OSTEOARTHRITIS

Osteoarthritis (AH-stee-oh-ar-THREYE-tis) is the most common type of arthritis, especially among older people. Sometimes it is called degenerative joint disease or osteoarthrosis.
Osteoarthritis is a joint disease that mostly affects the cartilage (KAR-til-uj). Cartilage is the slippery tissue that covers the ends of bones in a joint. Healthy cartilage allows bones to glide over one another. It also absorbs energy from the shock of physical movement. In osteoarthritis, the surface layer of cartilage breaks down and wears away. This allows bones under the cartilage to rub together, causing pain, swelling, and loss of motion of the joint. Over time, the joint may lose its normal shape. Also, bone spurs--small growths called osteophytes--may grow on the edges of the joint. Bits of bone or cartilage can break off and float inside the joint space. This causes more pain and damage.
People with osteoarthritis usually have joint pain and limited movement. Unlike some other forms of arthritis, osteoarthritis affects only joints and not internal organs. For example, rheumatoid arthritis--the second most common form of arthritis--affects other parts of the body besides the joints. It begins at a younger age than osteoarthritis, causes swelling and redness in joints, and may make people feel sick, tired, and (uncommonly) feverish.

How Does Osteoarthritis Affect People?
Osteoarthritis affects each person differently. In some people, it progresses quickly; in others, the symptoms are more serious. Scientists do not know yet what causes the disease, but they suspect a combination of factors, including being overweight, the aging process, joint injury, and stresses on the joints from certain jobs and sports activities.
What Areas Does Osteoarthritis Affect?Osteoarthritis most often occurs at the ends of the fingers, thumbs, neck, lower back, knees, and hips.

Osteoarthritis hurts people in more than their joints: their finances and lifestyles also are affected.
Financial effects include:
-The cost of treatment
-Wages lost because of disability.

Lifestyle effects include:
-Depression
-Anxiety
-Feelings of helplessness
-Limitations on daily activities
-Job limitations
-Trouble participating in everyday personal and family joys and responsibilities.

Despite these challenges, most people with osteoarthritis can lead active and productive lives. They succeed by using osteoarthritis treatment strategies, such as the following:
-Pain relief medications
-Rest and exercise
-Patient education and support programs
-Learning self-care and having a "good-health attitude."


Fighting Osteoarthritis With Exercise
You can use exercises to keep strong and limber, extend your range of movement, and reduce your weight.Some different types of exercise include the following:
Strength exercises:
These can be performed with exercise bands, inexpensive devices that add resistance.Aerobic activities: These keep your lungs and circulation systems in shape.Range of motion activities: These keep your joints limber.Agility exercises: These can help you maintain daily living skills.Neck and back strength exercises: These can help you keep your spine strong and limber.

Ask your doctor or physical therapist what exercises are best for you. Ask for guidelines on exercising when a joint is sore or if swelling is present. Also, check if you should (1) use pain-relieving drugs, such as analgesics or anti-inflammatories (also called NSAIDs), to make exercising easier, or (2) use ice afterwards.
Rest and joint care:
Treatment plans include regularly scheduled rest. Patients must learn to recognize the body's signals, and know when to stop or slow down, which prevents pain caused by overexertion. Some patients find that relaxation techniques, stress reduction, and biofeedback help. Some use canes and splints to protect joints and take pressure off them. Splints or braces provide extra support for weakened joints. They also keep the joint in proper position during sleep or activity. Splints should be used only for limited periods because joints and muscles need to be exercised to prevent stiffness and weakness. An occupational therapist or a doctor can help the patient get a properly fitting splint.
Nondrug pain relief:
People with osteoarthritis may find nondrug ways to relieve pain. Warm towels, hot packs, or a warm bath or shower to apply moist heat to the joint can relieve pain and stiffness. In some cases, cold packs (a bag of ice or frozen vegetables wrapped in a towel can relieve pain or numb the sore area. (Check with a doctor or physical therapist to find out if heat or cold is the best treatment.) Water therapy in a heated pool or whirlpool also may relieve pain and stiffness. For osteoarthritis in the knee, patients may wear insoles or cushioned shoes to redistribute weight and reduce joint stress.
Weight control:
Osteoarthritis patients who are overweight or obese need to lose weight. Weight loss can reduce stress on weight-bearing joints and limit further injury. A dietitian can help patients develop healthy eating habits. A healthy diet and regular exercise help reduce weight.

Pictures of Normal & OA Knees

Normal Knee OA Knee

The VISA Score for Grading Patellar Tendinosis (Jumper's Knee)

Overview :
The VISA (Victorian Institute of Sport Assessment) score can be used to grade the severity of symptoms in patients with patellar tendinosis (jumper's knee). It can be used to monitor patient's over time and to assess the impact of various interventions.

