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    Musculoskeletal Health Australia
    09/Aug/2023
    Health InformationMSK articles

    Your guide to shoulder pain and how to treat it

    I’ve never really thought about my shoulders. They’re just there. Useful for hanging a handbag on or supporting a heat pack for my neck. I only really notice them when, graceful person that I am 😉, I bash one on a door frame.

    That was until a few years ago when I slipped in the bathroom and fell hard on my arm, with my shoulder in an unnatural position. I was suddenly very keenly aware of my shoulder! I honestly thought I’d broken it. Fortunately, scans revealed nothing had broken, but I had injured the soft tissues.

    However, it was during that time I learned about shoulders. I know, I know, the crazy fun times never end for me 😂. But in my defence, I was stuck on the couch for a few days with my arm in a sling and an ice pack on constant rotation. So I didn’t really have a lot going on.

    And what I learned was fascinating.

    And since shoulder pain is incredibly common, I thought I’d share what I learned with you. Because if you haven’t had shoulder pain, you probably know someone who has. So buckle up, and let’s learn about shoulders, shoulder pain and how to treat it.

    Let’s start with the basics – how your shoulders work.

    DYK, the shoulder has not one, but four joints???

    This makes them complex, flexible structures with a large range of movement. Unfortunately, this flexibility can also put the shoulder at risk of injury and dislocation, especially through contact sports and falls.

    Your shoulder is made up of three bones: the shoulder blade (scapula), collarbone (clavicle), and upper arm bone (humerus).

    The main joint is the glenohumeral joint. This is where your humerus connects with your scapula. Like the hip, it’s a ball and socket joint. The top of your humerus is shaped like a ball and fits inside the socket or cup-shaped indentation in your shoulder blade. However, this socket is shallow, giving your shoulder great flexibility but also making it less stable.

    The other joints are:

    • the acromioclavicular joint – where the top of your shoulder blade (acromion) meets your collarbone
    • the sternoclavicular joint – where your collarbone meets your breastbone (sternum) near the base of your neck
    • and the scapulothoracic joint – where your shoulder blade meets the chest wall (thorax). It allows your shoulder blade to move smoothly over your ribs.

    Soft tissues surround the glenohumeral joint to form a capsule. This keeps the head of the arm bone in place in the joint socket. The joint capsule is lined with a synovial membrane that produces synovial fluid to lubricate and nourish the joint. Tendons, ligaments, bursa, and muscles also support the joints and bones in your shoulder to stabilise it and allow it to move freely. The bones, joints and soft tissue work together to make your shoulders incredibly mobile, so you can do all kinds of things like throw a ball, hug a friend, brush your hair, and scratch your back.

    When things go wrong – shoulder pain.

    Shoulder pain may come on quickly, e.g. if you injure yourself, or it can occur more gradually. It can be mild pain or, as I experienced, very painful 😥.

    There are many causes of shoulder pain, not all due to problems with the shoulder joints or associated structures. They include:

    • Other musculoskeletal conditions, such as rheumatoid arthritis, osteoarthritis, and polymyalgia rheumatica can affect the shoulder, causing pain.
    • Inflammation or injury to the soft tissues (e.g. muscles, bursae, tendons, ligaments) in and around the shoulder, for example, bursitis and frozen shoulder.
    • Ongoing stress or anxiety that causes your muscles to remain tense.
    • Neck and upper back joint and nerve problems can cause pain to be felt in and around the shoulder.
    • Referred pain. Shoulder pain may also be caused by problems affecting your abdomen (e.g. gallstones), heart (e.g. heart attack) and lungs (e.g. pneumonia).

    Note: if you feel shoulder pain radiating down your arm or you’re experiencing a tight feeling across the chest and shortness of breath, dial 000 immediately.

    Symptoms of shoulder pain.

    Unsurprisingly, the main symptom of shoulder pain is pain! Other symptoms include:

    • Reduced movement, stiffness and pain when moving your shoulder.
    • Weakness of the shoulder/upper arm.
    • Pain when lying or putting pressure on the affected shoulder.
    • Pins and needles (tingling). This is more likely to be associated with neck problems than the shoulder itself.

    Diagnosing shoulder pain.

    If you have shoulder pain that’s causing you distress or affecting your ability to do your daily activities, you should see your doctor. Your doctor will:

    • ask you questions about your shoulder pain, including potential causes (e.g. recent injuries, other health conditions), if you’ve had shoulder pain before, and how it affects you
    • ask about any other symptoms or health issues you have
    • do a thorough physical examination.

