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Your questions answered

Tuesday, June 12, 2018

Dr Naresh Shivdasani answers some common queries on backache, painful knees and walking. Do you have a problem?

From a young girl a month before her exams.

Doctor, I have a severe pain in the neck and upper back. I can't concentrate on my studies. My sleep is disturbed and pain-killers are not helping. What should I do?

Student

This is a common problem. There is so much pressure to do well in exams that one forgets the real goal i.e. to do well in life. Many of my colleagues from school and college, who were not considered 'good' students are doing extremely well in life.

To answer your query—stress caused by anxiety to do well in exams can cause severe pain in the neck and upper body. Headaches, bowel disturbances and frequency of urination are very common.

Make sure you do some regular stretching exercises. Get plenty of sunlight—don't be cooped up in a room studying all the time. Learning stress relief techniques will control the wandering mind and also help the pain.  Take some Vitamin supplements such as B-complex and Vitamin D. A mild pain-killer like paracetamol along with moist heated packs go a long way in relieving the pain.

Planning your studies will go a long way in relieving the stress. Putting in a good amount of effort into the studies also relieves the tension and one can go into the exam hall with confidence.

From a senior citizen

I have a healthy lifestyle, no medical problems, no smoking and moderate alcohol intake. When I walk for about ten minutes, I am forced to stop and rest for a few minutes before I am able to walk again. What could be the reason?

Anxious elderly gentleman

This kind of problem is commonly due to ‘spinal canal stenosis’. This condition develops as there are changes in the spine and the space available for the spinal cord (the main nerve going through the spinal column) becomes reduced. The blood supply for the spinal cord gets reduced causing a condition called ‘spinal claudication’. On walking, the demand for oxygen, carried by the blood, exceeds the supply. Since the blood supply is reduced, the nerves get ischemic, causing pain down the legs. On resting for some time, there is some recovery and one can walk again.

Some basic investigations like X-rays and MRIs of the spine are needed to quantify the stenosis. If the canal diameter is significantly reduced and lifestyle is compromised, one can consider surgery to decompress the cord. Minimally invasive surgery is available in most centres.

Strengthening exercises to tone the  back muscles, as well as the abdominal muscles help protect the spinal cord from progressive injury. Mild analgesics help to reduce the pain. Generally some drugs to help protect the nerves are also given. Any systemic factors like obesity and diabetes should also be controlled.

From a middle-aged lady

I am a 45-year-old lady, moderately obese, with pain in my right knee since the last few months. The pain increases on walking down steps and climbing slopes. What is the solution?

Plump lady

Seems like you have early Osteoarthritis of the knee. Work on the thigh muscles, both front and back, to strengthen them. The quadriceps muscle and the hamstrings control the movement of the knee joint. Increasing strength and reaction time of the muscles helps to delay the progress of the arthritis. The surface of the leg bone, (tibia) is quite small. While walking or running there is severely increased pressure on the joint surface. Any excess weight of the bodywill cause  the joint to degenerate more rapidly. Hence weight reduction is mandatory.

In case of severe pain, a centrally acting pain-killer is useful. Mild pain can be managed with paracetamol. Any local balm or gel can also be used. Avoid the use of Non- Steroidal Anti-Inflammatory (NSAIDs) drugs like ibuprofen or diclofenac. Moist heat also will help to decrease the pain.

These are general guidelines for common issues. Specific treatment would involve an examination by your doctor.

Dr Naresh Shivdasani (D.Orth, M.S. (Orth) is a Senior Orthopaedic Surgeon, with interest in Acupuncture and Spinal Manipulation. He believes that most disease originates from stress and lifestyle issues.

If you need advice, write to Dr Naresh Shivdasani at naresh.shivdasani@gmail.com;he will answer queries in this column.

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