Dr Ashar Ekhlaq Ahmed talks about muscle, bone and joint issues in Pakistan. He also emphasizes that healthy living can preserve bone and muscle strength in old age
SN: What are the common issues of muscles, bones and joints in Pakistan?sni
Muscle and bone related disorders are very common in Pakistan. Rheumatoid arthritis, an autoimmune and inflammatory disease, has global prevalence of one percent which is roughly the same for Pakistan. This means approximately 22 lac individuals suffer from the disease. Osteoarthritis is another common issue which causes back, hip and knee pain. Pain disorders like Fibromyalgia are present too. All of them are treatable with appropriate and timely intervention.sni
SN: What is the difference between a rheumatologist and orthopedic specialist?sni
Orthopedic specialists are trained to perform surgeries. Whereas rheumatologists are medical specialists who diagnose and treat musculoskeletal (muscle, connective tissues and bone related) disorders through medicines. These conditions can range from simple aches and pains to serious life-threatening inflammatory disorders. They are trained to perform procedures that include injecting joints and soft tissues for symptomatic relief.sni
SN: Which signs indicate the need to consult a rheumatologist?sni
A rheumatologist needs to be consulted for all causes of joint and muscle pain other than those related to fractures or joint surgery. Most of these conditions can be treated with medicines or physiotherapy. If surgical intervention is needed, the rheumatologist will refer the patient to an orthopedic. Rheumatologists, orthopedic surgeons, physiotherapists and occupational therapists work together as a part of a multi-disciplinary team.sni
SN: Do we have enough rheumatologists in the country? Are people aware of this specialty?sni
There is an acute shortage of these specialists and extreme lack of public awareness about this specialty in Pakistan. In the UK, there is approximately one rheumatologist for one lac population and overall 700 experts for 68.5 million people. Still there is a shortfall. In Pakistan, the number is approximately 70 to 80 for the whole population which means one rheumatologist for every 30 lac people. Also majority practice in larger cities, which makes it difficult for people of rural areas to access them.sni
Women are more prone to developing musculoskeletal problems due to various factors. They perform fine, repetitive work that can lead to neck, shoulder, and wrist problems
SN: What is the difference between muscle and joint pain?sni
Both can be localized or diffused and worsen with movement. Only a specialist can diagnose the type of pain after careful examination. Accurate diagnosis is necessary to provide appropriate and timely treatment.sni
SN: What makes women more vulnerable to muscle, bone and joint issues?sni
Women are more prone to developing musculoskeletal problems due to various factors. They perform fine, repetitive work that can lead to neck, shoulder, and wrist problems. Pregnancy effects pelvic bone causing pelvic pain and back issues. Carpal tunnel syndrome during pregnancy leads to hand pain and numbness. Also for cultural and religious reasons, a lot of women cover themselves and avoid going out which results in vitamin D deficiency. This deficiency, sedentary lifestyle and hormonal changes after menopause cause osteoporosis. Autoimmune musculoskeletal disorders like rheumatoid arthritis, lupus and connective tissue problems are common too.sni
SN: Why do musculoskeletal issues appear in younger age these days?sni
Obesity and sedentary lifestyle are the major culprits. These strain the weight bearing joints of back, knees, ankles and feet much more than they are naturally designed for. Thus joints get damaged at an earlier age. Rheumatoid arthritis and juvenile arthritis (in childhood) are getting diagnosed earlier as well.sni
SN: How does heavy weightlifting, incorrect posture and prolonged sitting affect muscles and joints?sni
Incorrect sitting posture for a desk job can cause back and neck problems. To prevent this, ensure that the height of chair and desk is correct, the back is positioned properly and take regular breaks or short walks during work-hours. Avoid putting wallet in the back pocket while sitting as it can disturb back alignment and cause muscle strains (injury to muscle and tendon). Also learn the correct way of weightlifting to avoid stress on muscles and joints.sni
SN: What are the non-medicated ways to treat back pain?sni
Healthy eating and maintaining a healthy weight can help in this case. Vertebral fractures are a common cause of back pain which can be prevented by staying safe from osteoporosis. This can be achieved through regular muscle strengthening exercises and posture improvement. Getting adequate sleep in correct position is necessary too. For this sleep on your side with a pillow between knees and feet on top of each other.sni
If the cause of back pain is injury, apply ice for about 20 minutes. This may not promote healing of the damaged tissue, but can relieve pain. If experiencing pain since long then use warm water bottle, a heating pad or a heated gel pack. Massage therapy, acupuncture, TENS machine (device that uses mild electric current to relieve pain) and physiotherapy etcetera are also beneficial for chronic back pain.sni