    From this, they can work out the likelihood of particular structures in the shoulder being involved.

    Sometimes they’ll suggest that scans are needed. They may include X-rays, ultrasounds, computed tomography (CT), or magnetic resonance imaging (MRI). The type of scan/s required will depend on the suspected cause of your shoulder pain. However, it’s important to know that many scans show changes to your shoulder that will likely represent the normal passage of time (even by age 45), not damage to your shoulder.

    Treating shoulder pain.

    Treating shoulder pain begins with understanding the cause of the problem. What works for one shoulder issue may not work for another. Your doctor will create a treatment plan based on your diagnosis.

    The following are some commonly used treatments for shoulder pain.

    • Heat and cold packs may provide temporary relief from pain and stiffness. Generally speaking, heat can relieve muscle spasms and tension. Cold can reduce swelling.
    • Physiotherapy will aim to fix problems such as shoulder, neck and upper arm stiffness and weakness. A physiotherapist will provide exercises to help improve mobility and the range of movement for your shoulder. They’ll also help you modify movements and activities that worsen your pain. This often includes learning new ways to do things related to your work, sport, or everyday activities that aggravate your shoulder. They may also tape your shoulder and show you how to use taping to support your shoulder and reduce stress on it.
    • Occupational therapy. If your shoulder pain makes everyday activities difficult, seeing an occupational therapist (OT) may be helpful. They can help you learn better ways to carry out activities such as bathing, dressing, working or driving. They can also provide aids and equipment to make everyday activities easier.
    • Medicines may help reduce the pain you’re experiencing while you work to maintain and restore movement and function. But it’s important to understand they’re not a long-term solution to shoulder pain. Talk with your doctor or pharmacist for advice about pain medicines. There are different types available, both over-the-counter and by prescription. They include:
      • Non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs reduce inflammation and pain but have side effects, so using the lowest dose for the shortest period is best.
      • Topicals. Rubs, gels, ointments, sprays, patches and creams applied to your skin (topically) can provide temporary pain relief.
      • Corticosteroid injection. If you have persistent shoulder pain and haven’t had relief from oral medicines or other treatments, your doctor may suggest a corticosteroid (steroid) injection. Corticosteroid injections into the joint can reduce inflammation and provide short-term pain relief for some people. However, pain relief varies and may last a few days to weeks. The number of injections you can have is limited due to potential harm. Discuss the benefits and risks of steroid injections with your doctor.
    • In cases of a frozen shoulder, hydrodilatation may be recommended. This is an injection of fluid (saline and a steroid) into the joint. There’s some evidence that it may relieve symptoms and improve range of motion. However, it’s unclear if this is due to the hydrodilatation, the steroid in the injection, shoulder exercises, or a combination.

    What about surgery?

    For most people, shoulder pain will improve over time with appropriate, conservative treatment. However, in some cases, surgery may be required.

    When considering surgery, you should be informed about what it involves, the rehabilitation process, and its potential benefits and risks.

    Managing shoulder pain to prevent future problems.

    Most people with shoulder pain will find it gets better over time. But there are things you can do to proactively prevent future problems.

    • Learn more about your shoulder pain. Are there activities or jobs that trigger your shoulder pain or make it worse? Knowing as much as possible about your shoulder pain means that you can make informed decisions about your healthcare and actively manage it.
    • Follow the advice of your healthcare team. The information, exercises, and modifications provided by your physio or occupational therapist during the worst of your shoulder pain will help prevent you from aggravating your shoulder and causing future issues.
    • Exercise regularly. Although you might think you need to protect your shoulder by not moving or resting it, it’s made for movement. And resting can make things worse. Regular exercise is vital for maintaining flexibility, muscle strength, and bone health. When starting an exercise program, you should incorporate activities that improve flexibility, muscle strength, balance, and overall fitness and endurance. Start exercising slowly and gradually increase the time and intensity of your exercise sessions over weeks and months. A physiotherapist or exercise physiologist can help you work out an exercise program right for you.
    • Manage your stress. Living with stress or anxiety can worsen your pain by causing the muscles throughout your body to tense or spasm. This is often felt in the shoulders and neck. There are many ways to reduce stress or anxiety, including exercise, massage, mindfulness, heat, breathing exercises, and guided imagery.
    • Get back to your normal activities. Try to be as active as possible and get on with your day-to-day life, including work and exercise. Returning to heavy manual jobs may take longer, and you may need support from a physio and/or OT.

