Musculoskeletal conditions

Arthritis is inflammation of one or more of your joints, small or big. The main symptoms of arthritis are joint pain and stiffness, which typically worsen with age. The most common types of arthritis (the one about usually people say “I have arthritis”) are osteoarthritis and rheumatoid arthritis.
Osteoarthritis causes cartilage — the hard, slippery tissue that covers the ends of bones where they form a joint — to break down. Rheumatoid arthritis is an autoimmune disorder that first targets the lining of joints (synovium) thus destroying it without mercy. There is also Psoriatic arthritis, where the arthritis of the fingers and toes is secondary to the skin disease psoriasis (link here), but only 10-30% of people with psoriasis will get this.
Uric acid crystals (causing Gout), infections or underlying disease, such as Psoriasis or Lupus, can cause other types of arthritis that are not so common.
In Canada, in 2014, there were 4,8 million cases of arthritis, where males accounted for 1,8 million cases and women had 2,9 million.

Osteoarthritis, commonly known as wear and tear arthritis, is the most common type of arthritis. This disease affects more than 10% of Canadians aged 15 or older.
It is associated with a breakdown of cartilage in joints and can occur in almost any joint in the body. It commonly occurs in the weight-bearing joints of the hips, knees, and spine. It also affects the fingers, thumb, neck, and large toe.
Osteoarthritis usually does not affect other joints unless previous injury, excessive stress or an underlying disorder of cartilage is involved.
Cartilage is a firm, rubbery material that covers the ends of bones in normal joints. Its main function is to reduce friction in the joints and serve as a “shock absorber.” The shock-absorbing quality of normal cartilage comes from its ability to change shape when compressed (flattened or pressed together).
Osteoarthritis causes the cartilage in a joint to become stiff and lose its elasticity, making it more susceptible to damage. Over time, the cartilage may wear away in some areas, greatly decreasing its ability to act as a shock absorber. As the cartilage deteriorates, tendons and ligaments stretch, causing pain. If the condition worsens, the bones could rub against each other, causing pain.
There are several factors that increase your chances of developing osteoarthritis. These are:
✓ Heredity. Some people have an inherited defect in one of the genes responsible for making cartilage. This causes defective cartilage, which leads to more rapid deterioration of joints.
✓ Obesity. Obesity increases the risk for osteoarthritis of the knee, hip, and spine. Maintaining an appropriate weight may help prevent osteoarthritis of these areas or decrease the rate of progression, once osteoarthritis is established.
✓ Injury. Athletes who have knee-related injuries may be at higher risk of developing osteoarthritis of the knee. In addition, people who have had a severe back injury may be predisposed to develop osteoarthritis of the spine. People who have had a broken bone near a joint are prone to develop osteoarthritis in that joint.
✓ Joint overuse. For example, people in jobs requiring repeated bending of the knee are at increased risk for developing osteoarthritis of the knee.
✓ Other diseases. People with rheumatoid arthritis, the second most common type of arthritis, are more likely to develop osteoarthritis. In addition, certain rare conditions, such as iron overload or excess growth hormone, increase the chance of developing OA.

Rheumatoid arthritis (RA) is a form of arthritis that causes pain, swelling, stiffness and loss of function in your joints. It can affect any joint but is most common in the wrist and fingers.
More women than men get rheumatoid arthritis. It often starts in middle age and is most common in older people. You might have the disease for only a short time, or symptoms might come and go. The severe form can last a lifetime and it is usually kept under control with powerful medication.
Rheumatoid arthritis is different from osteoarthritis, the common arthritis that often comes with older age. RA can affect body parts besides joints, such as your eyes, mouth and lungs. RA is an autoimmune disease, which means that it occurs when the immune system, which normally defends the body from invading organisms, turns its attack against the membrane lining the joints.
No one knows what exactly causes rheumatoid arthritis. Genes, environment, and hormones might contribute to this puzzling disease.
One specific thing about Rheumatoid arthritis is that it generally occurs in a symmetrical pattern, meaning that if one knee or hand is involved, the other one also is. The disease often affects the wrist joints and the finger joints closest to the hand. It can also affect other parts of the body besides the joints. In addition, people with rheumatoid arthritis may have fatigue, occasional fevers, and a loss of energy, which is also unique and differentiating from Osteoarthritis.