SN: What are the causes of muscle strain?sni
Using incorrect posture to lift heavy things, overstretching during exercise, overtraining at the gym without adequate rest or accident and injury during sports are some causes of muscle strain. Warming up before exercise and getting adequate rest between the sessions can help prevent it. If starting a new exercise or sport, begin gradually so that muscles get accustomed to the new movements. This will prevent unnecessary muscle strain and reduce risk of injury. Accidents can happen anywhere but always take precautions to avoid trips and falls.sni
SN: How does cold temperature and rainy season cause muscles to stretch?sni
There is no definite answer to this question. Some theories suggest that sensory nerves in joints are extremely sensitive to pressure change. So change in atmospheric pressure in cold environment causes muscles to stretch. Others say that tendons and ligaments constrict causing pain in previously damaged structures. Also in cold and wet weather conditions, people become less active. This lack of movement can cause stiffness and pain.sni
SN: Does massage help relieve the pain? What is the proper way to do it?sni
Deep massages can help muscle strains by relaxing the muscles and reducing spasm. However, prefer getting professional services of a masseuse and start with 30-minute sessions at a time.sni
SN: How do hot and cold therapies help?sni
Heat increases the temperature of soft tissues (muscles, tendons and blood vessels etcetera) and blood flow to the affected area. This increased flow delivers more nutrients and oxygen that aids in healing and repair of the muscle. Heat also helps the muscle to relax, decrease muscle tone and increase flexibility. But in case of acute or fresh injury, open wound, swelling or inflammation opt for cold therapy. By reducing the temperature and numbing the nerves, cold therapy can help reduce pain.sni
Deep massages can help muscle strains by relaxing the muscles and reducing spasm. Prefer getting professional services of a masseuse and start with 30-minute sessions at a time
SN: What causes joint stiffness?sni
Any type of arthritis or injury to joints or muscles can cause stiffness. It is especially common in small joints of hands, wrists elbows, feet, and ankles. Early morning stiffness in these joints in a symmetrical manner indicates underlying rheumatoid arthritis. It usually improves with movement and time but in severe cases can last for several hours or whole day. Early morning or night-time back pain is another example which can indicate spine disorders. In all the cases seek urgent help to prevent complications like joint damage, fractures and disability.sni
SN: Some remain active even in older age but others have difficulty moving. Why is it so?sni
Frailty is a common problem of old age. However, people may age differently. Some remain fit and active even in old age and several factors are responsible for this. For example, hormonal changes in women after menopause and men with advancing age leads to loss of muscle mass and strength. Some may develop conditions like stroke or Parkinson’s which affect their mobility and ability to perform tasks.sni
SN: What impact does wearing high heels have on feet muscles?sni
High heels lead to slower walking and shorter step length. With time this can cause shortening of the calf muscles, increase stiffness in the ankle tendons and higher muscle activity in the legs and feet. These disturbances cause problems like pain in foot joints, tightness of ankle tendons, arthritis in feet, knee osteoarthritis, plantar fasciitis (pain at the bottom of heel) and lower back pain. Instability and imbalance are also problems which can result in a greater risk of falling and slipping. So avoid wearing them regularly.sni
SN: What lifestyle changes can improve muscle strength and prevent bone and muscle problems?sni
Maintaining a healthy lifestyle promotes good health at any age and can certainly preserve bone and muscle strength in old age. So maintain a healthy weight, eat balanced diet and perform regular weight bearing exercises. Some individuals develop lactose intolerance in later age. Therefore, women being at a higher risk can minimize symptoms and prevent osteoporosis by taking nutritional supplement that contains calcium and vitamin D. These must be taken daily during post-menopause phase with doctor’s advice.sni
SN: Anything you would like to add at the end?sni
In Pakistan, there is a culture of non-specialists trying to treat autoimmune conditions related to rheumatology. This leads to poor care quality, substandard and often harmful treatment which can be injurious to a patient’s health. One of the primary tenets of medicine is to ‘do no harm’ so medical professionals must practice within their area of competence. Rheumatologists can treat over 200 inflammatory conditions. So if one feels he has an underlying joint, muscle or connective tissue problem, he must consult a qualified rheumatologist without delay.sni
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