    Contact our free national Help Line

    Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265, email (helpline@msk.org.au) or via Messenger.

    More to explore

     

    CONTINUE READING
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    Lisa Bywaters
    09/Aug/2023
    Health InformationMSK articles

    Money, money, money

    Not much has changed since ABBA sang in 1976 “All the things I could do, if I had a little money.” Money – or the lack of it – has been causing us headaches and stress since we started using it.

    Living with a musculoskeletal condition – or multiple conditions – can be expensive. Medications, healthcare appointments, time off work (or not being able to work), exercise classes, complementary therapies, and aids and equipment are costly on top of everyday expenses.

    When you add rising living costs, financial stress is almost inevitable.

    Fortunately, there are things you can do if you’re in this situation. And it starts now.

    Acknowledge the situation.

    This is the crucial first step. As much as we’d like to bury our heads in the sand when we feel anxious or worried about anything (I know that’s my go-to reaction 😑), it won’t solve the problem. We need to look it in the eye, acknowledge it exists and start to deal with it – one step at a time.

    Create a budget.

    This may sound daunting, but you need to know where your money’s going. You need to be able to track what money is coming in and what you’re spending it on. MoneySmart is an Australian Government website with many tools and resources to help you manage your money. They have a section on budgeting to help you create a budget that works for you and your circumstances.

    By understanding where your money’s going, you can start to see where you can make some savings or cut some costs. It’ll also put you in a better position when/if it comes time to talk with your bank, utility companies etc.

    Know your rights.

    When you’re struggling and stressed, it’s easy to become overwhelmed. But there are laws to help protect you if you’re suffering from financial hardship. The National Debt Helpline has information to help you understand your rights and protections.

    Seek help.

    If you’re finding it challenging to create a budget or find a way out of your financial problems, contact the National Debt Helpline and talk with a financial counsellor. They’re free, confidential, and independent. You can call them on 1800 007 007 weekdays 9.30am-4.30pm. They also have a live chat function on their website, available weekdays from 9.00am-8.00pm, or you can also send them a message outside of hours, and a counsellor will get back to you. National Debt Helpline also has a huge range of other resources to help you if you’re struggling with debt or controlling your finances.

    Talk to your bank.

    If you’re having difficulties paying your mortgage, personal loans or credit card repayments, talk with your lender about your options, such as making smaller repayments over a longer period or pausing repayments.

    The Australian Banking Association has some useful resources on their website, including information about your rights and what your bank can do to help you.

    Talk to your utility companies.

    Contact your supplier if you can’t afford to pay your gas, electricity, water, and phone bills. But first, check out this information from the National Debt Helpline about how to do this.

    Be wary of buy now, pay later schemes, payday loans, and consumer leases.

    If you’re under financial stress, these options may seem like a convenient way to pay for things you need. However, they’re also an easy way to get into even more debt. Learn more by reading MoneySmart’s info on the potential problems with payday loans, consumer leases, and buy now, pay later schemes.

    Talk with your doctor about GP management plans.

    Living with a chronic condition (or multiple conditions) can cost a lot of money. Discuss accessing a GP Management Plan and Team Care Arrangement with your doctor so that you can get coordinated care to manage your health condition. You may be eligible for Medicare rebates for certain allied health services. You can find out more on the Department of Health website.

    Talk with your doctor and pharmacist about safety nets.

    They exist to help lower the out-of-pocket medical costs for people who, due to their health condition/s, spend a lot of money on Pharmaceutical Benefits Scheme (PBS) medications. Your doctor and pharmacist can give you more information about these safety nets.

    Talk with your doctor about 60-day scripts.

    From 1 September 2023, eligible people living with chronic conditions can buy 60 days’ supply of some medicines. This will reduce the cost of some medicines for people with stable, chronic conditions. For more info, check out the Consumers Health Forum 60-day scripts website, and talk with your doctor about whether this is an option for you.

    Find out about government allowances and benefits.

    The Australian Government provides a wide range of allowances and benefits you may be eligible for, including:

    The Australian Government’s Services Australia website provides a lot of information about these payments (and others), including information about eligibility criteria.

    You can also talk with our nurse on the MSK Help Line if you’re having trouble navigating through these social services schemes. Contact them on 1800 263 265 weekdays or email helpline@msk.org.au.

