DR. CORA LIM
MEDICAL INSIDER
Rheumatology Made Simple
(Part 2)
In our discussion of the first part of the topic
“Rheumatology Made Simple” last week, we discussed the
following: Rheumatic Diseases Commonly Seen In
Primary Care Practice, Rheumatic Disease Categories,
Ambulatory Rheumatology, Causes of Soft Tissue,
Shoulder Pain Syndrome, Hip Pain Syndrome, and
Knee Pain Syndrome.
As we continue this discussion, we will focus on the
following:
Low Back Pain: Some generalities of low back pain
include – 1) Low back pain is a very common
disorder; 2) Mostly related to dysfunction of muscles,
ligaments, tendons & fascia; 3)
Symptoms & x-rays seldom correlate in most cases of
the back pain; 4) May be associated with several
musculoskeletal & other medical disorders
Simple Back Ache – The simple back ache patients
are aged 20-50 years; the pain is in the lumbosacral
region, buttocks & thighs; the pain is mechanical in
nature; the pain varies with physical activity; the
patient is otherwise well.
Special Considerations In Chronic Low Back Pain
– The following are the special considerations in
chronic low back pain: Examine the person more than
the pain & its mechanisms; Stay alert for secondary
gains & malingering; Treatment modalities attempt to
modify the pain to tolerable levels; Analgesics, anti-
inflammatory drugs, antidepressants; Treatment can
be difficult (and frustrating); Cartilage degradation:
loss of matrix integrity; Role of cytokines, enzymes,
nitric oxide; Age is the strongest risk factor; Other risk
factors: obesity, injury, muscle weakness; Knees &
hips are most commonly affected; Herbenden’s &
Bouchard’s nodes; Mechanical pain, no systemic
features
Exercise Considerations in Hip or Knee
Osteoarthritis-I: Maintain proper weight; -Maintain
range of motion and flexibility; Exercise in water, on a
bicycle or a rowing machine; Alternate weight-bearing
and nonweight-bearing activities; and Use cane on
contralateral side
Exercise Considerations in Hip or Knee
Osteoarthritis-II: Do not carry loads more than 10%
body weight; Minimize use of stairs, one-legged
stance, low seating; Walking speed should not
exacerbate joint symptoms; Select shoes and insoles
for shock attenuation; and Warm-up prior to walking
exercise. (To be continued)