The Victorian Institute of Sport is in South Melbourne, Victoria, Australia.

Questionnaire

(1) How many minutes can you sit pain free?
• points = INTEGER (MINIMUM (100, (minutes/10))

(2) Do you have pain walking downstairs with a normal gait cycle?
• points from 0 to 10
• severe strong pain: 0 points
• no pain: 10 points

(3) Do you have pain at the knee with full active non-weight bearing knee extension?
• points from 0 to 10
• severe strong pain: 0 points
• no pain: 10 points

(4) Do you have pain when doing a full-weight bearing lung?
• points from 0 to 10
• severe strong pain: 0 points
• no pain: 10 points

(5) Do you have problems squatting?
• points from 0 to 10
• unable: 0 points
• no problems: 10 points

(6) Do you have pain during immediately after doing 10 single leg hops?
• points from 0 to 10
• strong severe pain/unable: 0 points
• no pain: 10 points

(7) Are you currently undertaking sport or other physical activity?
• not at all: 0 points
• modified training +/- modified competition: 4 points
• full training +/- competition but not at same level as when symptoms began: 7 points
• competing at the same or higher level as when symptoms began: 10 points

(8) Complete EITHER 8a, 8b, OR 8c, selecting as follows:
• If you have no pain while undertaking sport, please complete 8A only.
(8a) If you have no while undertaking sport, for how long can you train/practice?
• If you have pain while undertaking sport but it does not stop you from completing the activity, please complete 8b only.
(8b) If you have some pain while undertaking sport, but it does not stop you from completing your training/practice, for how long can you train/practice?
• If you have pain that stops you from completing sporting activities, please complete 8c only.
(8c) If you have pain that stops you from completing your training/practice, for how long can you train/practice?

Question nil 0-5 mts 6-10 mts 11-15 mts > 15 minutes
8a 0 7 14 21 30
8b 0 4 10 14 20
8c 0 2 5 7 10

total VISA score =
= SUM(points for responses to all 8 questions)

Interpretation:
• minimum score: 0
• maximum score: 100
• The higher the score, the better the patient's condition.
• Patients may be categorized into groups based on 81-100, 61-80, and < name="ref">References:
Visentini PJ, Khan KM, et al. The VISA Score: An index of severity of symptoms in patients with jumper's knee (patellar tendinosis). J Science and Medicine in Sport. 1998; 1: 22-28.

How to Lift and Carry Safely

Lifting and carrying are power jobs—when you lift and carry the wrong way, you can damage your back. Back injuries are the most common type of injury in the workplace, causing approximately 900,000 disabling injuries in 1995. Over half of these injuries are from lifting.
Back injuries may be difficult to treat and may have lengthy and expensive rehabilitation times.
Whether you are lifting at home or at work, make an effort to take care of your back. The National Safety Council recommends a number of tips to prevent unintentional injuries and keep your back strong and healthy.
Power warm-ups
You will work better if you start each day with slow stretches. These warm-ups let you ease comfortably into your workday and help you avoid injuries.
Leg and back warm-up
Prop one foot on a chair or a stool for support
Take a deep breath
Ease forward slowly—keep your back slightly curved
Blow slowly outward as you ease forward to a seven count
Repeat seven times
Switch and do the same with the other foot
Backbend
Stand with your feet about 12 inches apart
Support the small of your back with your hands
Hold your stomach in firmly and take a deep breath
Arch backward—bend your head and neck as you go, blowing air slowly out for seven counts
Repeat seven times
Power lifting tips
Protect your hands and feet by wearing safety gear
Size up the load—tip it on its side to see if you can carry it comfortably. Get help if the load is too big or bulky for one person. Check for nails, splinters, rough strapping and sharp edges
Lift it right—make sure your footing is solid. Keep your back straight, with no curving or slouching. Center your body over your feet, get a good grip on the object and pull it close to you. Pull your stomach in firmly. Lift with your legs, not your back; if you need to turn, move your feet and don't twist your back
Tough lifting jobs
Oversized loads: do not try to carry a big load alone; ask for help. Work as a team by lifting, walking and lowering the load together. Let one person call the shots and direct the lift. Use proper mechanical devices for heavy loads.
High loads: use a step stool or a sturdy ladder to reach loads that are above your shoulders. Get as close to the load as you can and slide the load toward you. Do all the work with your arms and legs, not your back.
Low loads: loads that are under racks and cabinets need extra care. Pull the load toward you, then try to support it on one knee before you lift. Use your legs to power the lift.
Always use your stomach as a low back support by pulling it in during lifting.
Remember, a strong, healthy, powerful back is vital to your job. It also helps you enjoy life. Take pains to avoid injuries by making it a full-time job to take care of your back!

