Feature published in Shifa News, October 2016
Zuhra, a middle-aged woman and Mobeen, her younger cousin were traveling on metro bus from Islamabad one afternoon. Zuhra was holding her right knee with one hand and a popular Urdu tib magazine in the other. On inquiring what she was reading, Mobeen came to know Zuhra was searching for a home remedy for her knee pain. “My knee has been hurting for so long. I am sure I will find something to treat it here.”
“Please look for a remedy for calcium deficiency as well. My back hurts a lot, though I use supplements regularly,” adds Mobeen.
Zuhra and Mobeen are probably hunting for something to ease their joint pain, a common health condition. It however seems, they have self-assessed their health issues and without much awareness are looking for a cure themselves. Many around us have such attitude in dealing with health problems especially when it comes to joint problems.
According to Dr Zafar Ullah, a rheumatologist at Shifa International Hospital, Islamabad around 15 to 20 percent patients suffer from these diseases in Pakistan estimatedly. “Up to 700 patients with joint problems are registered each month at our hospital alone. The percentage of patients from all over the country is even higher.”
“Maintaining good bodyweight is necessary to prevent joint problems. Although people with well-maintained weight can also have joint problems, but being overweight or obese puts more stress on knee joints causing them to wear away rapidly”
There are more than 150 types of joint diseases. These conditions are usually progressive and associated with pain. Moreover, they are not gender or age specific. “Even young people develop joint-related problems nowadays,” says Dr Zafar.
Highlighting the types of joint problems in the country, Dr Zafar says, osteoarthritis or degenerative arthritis is the most common in which joints start to wear and tear with age or weight gain. Rheumatoid arthritis (ganthiyan) is also a common joint problem which is otherwise rare in the world. Then there is inflammatory arthritis and connective tissue disorder that is frequently seen among women. “Inflammatory conditions of joints and muscles that involve other organs like kidney, brain and lungs and also affect blood pressure level are also common.”
In elderly, age can be a major factor in developing joint issues. However, in youngsters, major causes of these diseases include: unhealthy diet, excess weight or obesity, incorrect body postures and use of inaccurate shoes.
Imbalance of uric acid is also considered a cause of joint pain, particularly in women. “However, it generally does not affect their health until after menopause.” This problem is more common in men. Nevertheless, excessive uric acid does not create issues in many cases. “But when it does, its pain is extremely unbearable and the patient is unable to move on his own,” explains Dr Babur Salim, a rheumatologist at Fauji Foundation Hospital, Rawalpindi.
Many people confuse muscle and joint pain with each other. “Joint pain causes swelling and contraction for more than one hour. Muscle pain, on the other hand, is temporary and does not cause swelling,” explains Dr Babur, before adding, “a painkiller should not be taken in such joint pain.”
People consider steroids as harmful. However, experts believe proper diagnosis and treatment from a rheumatologist becomes necessary even if he prescribes steroids. “Right and controlled use of steroids can even help save a patient’s life,” says Dr Zafar.
“It is also a myth that using steroids would hinder the efficiency of other medicines. They are essential and extremely beneficial if used with proper monitoring and care,” adds Dr Babur.
Explaining further, Dr Zafar says, steroid injections are recommended only when the patient is not getting pain relief through medicines or the other option has more side effects than these injections. “Careful selection of the patient is necessary. They cannot be prescribed to every other patient in pain.” They work best in acutely inflamed swollen warm joints and frozen shoulder. Steroids are also a good option for osteoarthritis patients who want to avoid surgery. It is symptomatic treatment and not a permanent solution. “Some may get relief for a year or so after which it can be repeated. Nevertheless, some degenerative arthritis patients do not find any relief after the steroid shot.”
Joint condition is indeed painful. There are however, certain lifestyle changes which patients can make to ease their pain and prevent the problem.
Vitamin D is important for healthy bones and joints. Eat organic foods rich in vitamin D like fish, egg yolk and cheese. But you get only a small amount of it through diet (unless food is fortified). Its main source however, is sunlight. Regularly sitting in sunlight for at least half an hour fulfills the need.
“Avoid junk and bakery goods and foods high in carbohydrates. Even smoking can play an indirect role in causing joint issue in some people,” says Dr Zafar.
Moreover, people usually associate joint pain with calcium deficiency. “Although calcium is not required in the body to that extent. It is an overrated mineral. Besides, excessive calcium deposits in the blood vessels can create heart and kidney problems,” he highlights further.
In case you are diagnosed of calcium deficiency through a blood test, Dr Zafar recommends recovering through diet modification rather than supplements. “Young people usually do not require supplements. They are prescribed to the elderly.”
Foods such as milk, yogurt, fish, orange and cheese are good sources of calcium. And taking it 15 minutes before breakfast allows it to get absorbed properly.
Furthermore, it is also a misconception that eating certain foods such as rice, potato, beef or lassi can cause or aggravate joint pain. Experts negate these claims as there are no scientific evidences to them.
Battling weight gain & inactivity
Maintaining good bodyweight is necessary to prevent joint problems. “Although people with well-maintained weight can also have joint problems, but being overweight or obese puts more stress on knee joints causing them to wear away rapidly,” says Dr Babur.
Mahnaz Nasir, a nutritionist at Hameed Latif Hospital, Lahore informs that the best way to maintain your weight is to consume whatever you eat.
Exercise such as walking, cycling or jogging not only for joints but for muscle and overall health. However, avoid heavy weight and excessive exercise. “A car wheel for instance, can soon damage if not used gently. Similar is the case with our joints,” adds Dr Zafar.
Rough use of joints causes osteoarthritis. The joint layer in the knees called cartilage begins to wear down in this disease. It occurs due to extreme physical activity or if the patient is overweight. “Earlier, it used to occur after the age of 50. But today even 40 year olds or younger suffer from the problem,” informs Dr Babur.
Moreover, be gentle while climbing stairs. People who rush while taking stairs put unnecessary pressure on their knees. Dr Babur warns not to make it a habit to run unnecessarily while climbing stairs or walking. “Other precautions for knee patients include using toilet seat, offering prayers on a chair and avoiding sitting on the floor.”
Keeping the perfect posture
Other lifestyle changes include adopting the right posture while sitting, standing, sleeping and walking. Prolonged sitting, standing or walking incorrectly also causes joint problems. Dr Babur recommends sitting straight by joining the whole body with the back of the chair. There should be no gap between the chair and your back. Also, walk straight. To make it a habit, stand up straight three to four times daily with your back, head and shoulders touching a wall. Then walk in this position for several minutes. “Moreover, take a break for at least one to two minutes after every 30 to 45 minutes of continuous sitting or standing.”
Right foot gear
According to the rheumatologists, footwear also matter. Incorrect shoes not only affect feet joints but also create knee, hip and waist issues. High heels, flat shoes, walking barefoot cause heel problems such as plantar fasciitis, especially if you are overweight. “Flats or improper shoes put extra pressure on heels causing inflammation in the feet,” says Dr Babur.
Therefore, selecting the right foot gear is extremely important. “Buy soft shoes that have an arch. However, special shoes are also available at limb centers,” he informs.
To prevent backache use a firm mattress for sleeping. It should not be too soft or hard. Sometimes an incorrect pillow can also cause neck pain. “This also happens when your pillow is too hard or soft. Avoid using lots of pillows. Use only one pillow which is firm and thin,” adds Dr Babur.
Oiling to relax
Many people think massaging is a good solution to prevent backache or other joint pains. “Oil massage is only a supportive method. It relaxes joint muscles by temporarily relieving pain, but is not the permanent solution,” says Dr Zafar.