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Common Joint Problems COMMON JOINT PROBLEMS 1. OSTEOARTHRITIS Arthritis means ‘inflammation of a joint’ and is a common finding in many people. In some it will cause severe pain and disability while in others it may go unnoticed or just cause a feeling of a little stiffness. Osteoarthritis (OA) is ‘wear and tear’ whareas Rheumatoid Arthritis (RA) is very inflammatory and generally leads to more pain and disability. Osteoarthritis is much more common. In Osteoarthritis, the cartilage on the end of a bone becomes worn and begins to flake into the joint. The joint will then inflame as it tries to heal the wear and tear up. The inflammatory process contains many irritating chemicals which cause swelling. Pain nerve endings in the joint become irritated by the chemicals and the extra pressure caused by the swelling and this pain in turn causes stiffness and loss of muscle around the joint. This can happen in most joints. By freeing up the stiff joints and muscles and strengthening the muscles around the joint we can alleviate pain. 2. SPONDYLOSIS Spondylosis is extremely common and is where the discs between the back bones (vertebrae) become inflamed and worn. Usually beginning after the age of 35, this leads to thinning of the discs and stiffness of the spinal joints. As the discs become thinner, the little facet joints at the side of the discs can rub together more causing osteoarthritis and further pain and stiffness. The discs themselves can cause pain and become inflamed or bulge out backwards. The surrounding muscle becomes weak and poor in quality. Again, by freeing up the stiffness and strengthening the muscles of the spine we can often alleviate pain. BULGING DISCS 3. RHEUMATOID ARTHRITIS Rheumatoid arthritis is a more aggressive inflammatory disease than osteoathritis and generally leads to more pain and disability. It flares up form time to time and these acute episodes can last days, weeks or months. There seems to be an inherited factor, as there is with osteoarthritis. Blood tests can be done to show weather you have the condition and it is important that drug management and proper advice are given early. As it is an inflammatory condition we have to be careful about moving joints around during the acute phase and so we let things settle until this phase is over. Anti-inflammatory drugs such as Voltarol (Diclofenac) can be very effective at controlling the pain and inflammation. Sometimes, more powerful anti inflammatories called steroids are prescribed. Your doctor may prescribe hydrotherapy (exercises in water) or physiotherapy to exercise the stiff joints. 4 Non-specific Joint Pain Some people complain of mild to severe ‘jointy’ problems which appear inflammatory in nature. Often there is no injury, exacerbations seem to affect many joints at once and are associated with joint stiffness, especially on waking, pain at night and occasionally swelling. If you have this type of problem we will have blood tests done, either at your G.P surgery or here at Gilmour Piper to try and find out what is causing the it. Often, blood tests are clear and nothing much shows up. If this is the case, we can help you manage things. If signs of inflammatory disease show up on blood tests then usually this is managed between ourselves, your G.P and a rheumatologist. 9 May 2005

 

Tennis Elbow TENNIS ELBOW WHAT IS IT ? Tennis elbow is a condition that is caused when the tendons that insert into the outside of the elbow become inflamed causing either localised pain at the outside of the elbow or pain here and down the forearm and even up into the upper arm and shoulder. The pain can be mild or severe and is usually made worse by using the arm. Inflammation may lay down too much scar tissue, causing gradually worsening pain. WHAT CAUSES IT ? Either repetitive overuse or misuse, such as computer work or, less commonly, an injury from some other activity such as lifting or decorating. Other common causes are driving long distances, manual work and tennis or racket sports. Sometimes trapped nerves in the neck can cause pain in the elbow as can a knock to the outside of the elbow or poor posture. Normally the pain starts without any apparent trauma and just builds up over the weeks or months until it becomes more noticeable. It can be severe enough to wake you in the night or it may just be a niggle that stops you from playing sport or using the computer. HOW DO YOU TREAT IT ? As with most things, early treatment is the key because the scar tissue has less time to lay down and thicken. Once your practitioner has found out the cause of the pain, treatment consists of relative rest from the activity identified as the main cause, massage, ultrasound, stretches and acupuncture. Acupuncture has been shown to be more effective than steroid injections in research trials. If your neck is causing some of the pain, your practitioner will treat this with gentle manipulation to free the stiff joints and exercises. They may give you advice on maintaining the correct posture at work or during an activity that makes the pain worse. Progressive strengthening exercises are given when the elbow is virtually pain free and you are back to doing a little of your usual activities. OSTEOPATHY OR PHYSIOTHERAPY? There is usually little difference in the type of treatment you can expect. Our practitioners can also give you acupuncture if this is indicated. 9 May 2005