Pain

Exercises for pain relief
It is essential that you consult your health professional before commencing these exercises. Robin Mckenzie has written an easy to follow guide called "Treat your own back" and invented the following exercises. Exercise One Lying Face Down Lie face down with your arms beside your body and your head turned to one side Stay in this position, take a few deep breaths and then relax completely for four to five minutes. You must make a conscious effort to remove all tension from the muscles in your lower back; without COMPLETE RELAXATION there is NO CHANCE of ELIMINATING any DISTORTION that may be present in the joint. This exercise is used mainly in the treatment of acute back pain that is pain that is short-lived and is one of the First Aid exercises. It should be done once at the BEGINNING of EACH exercise session, and the sessions are to be spread evenly six to eight times throughout the day. This means that you should repeat the sessions about every two hours. In addition, you must lie face down whenever you are resting. When in acute pain you should avoid sitting, at least during the first few days. Exercise Two Lying Face Down in Extension Remain face down. Place your elbows under your shoulders so that you lean on your forearms. During this exercise you should commence taking in a few deep breaths and allow the muscles in the lower back to relax completely. Again you should stay in this position for about five minutes. You must make a conscious effort to remove all tension from the muscles in your lower back; without COMPLETE RELAXATION there is NO CHANCE of ELIMINATING any DISTORTION that may be present in the joint. This exercise is used mainly in the treatment of severe low back pain and is one of the First Aid exercises it should always follow exercise one and is to be performed once per session. Should you experience severe and increasing pain on attempting this exercise, there are certain measures to be taken before you can continue exercising, these are discussed in the section 'No response or benefit' Exercise Three Extension in Lying Remain face down. Place your elbows under your shoulders in the press-up position. Now you are ready to start exercise 3. Straighten your elbows and push the top half of your body up as far as the pain permits. It is important that you completely relax the pelvis, hips and legs as you do this. Keep your pelvis, hips and legs hanging limp and allow your back to sag. Once you have maintained this position for a second or two, you should lower yourself to the starting position. Each time you repeat this movement cycle you must try to raise your upper body a little higher, so that in the end your back is extended as much as possible with your arms as straight as possible. Once your arms are straight, remember to hold the sag for a second or two as this is a most important part of the exercise. The sag may be maintained for longer than one or two seconds if you feel the pain reducing or centralizing. This is the most useful and effective first aid procedure in the treatment of acute low back pain. The exercise can also be used to treat stiffness of the low back, and to PREVENT low back pain RECURRING once you are fully recovered. When used in the treatment of either pain or stiffness, the exercise should be performed ten times per session and the sessions are to be spread evenly six to eight times throughout the day. Should you not respond or have increasing pain on attempting this exercise, there are certain measures to be taken before you can continue exercising, these are discussed in the section 'No response or benefit' read it now. Exercise Four Extension in Standing Stand upright with your feet slightly apart. Place your hands in the small of your back with your fingers pointing backwards and your thumbs pointing forwards. You are now ready to start Exercise Four Bend your trunk backwards at the waist as far as you can, using your hands as a fulcrum. It is important that you keep your knees straight as you do this. Once you have maintained this position for a second or two you should return to the starting position. Each time you repeat this movement cycle, you should try to bend backwards a little further so that in the end you have reached the maximum possible degree of extension. When you are in acute pain, this exercise may replace exercise 3 should circumstances prevent you from exercising in the lying position. This exercise however is not as effective as exercise 3. Once you have fully recovered and no longer have low back pain, this exercise is your MAIN TOOL in the PREVENTION of further BACK PROBLEMS As a preventive measure, repeat the exercise every once in a while whenever you find yourself working in a forward bent position. Perform the exercise BEFORE the pain appears. Exercise Five Flexion in Lying Lie on your back with your knees bent and you feet flat on the floor or bed. You are now ready to start Exercise Five Bring both knees up towards the chest. Place both hands around your knees and gently but firmly pull the knees as close to the chest as the pain permits. Once you have maintained this position for a second or two you should lower the legs and return to the starting position. It is important that you DO NOT RAISE YOUR HEAD as you perform this exercise, or STRAIGHTEN YOUR LEGS AS YOU LOWER THEM. Each time you repeat this movement cycle, you should try to pull your knees a little further so that in the end you have reached the maximum possible degree of flexion. At this stage your knees may touch the chest. This exercise is used in the treatment of stiffness in the low back which may have developed since your injury or pain began. While