Fibromyalgia is the most common musculoskeletal condition after osteoarthritis. Still, it is often misdiagnosed and misunderstood. Its characteristics include widespread muscle and joint pain and fatigue, as well as other symptoms. Fibromyalgia can lead to depression and social isolation.
This multifactorial syndrome is characterized, in part, by abnormal central processing of pain signals.
In this syndrome, the following symptoms commonly occur together:
✓ Widespread muscle pain
✓ Anxiety and/or depression
✓ Decreased pain threshold or tender points
✓ Incapacitating fatigue
These symptoms are usually made worse by stress or anxiety, physical exertion and changes in weather (barometric pressure). This syndrome has also been known to occur among patients having widespread inflammation (such as Rheumatoid arthritis) or those undergoing medication or substance withdrawal.
Other fibromyalgia symptoms include:
✓ Abdominal pain
✓ Chronic headaches
✓ Dryness in mouth, nose, and eyes
✓ Hypersensitivity to cold and/or heat
✓ Inability to concentrate (called “fibro fog”)
✓ Incontinence
✓ Irritable bowel syndrome
✓ Numbness or tingling in the fingers and feet
✓ Stiffness
It is estimated that fibromyalgia affects 900,000 Canadians or approximately 3% of the population. Women are 10 times more likely to get this disease than men.
Doctors don’t know what causes fibromyalgia, but it most likely involves a variety of factors working together. These may include:
✓ Genetics. Because fibromyalgia tends to run in families, there may be certain genetic mutations that may make you more susceptible to developing the disorder.
✓ Infections. Some illnesses appear to trigger or aggravate fibromyalgia.
✓ Physical or emotional trauma. Post-traumatic stress disorder (PTSD) has been linked to fibromyalgia.
One way to see if what you have is Fibromyalgia is to check for the criteria outlined by the American College of Rheumatology. These criteria include widespread pain that persists for at least three months and in combination with at least 11 of the following 18 specified tender points (in both the right and left sides of the body) both above and below the waist, and in the chest, neck, and mid or lower back.

On a recent development, there is a blood test to help diagnose fibromyalgia. The test, called FM/a, identifies markers produced by immune system blood cells in people with fibromyalgia. This test is experimental though and is expensive.
Patients with FMS are often diagnosed with many overlapping medical conditions, such as Chronic Fatigue Syndrome (CFS), Irritable Bowel Syndrome, tension headaches and premenstrual syndrome. Approximately 70% of patients diagnosed with FMS meet all the diagnostic criteria for CFS, with the only significant differences being the existence of muscle pain in FMS and fatigue in CFS. At our clinic we offer IV Therapy, vit.B12 injections, herbal extracts and nutraceuticals for patients with this syndrome.

Back problems are among the most common chronic conditions in Canada. Four out of five adults will experience at least one episode of back pain at some time in their lives, although occurrence is most often between the ages of 30 and 50. Back problems appear with equal frequency in men and women.
The hurt can stem from sore muscles, ligaments and tendons, herniated discs, fractures, and other problems.
Injuries from contact sports, accidents, and falls can cause problems ranging from minor muscle strains, to herniated discs, to fractures that cause severe damage to the spinal column or cord.
Also, we often bring on our back problems through bad habits, such as:
✓ Poor posture
✓ Overexerting yourself at work or while playing
✓ Sitting incorrectly at the desk or at the steering wheel in the car
✓ Pushing, pulling, and lifting things without thinking of your spine
One of the more common types of back pain comes from straining the bands of muscles surrounding the spine. Although such strains can occur anywhere along the spine, they happen most often in the curve of the lower back. The next most common place is at the base of the neck.
The cause of back pain, however, is not always apparent; in fact, in approximately 85% to 90% of individuals with back pain, no specific cause can be identified.
Some will say it may be caused by weakened muscles that can’t handle everyday walking, bending, and stretching. In other cases, back pain may come from an injury involving pulling or twisting or some kind of overuse or repetitive damage.
Pregnancy commonly brings on back pain, too. Hormonal changes and weight gain put new kinds of stresses on a pregnant woman’s spine and legs thus creating this dreadful condition.