 

Acupuncture ACUPUNCTURE Your questions answered The term acupuncture is derived from two words, acus (needle) and punctura (puncture). Stone needles exist from the Han dynasty in about 700 BC which were used to pierce the skin. Chinese legend says that when a warrior was pierced by an arrow, a disease in an unrelated area of the body was simultaneously cured. Chinese physicians worked out the relationship between the punctured point and the disease it cured and their connections. These became known as ‘channels’ or ‘ meridians’ Traditional Chinese medicine, which includes acupuncture as a part, takes into account many things about the patient including diet, daily variations in symptoms and diagnosis using the pulse and tongue. ACUPUNCTURE FOR BACK AND NECK PAIN The acupuncture we use here at Gilmour Piper is modern and non traditional. The ancient traditional Chinese methods were based on a set of assumptions about the world that are now not part of modern science and we now have a scientific basis for the theory of how acupuncture works. Modern acupuncturists have found that you don’t have to believe in the ancient theories of Chinese traditional medicine to gain the same enormous benefits from acupuncture, which is why so many doctors, physiotherapists and osteopaths use it today, normally in conjunction with other techniques, to treat pain. Acupuncture or ‘dry needling’ (meaning using an acupuncture needle with no drugs instead of a hypodermic syringe which may have a steroid and local anaesthetic solution in it) is used in the treatment of muscular conditions and in the control of pain. Patients often have ‘trigger points’ within a muscle that act as small transmitters of pain. Studies done as far back as the 1930’s have shown that these small points can radiate pain all over the body, commonly from the back or neck to the arms or legs. Needling these seems to abolish the trigger points and reduce pain significantly in many cases. Some people who have had pain for a long time (chronic pain) have adaptations within their nervous system (spinal cord) which make more pain get to the brain than is necessary. In fact, in many cases the original injury has healed and it is only the ‘memory’ of the pain in the injured area that causes discomfort, which can often be severe. Acupuncture can help in some cases of chronic pain and is commonly used with a graded exercise programme. There is good recent evidence that acupuncture is better than ‘normal medicine’ for conditions such as tennis elbow and arthritis of the knee and so we commonly use it for these conditions. In conjunction with a clinical diagnosis as part of a treatment plan we normally use other treatments such as manipulation, massage, stretching and strengthening exercises in combination with acupuncture for maximum effect. ACUPUNCTURE FOR HEADACHES, SINUS AND HEAD PAIN ACUPUNCTURE FOR KNEE PAIN Does it hurt? You will be pleased to know that the needles are extremely thin and do not commonly cause much discomfort as they go in! Occasionally you may experience an increase of pain over the next day or two. This then quickly subsides. Is it safe? Yes. We do not needle in any dangerous areas and nor do we needle too deeply! The needles are sterile, vacuum packed and single use to minimise the risk of infection. Occasionally a bruise may appear where a needle has been inserted. Who shouldn’t have acupuncture? You need to tell us if you take aspirin or other anti coagulants such as warfarin as you may bruise excessively. If you are pregnant there are two or three points that we do not needle. You need to tell us if you are a blood donor as you may require a certificate that tells the transfusion service you have had acupuncture. You should not have acupuncture if you are badly needle phobic! Which conditions do you think benefit most from acupuncture? We think our patients commonly experience relief from many symptoms if acupuncture is used in conjunction with other more conventional treatments such as physiotherapy and osteopathy. Our patients are getting used to seeing a combination of an osteopath and a physiotherapist (for no extra charge!) as we believe our mutual understanding has made this approach the way forward through the minefield of muscular – skeletal pain and we now find that many are also finding acupuncture as part of this combination very helpful in reducing the length of time they are in pain. As acupuncture is normally introduced as part of an ongoing treatment plan there is usually no extra charge for this either! If you have any questions, please ask at reception to speak to one of our practitioners Here is a list of the conditions we often find acupuncture helpful in treating Tennis elbow pain Muscular pain Headache and head pain Some types of back pain Pain from arthritis of the knee Sinus pain PMT, period pain and night sweats 9 May 2005

