the sensors and receptors in the joint. By doing so, coordination is improved and the joint moves in better balance during walking and other weight-bearing activities.

Studies show it doesn’t matter what kind of exercise is done, aerobic exercise and resistance training both result in decreased pain, improved function, and increased activity. X-rays taken before and after exercise did NOT show any worse changes in the joint.

Finally, since being overweight adds an increased load to the joints, weight loss is always advised. Exercise can help with this part of the management program, too.

Exercise keeps joints from becoming stiff from a lack of movement. Exercise also strengthens the muscles around the joints. This gives the joints better support. Swimming or pool programs can improve aerobic fitness without stressing the joints. Low-intensity aerobic exercise can also cause the release of chemicals in the body. The chemicals act as natural pain relievers.

Arthritis medications can have many negative side effects. Exercise can help reduce the use of medications. Exercise can help patients lose weight. Fewer pounds means less stress on the joints. Exercise to improve balance and coordination can help prevent falls and fractures.

Osteoarthritis without exercise can become a vicious cycle. For example loss of joint motion causes changes in the way you walk. The forces through the joint change slightly. Over time repeated microtrauma from too much or uneven joint loading causes joint pain. Swelling and painful muscle spasms can also occur.

In general, exercise has many other positive health benefits. It improves mood and mental health; and prevents conditions such as diabetes, osteoporosis, and heart disease.

You raise a good point and an equally good question. It’s true that studies support the use of exercise to prevent and treat osteoarthritis. It’s also true that pain, stiffness, and limited motion keep many people from exercising.

The first step is to get control of your pain. Your doctor will be able to help you with this. There are many new safe and effective arthritis medications available now to help patients with this.

Finding the right kind of exercise is the next step. This may be an aquatics program at your local YMCA or health club. It may be an at-home program such as “Get Fit While You Sit” (http://www.getfitwhileyousit.com) or it could be a walking program at a shopping mall. A physical therapist can help you find the right match for your health, joint motion, and symptom level.

In any exercise program the idea is to find something that you are willing to do long-term. Ten minutes a day for 10 years is better than an hour three times a week but only for three months.

It’s a well-known fact that regular exercise three to five times each week helps combat the changes that aging and declining hormone levels bring. For women, decreased estrogen causes bone loss, weight gain, and elevated cholesterol. There’s even some concern that muscle strength is lost as a result of decreased estrogen levels.

Many people start an exercise program but have trouble keeping it up. Experts offer the following advice:

Jumping and weight bearing activities are known to prevent bone loss and even increase bone mass in some women. A physical exam is a good idea before starting such a program.

Menopausal and postmenopausal women are at increased risk of osteoporosis and heart disease. These two conditions increase your risk of bone fracture and heart attack, which could be brought on by an activity like jumping rope.

A mixed training program can help with changes that occur with aging and the hormonal changes of menopause. Jumping rope can provide a warm up, an aerobic workout, and endurance training. It doesn’t offer resistance training needed. A separate program for this is advised.

Until recently, doctors thought that Complex Regional Pain Syndrome (CRPS) was caused by a problem in the sympathetic nervous system (SNS). The SNS is a set of nerves that control the size of blood vessels, sweating, and other body functions.

If it was always caused by the SNS, then the nerve blocks should always work. Since they don’t doctors now think only some patient have pain that comes from the SNS. The only way to know for sure is to try the nerve blocks, so it wasn’t wasted time or treatment on your behalf.

If a damaged SNS isn’t the problem, then what is the cause of the CRPS? Experts agree that there are problems somewhere in the nervous system. Perhaps the central nervous system (the brain and spinal cord). No one is sure just yet.

There are other factors that affect the nervous system like emotional stress. There is some evidence that certain personality types are more prone to CRPS.

We understand and appreciate your frustration. Chronic pain conditions can be very debilitating. For most of us, going from an active lifestyle to one constantly changed by pain can be very upsetting.

