Osteoarthritis
Also called degenerative joint disease, this is the most common type of arthritis, which occurs most often in older people. This disease affects cartilage, the tissue that cushions and protects the ends of bones in a joint. With osteoarthritis, the cartilage starts to wear away over time. In extreme cases, the cartilage can completely wear away, leaving nothing to protect the bones in a joint, causing bone-on-bone contact. Bones may also bulge, or stick out at the end of a joint, called a bone spur.
Osteoarthritis causes joint pain and can limit a person’s normal range of motion (the ability to freely move and bend a joint). When severe, the joint may lose all movement, causing a person to become disabled. Disability most often happens when the disease affects the spine, knees, and hips.
Symptoms
Arthritic symptoms generally include swelling and pain or tenderness in one or more joints for more than two weeks, redness or heat in a joint, limitation of motion of joints, early morning stiffness, and skin changes, including rashes.
Doctors diagnose arthritis with a medical history, physical exam and x-rays. There is no blood test for osteoarthritis.
Causes and risk factors
Osteoarthritis is caused by the wearing out of the cartilage covering the bone ends in a joint. This may be due to excessive strain over prolonged periods of time, or due to other joint diseases, injury or deformity. Primary osteoarthritis is commonly associated with ageing and general degeneration of joints.
Secondary osteoarthritis is generally the consequence of another disease or condition, such as repeated trauma or surgery to the affected joint, or abnormal joint structures from birth.
Management of Osteoarthritis
There are several treatments and lifestyle modifications that can help you ease your pain and symptoms.
- Medications: Pain-relieving medications such as NSAIDs, COX-2 inhibitors and opioids may be prescribed. Topical medications such as ointments can be applied over the skin where there is pain. If the pain is very severe, corticosteroid injection can be given directly into the affected joint to ease the pain.
- Other treatments: Your physiotherapist will teach you exercises to keep joints flexible and improve muscle strength. Heat/cold therapy which involves applying heat or cold packs to the joints provides temporary pain relief. Lifestyle modifications can be done to control weight and avoid extra stress on the weight-bearing joints.
- Surgery: Joint replacement surgery is considered as an option when the pain is so severe that it affects your ability to carry out normal activities.
Degenerative Disc Disorders
Degenerative disc disease is a term used to describe age-related changes that occur in the soft discs present between the vertebral bones of the spine. These discs absorb stress and permit movement of the spine. Disc degeneration can lead to pain, limitation of movement and other symptoms. It is usually more pronounced in the region of the neck and lower back.
Causes
Continuous wear and tear with age causes the intervertebral discs to lose their water content and shrink in size. Initially, the nucleus at the center of the disc loses its ability to absorb water and becomes thick and dehydrated. Later, the outer layer of the disc, called the annulus, may bulge, develop cracks or rupture causing the disc to collapse.
As a result, discs lose their ability to act as shock absorbers, making the spine less flexible. The space between the bones becomes narrow resulting in compression of nerve structures. Increased stress on the vertebral bones can result in the formation of bone spurs which can also compress on the nerves producing symptoms. Degenerative disc disease can lead to osteoarthritis or loss of cartilage in the intervertebral joints and can also lead to narrowing or stenosis of the spinal canal.
Degenerative disc disease is more common in those who are overweight, those who perform repetitive lifting, and in smokers.
Signs and Symptoms
Symptoms of degenerative disc disease include pain in the neck, arm, lower back, buttocks and legs, depending on the region of the spine affected. The pain occurs gradually but can sometimes start after a sudden injury or a normal movement such as bending or twisting. Other symptoms such as numbness and a tingling sensation may also be present.
Diagnosis
To diagnose degenerative disc disease, your doctor will review your symptoms and medical history and perform a physical examination to evaluate the location of pain, range of motion, nerve damage or identify other abnormalities such as an infection or presence of a tumor. Imaging tests may be ordered if necessary.
Treatment
Symptoms of degenerative disc disease may be relieved by warm or cold packs applied to the area. Anti-inflammatory or pain medications may be prescribed to keep you comfortable. Physical therapy may be recommended to strengthen and stretch the muscles in the back. Your doctor will provide specific treatment for conditions such as osteoarthritis or spinal stenosis caused by degenerative disc disease. Surgery may sometimes be necessary in certain situations and usually involves removal of the degenerative disc and placement of a bone graft within the disc space to maintain an ideal distance between adjacent vertebrae and promote fusion of the adjacent bones. This limits movement of the region thus controlling pain. Sometimes, an artificial disc is inserted which permits movement.
Mechanical Back Pain
The upper and mid back is made up of 12 bones (vertebrae) stacked one above the other, and is called the thoracic spine. It extends from the base of your neck to the level of your lowest rib. This region has less mobility than the neck and lower back, so pain is less common.
Causes of upper and mid back pain include:
- Poor posture
- Strain or injury of the supporting muscles or ligaments
- Fracture of vertebrae
- Wear (arthritis) or damage to the spongy discs (cartilage) present between two vertebrae
- Myofascial pain that affects the connective tissue surrounding muscles
- Rarely cancer, infection and gallbladder disease
Upper and mid back pain can be experienced as a dull, sharp, burning pain associated with muscle stiffness. Weakness, numbness or tingling sensation in your arms and legs, or loss of bowel and bladder control may also be present, and require immediate attention.
To identify the source and severity of your pain, your doctor will review your symptoms and medical history, and perform a physical examination. Imaging tests such as an X-ray or MRI may be ordered to identify fractures, herniated discs or other pathology.
Your doctor may suggest over-the-counter pain medication for cases of mild to moderate pain. Heat and ice application, massage, spinal manipulation may also be performed. For more severe cases, prescription pain medication including antidepressants, muscle relaxants or narcotics may be recommended. Spinal injections are administered for cases of extreme pain. Surgery is rarely necessary. Physical therapy is recommended to strengthen the back and prevent recurrences.
Preventing Back Pain at Work and Home
The back is subject to wear and tear from daily activities and stresses. Pain may vary in severity and duration. Although the natural degenerative processes that take place with aging cannot be avoided, precautions can be taken at home and your workplace to minimize its impact. A healthy lifestyle with good habits such as regular exercise, adequate sleep, good posture, a diet adequately supplemented with calcium and vitamin D, and avoiding weight gain, smoking and stress can go a long way in keeping the back healthy.
At home
When lifting objects try to bend at the knees instead of the waist and let your legs do the lifting, not your back. Keep the object close to your body. Know your limits and get help if you feel it is too heavy. The way you sleep can also affect the health of your back. Use a firm mattress, check for wear-and-tear and change it regularly. Avoid sleeping on your stomach.
At work
Repetitive motions may result in back pain. It is necessary to take short breaks while at work. Tools and equipment should be easily accessible and adjusted to your body. Sitting puts more stress on the back than standing, so adjust your chair so that your feet are on the floor with your knees and hips at the same level. Your lower back must be adequately supported. Change your position once in a while. Avoid slouching. If you use a keyboard, place it at the level of your elbows with your forearms parallel to the ground.
Stress can create tension in the back. Avoid stress by planning ahead, knowing your priorities and using relaxation techniques.
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