 

Late arrival for appointments Could we remind patients that we will always do our best to accommodate you if you arrive late for your appointment. However, if you are more than 15 minutes late we may request that you rebook the appointment rather than rush your treatment in the remaining time. This is in the best interests of practitioners and patients. 11 October 2004

 

Building Matters We have recently re-decorated the waiting area and consulting rooms and udergone a review of our facilities for less able bodied members of the public particularly in light of the new disability and discrimination act. Disabled access is at the top of the driveway and reception are called via an intercom system. We have toilet facilities for those less able bodied and a lift allowing easy access to all areas of the building 11 October 2004

 

Our Staff As with any organisation delivering quality care to patients we rely on an excellent administration team. We have a skilled team of receptionists to deal with your enquiries headed by our Office Manager Michelle Mahoney. If you have any feedback or comments regarding your treatment or visit please contact one of our team or Michelle directly and we will endeavour to address any problems you have 11 October 2004

 

Interactive Bookings The website www.gilmourpiper.co.uk is now more interactive. You can give us feedback, ask questions or even request an appointment.Please revisit the site, which will continues to evolve and is regularly updated 11 October 2004

 

Practice Brochure Our Practice brochure is available from the practice for those patients who wish to find out more about the Practitioners who work here and the conditions we can treat. Please call in or phone on 01473 217592 to receive one or ask any questions 11 October 2004

 

Presentation material Presentations for the IPRS and EASG are now available on line. For further information please contact Andrew Gilmour. 3 May 2003

 

The back pain crisis in 21st Century – an update Back Letter Vol 18 no 1 Jan 2003. Helpful review of the status of the back pain disability crisis at the beginning of the 21st Century. There is exciting evidence of a dramatic fall in back related disability awards in at least one major industrial nation. Great Britain reports a 42% reduction in new awards of back related disability since the mid 1990’s. The overall prevalence of back pain does not seem to have changed over the last few decades. There has been no obvious spike in serious spinal diseases. What has changed is the way individuals, the medical community, and society have reacted to back pain. The move away from a culture of bed rest, off work and dependency has shifted towards active rehabilitation and return to work. In short benefits for back pain rose hugely from the late 1970’s to early 1990’s in Great Britain as they did in many other countries. From the mid 1990’s however there has been a steady fall in the number of new awards and a total reduction now making 42%. For further articles from the Back Letter visit www.backletter@lww.com 12 February 2003

 

The UK back exercise and manipulation (UK Beam) trial This high profile trial developed by the Medical Research Council (MRC) and the NHS Research and Development Programme. A randomised trial of treatment for back pain in primary care. The Department of Health Services at the University of York and the MRC General Practice Research Framework (GPRF) were responsible for co-ordinating the trial to evaluate the effectiveness of an exercise programme, spinal manipulation or manipulation and exercise combined. A total of 1,334 registered patients in 14 geographical locations across the UK were randomised to receive their care by General practitioner, or additionally to have manipulation or exercise, or manipulation followed by exercise. Those allocated to manipulation are randomised to treatment in NHS or private facilities. Outcomes were measured at 1, 3 and 12 months after randomisation, the main outcome measured being the Rowland Disability Questionnaire, but other questionnaires about general health, experience of pain, and beliefs were included. Good follow up rates were achieved, 84% at 1 month, 77% at 3 months and 75% at 12 months. Watch for this large complex trial results with an impressive amount of data being published during the course of 2003 12 February 2003

 

Multidisciplinary Spinal Team This practice now operates as part of a team of clinicians whose aim is to find the best way forward for patients with particularly persistent, challenging or recurrent problems. It consists of Mr David Sharp, (Consultant Spinal Surgeon), Dr Mike Bailey (Consultant in Anaesthetics and Pain Management), Dr Simon Harley (Spinal Physician), Marc Rapkin (physiotherapist) and Andrew Gilmour and Mark Piper (osteopaths). We meet once a week to ‘brainstorm’ and feedback to patients. 22 July 2002