Osteoporosis is a very common condition and in Canada at least 1 in 3 women and 1 in 5 men will suffer from an osteoporotic fracture during their lifetime. The overall yearly cost to the Canadian healthcare system of treating osteoporosis and the fractures it causes was over $2.3 billion as of 2010. Huge.
Osteoporosis is a common disease that weakens bones. As bones weaken, your risk of sudden and unexpected fractures increases. Osteopenia is the forerunner of osteoporosis and it refers to early signs of bone loss when Bone Mineral Density (BMD) is lower than normal but not lower enough to be considered osteoporosis. It is a silent but destructive condition that robs bones during a woman’s most productive time.
No matter what your age or sex, osteoporosis and osteopenia can affect you. Your bones might seem sturdy now. You may be very active and doing the things you want. But osteoporosis and osteopenia are quiet, accomplished thieves. In fact, there are usually no visible signs.
The bone loss with osteoporosis occurs over many years and can become severe. It may be so severe that the normal stress on bones from sitting, standing, coughing, or even hugging a loved one can result in painful fractures and immobility. Then, after the first fracture, you are at risk for more fractures. These future fractures may cause you to live with daily chronic pain and disability.
The medicine doesn’t know a lot about what causes osteoporosis. We do know how osteoporosis develops throughout a person’s life. Bones are complex, living tissue. Your body constantly breaks down old bone and rebuilds new bone. This bone-building process is called “remodeling.”
In terms of risk factors for osteoporosis, several were identified:
✓ Family history: Osteoporosis seems to run in families. If your mother had a hip fracture or spinal collapse fracture, chances are you are at risk for osteoporosis.
✓ Gender: Women are four times more likely than men to get osteoporosis. But men also suffer from osteoporosis.
✓ Age: The risk of osteoporosis increases with age. Women over age 50 have the greatest risk of developing osteoporosis. However, anyone of any age can have osteoporosis. But the older you are, the more risk you have of fractures and osteoporosis.
✓ Bone structure and body weight: Petite and thin women have a greater risk of developing osteoporosis. Weight loss after age 50 in women also seems to increase the risk of hip fractures. Weight gain decreases the risk. Small-boned, thin men have a greater risk of osteoporosis than men with larger frames and more body weight.
✓ History of fractures: Having one fracture increases the chance of more fractures.
✓ Smoking: studies show that cigarette smokers (past or current smokers) have lower bone densities and higher fracture risks. Women who smoke have lower levels of estrogen, a key component for having healthy bones, compared to non-smokers. They also frequently go through menopause earlier.
✓ Medications: Some medications may increase your risk of osteoporosis. These include long-term use of steroids (prednisone), thyroid drugs, anticonvulsants, antacids, and other drugs.

As many as 4 out of every 10 people will get sciatica, or irritation of the sciatic nerve, at some point in their life. This nerve comes from either side of the lower spine and travels through the pelvis and buttocks. Then the nerve passes along the back of each upper leg before it divides at the knee into branches that go to the feet.
Anything that puts pressure on or irritates this nerve can cause pain that shoots down the back of one buttock or thigh. The sensation of pain can vary widely. Sciatica may feel like a mild ache; a sharp, burning sensation; or extreme discomfort. Sciatica can also cause feelings of numbness, weakness, and tingling.
In about 90% of cases sciatica is caused by a herniated disc with nerve root compression.
Pain may be made worse by prolonged sitting, standing up, coughing, sneezing, twisting, lifting, or straining.
Sciatica pain may make it difficult to be active. But bed rest is not recommended as a mainstay treatment. To manage new sciatica pain, you may find that certain positions and activities are more comfortable than others.
If symptoms are not severe but persist beyond a couple of weeks, your doctor may recommend physical therapy. The proper exercises may actually help reduce sciatic pain. They can also provide conditioning to help prevent the pain from coming back.
Acupuncture is a must here.
If pain from sciatica persists for at least 6 weeks despite treatment, you may be referred to a specialist. Only a very small percentage of people with sciatica will require surgery. The goal for surgery is to remedy the cause of the sciatica. For example, if a herniated disc is putting pressure on the nerve, then surgery to correct the problem may relieve sciatica pain.
Most patients with acute sciatica have a favorable prognosis but about 20%-30% have persisting problems after one or two years.