damaged tissues may have now healed, they may have also shortened and become less flexible; it is now necessary to restore their elasticity and full function by performing flexion exercises. These exercises should be commenced with caution. In the beginning you must only do five or six per session, and the sessions are to be repeated three or four times per day. As you have probably realized, this exercise eliminates the lordosis once the knees are bent to the chest, so in order to rectify any distortion that may result, FLEXION EXERCISES MUST ALWAYS BE FOLLOWED BY A SESSION OF EXERCISE 3 - EXTENSION IN LYING. You may stop performing Exercise 4 when you can readily pull the knees to the chest without producing tightness or pain. You may then progress to Exercise 6 Exercise Six Flexion in Sitting Sit on the edge of a steady chair with your knees and feet well apart and let your hands rest between your legs. You are now ready to start Exercise 6 Bend your trunk forwards and touch the floor with your hands. Return immediately to the starting position. Each time you repeat this movement cycle you must bend down a little further so that end you have reached the maximum possible degree of flexion. At this reached the maximum possible degree of flexion and your head is as close as possible to the floor. The exercise can be made more effective by holding on to your ankles with your hands and pulling yourself down further. Exercise 6 SHOULD ONLY BE COMMENCED AFTER THE COMPLETION OF ONE WEEK OF EXERCISE 5, WHETHER EXERCISE 5 HAS BEEN SUCCESSFUL OR NOT IN REDUCING YOUR STIFFNESS OR PAIN. In the beginning you must only do five or six repetitions per session and the sessions are to be repeated three or four times per day. FLEXION EXERCISES MUST ALWAYS BE FOLLOWED BY A SESSION OF EXERCISE 3 - EXTENSION IN LYING. No Response or Benefit after exercising without any relief or benefit for three or four days, you may conclude that the exercises as performed are ineffectual. There are two main causes for lack of response or benefit from these exercises. A lack of response to these exercises is possible in some people when their pain is felt only to one side of the spine, or is felt much more to one side than the other. If your pain during the course of the day is felt only to one side, more to one side as you perform Exercises 1, 2, 3 you may need to modify your body position before commencing them. To achieve this modification, you should: 1. Adopt a position to perform Exercise 1 and allow yourself to relax for a few minutes. 2. Remain face down and now shift your hips AWAY from the PAINFUL side; that is if your pain is usually more on the right side you must move your hips three or four inches to the left, and once more completely relax for a few minutes. 3. While allowing the hips to remain off-centre, lean on the elbows as described in exercise two and relax for a further three or four minutes. You are now ready to commence Exercise 3. With the hips still off-centre, complete one session of Exercise 3 and relax once more. You may need to repeat the exercise several times but before commencing each session of ten you should ensure that the hips are still off centre; remember, away from the painful side. Even with your hips in the off-centre position, you should try with each repetition to move higher and higher. You should reach the maximum amount of extension possible at which time the arms should be completely straight. For the next three or four days you should continue to perform Exercises 1, 2, 3 from the modified starting position. After a few days of practice you may notice that the pain is distributed more evenly across the back or may have centralized. Once this occurs you may stop shifting the hips before exercising and continue exercising as described earlier. Occasionally shifting the hips away from the painful side is sufficient to stop the pain completely. The second cause for lack of response to the exercise arises when Exercise 3 is performed without adequate fixation. Exercise 3 occasionally gives benefit for a few hours only and then the pain returns. The effectiveness of Exercise 3 can be improved by holding the pelvis down using the hands of another person, or by constructing a simple device which can be improvised at home using an ironing board with a seat belt or strong leather strap placed firmly around the waistline. This added fixation frequently makes the difference between the success and failure of the exercise. RECURRENCE Irrespective of what you are doing or where you are, at the first sign of recurrence of low back pain you should immediately start the exercises which previously led to recovery and follow the instructions to relieve acute pain. You should at once commence Exercise 4 - Extension in Standing. If this does not abolish your pain within minutes, you must quickly introduce Exercise 3 - Extension in Lying. The immediate performance of Exercise 3 can so often prevent the onset of a disabling attack. If your pain is already too severe to tolerate these exercises, you should commence Exercises 1 and 2 - Lying face down and lying down in extension. Finally, if you have on sided symptoms which do not centralize with the exercises recommended so far, you should shift your hips away from the painful side before commencing the exercises and hold your hips in the off-centre position while you exercise. In addition to the exercises, you must pay extra attention to your posture and maintain the Lordosis as much as possible. If this episode of low back pain seems to be different from previous occasions and if your pain persists despite the fact that you closely follow the instructions, you should seek advice.