Complex regional pain syndrome (CRPS) is not well understood. We do know it occurs after trauma or an injury of some kind. Doctors think it could be something that runs in families. Sometimes it occurs in an injured arm or leg that has been immobile in a cast or sling for a long time. Possibly stress has a key role in its development.

Sphenopalatine block is a nontraditional treatment used for chronic pain. It’s used sometimes in conditions like fibromyalgia, headache, and myofascial pain syndrome. Usually the patient has been treated without success with drugs, physical therapy, and acupuncture.

The sphenopalatine block puts a local anesthetic (lidocaine, tetracaine) on the sphenopalatine ganglion (SPG). The SPG is a group of nerve cells outside the nervous system. Pain messages can’t get through to the brain when blocked by this numbing agent.

Reports on the use of this type of block suggest it gives partial relief of pain. Patients may get up to 50 percent pain reduction.

A recent study at the Robert Wood Johnson Medical School in New Jersey reported use of sphenopalatine block in two cases. Both patients were women who had an accident and were left with leg pain diagnosed as complex regional pain syndrome. They both got 50 percent relief of their painful symptoms.

You are doing the right exercises to train the deep muscles that stabilize the spine. This is referred to as local stability. This is a good place to start. It will help your muscle adjust to postural changes during large body movements. Many experts think improving local stability will help prevent back injuries.

The hands-and-knees exercises minimize the activity of the rectus abdominus (RA) muscle compared to the other muscles in the abdomen and pelvis. This is good because the RA tends to be overactive in some people with back problems. The RA is the abdominal muscle that goes straight up and down over your belly.

The next step is to work on the global stability system. This means stimulating the larger, more surface muscles around the abdomen and pelvis. This includes the RA and paraspinal muscles along the sides of the back. Placing the ball further from the center of your body will activate these muscles.

For example try the “roll out” exercise. Facing the floor with your arms straight and your palms flat on the floor, place the ball under you lower legs just below your knees. Don’t let the ball slide out from under you.

Take a deep breath, pull your belly button in as if you are zipping up a pair of tight pants. Breathe out as you move forward. Don’t let your upper body or back sag. Keeping the abdominal muscles contracted will help with this. Go as far forward as you can rolling the ball down your legs. In a very advanced version of this exercise the ball will roll until only the toes are touching the ball.

Many people are using a gym or Swiss ball to get an all around body fitness workout. Depending on the exercise you do, you can work on deep or surface muscles in the spine. Depending on where you place the ball you can activate various abdominal muscles. And weights can be hand held or wrapped around the wrists or ankles for a greater work out to the arms and legs.

There are many videos available for home use. May we suggest some products developed by physical therapists with a knowledge and understanding of the latest research regarding anatomy, biomechanics, and movement? Try Orthopedic Physical Therapy Products at http://www.optp.com for several different products
available.

Other exercise options include yoga and T’ai Chi. There are several different types of each with varying degrees of exertion. Yoga has more of a resistance training element. T’ai Chi emphasizes balance and coordination.

The exercise balls are sized based on your height. Each ball has an optimal firmness that dictates its size. You can make it softer or harder depending on how much air is put inside the ball to inflate it. The diameter of the ball in centimeters (listed below) is based on the firmest setting.

Standard chart for ball sizes. Some companies may vary slightly:

The overload principle refers to resistance training. Overload occurs when a greater than normal physical demand is placed on a muscle. The amount of overload needed depends on the muscular fitness of each individual. Overload can be used to improve strength and endurance.

To gain strength, moderate to high loads (resistance or weight) are needed. When it comes to endurance training, the number of repetitions is more important. Muscles can be further loaded by decreasing the rest period between sets of exercises.

As the muscle adapts to the new load, more weight or more repetitions are added. Injury can occur from over training so caution must be used when progressing the program. If you’re working out at a training club or facility, the staff should be trained in these concepts. They will be able to help you get set up on the right program.