Ankylosing spondylitis is a type of arthritis that affects the spine. Ankylosing spondylitis symptoms include pain and stiffness from the neck down to the lower back. The spine’s bones (vertebrae) may grow or fuse together, resulting in a rigid spine. These changes may be mild or severe, and may lead to a stooped-over posture. Early diagnosis and treatment helps control pain and stiffness and may reduce or prevent significant deformity.
Ankylosing spondylitis affects about 0.1% to 0.5% of the adult population (around 42,000 in Canada). Although it can occur at any age, spondylitis most often strikes men in their teens and 20s. It is less common and generally milder in women and more common in some First Nations tribes.
The most common early symptoms of ankylosing spondylitis include:
✓ Pain and stiffness. Constant pain and stiffness in the low back, buttocks, and hips that continue for more than three months.
✓ Pain in ligaments and tendons. Spondylitis also may affect some of the ligaments and tendons that attach to bones. Tendonitis (inflammation of the tendon) may cause pain and stiffness in the area behind or beneath the heel, such as the Achilles tendon at the back of the ankle.
✓ Bony fusions. Ankylosing spondylitis can cause an overgrowth of the bones, which may lead to abnormal joining of bones, called “bony fusion.” Fusion affecting bones of the neck, back, or hips may impair a person’s ability to perform routine activities.
Ankylosing spondylitis is a systemic disease, which means people with the condition also may have fever, fatigue, and loss of appetite. Eye inflammation (redness and pain) occurs in some people with spondylitis. In rare cases, lung and heart problems also may develop.
Although the cause of ankylosing spondylitis is unknown, there is a strong genetic or family link. Most, but not all, people with spondylitis carry a gene called HLA-B27. Although people carrying this gene are more likely to develop spondylitis, it is also found in up to 10% of people who have no signs of the condition.

Carpal tunnel syndrome is numbness, tingling, weakness, and other problems in your hand because of pressure on the median nerve in your wrist.
The median nerve and several tendons run from your forearm to your hand through a small space in your wrist called the carpal tunnel. The median nerve controls movement and feeling in your thumb and first three fingers (not your little finger).
This pressure can come from swelling or anything that makes the carpal tunnel smaller. Many things can cause this swelling, including:
✓ Illnesses such as hypothyroidism, rheumatoid arthritis, and diabetes.
✓ Making the same hand movements over and over, especially if the wrist is bent down (your hands lower than your wrists), or making the same wrist movements over and over.
✓ Pregnancy.
Symptoms most often occur in the thumb, index finger, middle finger, and half of the ring finger. If you have problems with your other fingers but your little finger is fine, this may be a sign that you have carpal tunnel syndrome.
Surgery is an option. But it’s usually used only when symptoms are so bad that you can’t work or do other things even after several weeks to months of other treatment.
Acupuncture is great for this condition.

Also called Runner’s heel, plantar fasciitis is inflammation of the thick, fibrous band of tissue (”fascia”) that reaches from the heel to the toes, supporting the muscles and arch of the foot. When the plantar fascia is overly stretched, tiny tears can occur in its surface, causing inflammation and pain. While some people have attributed this type of pain to bony growths called heel spurs, it’s now believed that heel spurs are a result of rather than a cause of the pain from plantar fasciitis.

A number of factors contribute to the condition. While men can get plantar fasciitis, it is more common in women. You’re also more likely to suffer from this condition as you age or if you:

• Take up a new form of exercise or suddenly increase the intensity of your exercise
• Are overweight
• Are on your feet for several hours each day
• Tend to wear high-heeled shoes, and then switch abruptly to flat shoes
• Wear shoes that are worn out, with weak arch supports and thin soles
• Have flat feet or an unusually high arch
• Have legs of uneven lengths or an abnormal walk or foot position
• Have tight Achilles tendons, or “heel cords”