    Find out about the National Disability Insurance Scheme (NDIS).

    The NDIS helps people under 65 with permanent and significant disability get care and support. It pays for reasonable and necessary support that a person needs to live and enjoy their life. The NDIS also provides information and connections to local services to people who aren’t eligible for funding. Find out more about the NDIS.

    There’s light at the end of the tunnel.

    When you’re in debt or dealing with financial hardship, it can seem like there’s no way out. But there are a lot of organisations and services available to help you. This article has just scraped the surface of them.

    There are more for you to explore in the links below.

    If you need help with debt or just want to learn how to manage your money better, I’d urge you to look at MoneySmart, National Debt Helpline and The Salvos. They provide excellent, easy-to-understand resources on a wide range of issues relating to money.

    Contact our free national Help Line

    Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265, email (helpline@msk.org.au) or via Messenger.

    More to explore

    CONTINUE READING
    DNA.jpg
    Lisa Bywaters
    09/Aug/2023
    Health InformationMSK articles

    Pharmacogenomics… huh???

    Your genetics and personalised medicine

    You may have heard something about personalised medicine and the tongue twister – pharmacogenomics. But what is it? And might it be beneficial? We take a quick look at this exciting field of research and things to consider before diving in.

    Let’s start with the word… it’s a mouthful!

    The word “pharmacogenomics” is a combination of pharmacology and genomics:

    • Pharmacology is the study of the uses and effects of medicines.
    • Genomics is the study of all of a person’s genes (their genome), including how genes interact with each other and with your environment.

    A (very) little bit of biology 101.

    Almost all the cells in your body contain DNA. DNA is the genetic information that helps make people who they are.

    DNA is a double helix. You’re probably familiar with the image – it’s shown on practically every crime or detective show. 😉 It looks like a twisted ladder.

    Four different chemicals (nucleotides) pair up to make the ladder’s rungs.

    Genes are stretches of DNA. They can be long or short. You inherit your genes from your parents – one copy of each gene from each parent. They contain the instructions to build your body and make you uniquely ‘you’.

    Where drugs come into the story.

    Your genetic makeup affects the way you respond to medicines.

    It can affect whether a medicine is effective, whether it has no effect or whether you have a bad reaction or side effect. It can also affect the dosage you may need. For example, some people absorb medicines too quickly, meaning they need a higher dose to experience any benefit; others process them too slowly, leading to side effects.

    Knowing this information about your genes has the potential to help your doctor provide more personalised medicine and a more effective treatment plan.

    So how do you know how your genes will react to medicines? You can take a test.

    Pharmacogenomic tests are available via some GPs and pharmacists and through direct‐to‐consumer services. They’re generally not covered by Medicare, so you’ll have to pay the total cost of about $150-200.

    These tests usually require a cheek swab, salvia sample or blood sample. The sample is sent to be analysed, and a report is provided. If you have gone through your doctor or pharmacist, they’ll explain the results.

    Before you jump.

    Before jumping on board and spending your hard-earned dollars on a test, there are some things to consider.

    • Do you need another test? Many people with chronic conditions already have lots of routine tests to manage their condition. This is not only costly but time-consuming. So ask yourself, “Am I experiencing significant problems with my medicines? And does this test have the potential to provide real benefit?” If so, talk with your doctor. It may be alternative medicines or treatments are an option. Or it might be that your doctor thinks a pharmacogenomic test will help. But first, have the conversation. And read Choosing Wisely Australia’s 5 questions to ask your doctor or other healthcare provider before you get any test, treatment, or procedure.
    • The cost. It’s not covered by Medicare, so you’ll have to pay for it yourself.
    • Pharmacogenomic tests aren’t available for all medicines. And not all genes and gene variants are tested. International guidelines have so far identified about 15 genes for which testing can inform the prescribing of 30 different medications with good evidence of clinical benefit.
    • Not all GPs or pharmacists have the experience or training to understand how to best use these tests and understand the results.
    • Your genes aren’t the only player in this game. It’s much more complicated, and many other factors affect how your body reacts to medicines. They include your general overall health, age, other medicines and supplements you’re taking, body size, inflammation, and kidney or liver problems. Your genetics are just one part of the puzzle.
    • Safety of your information. Many direct-to-consumer companies offering these tests are overseas, even if the initial delivery address is within Australia. Australian law protects your privacy rights for services provided in Australia, but these protections don’t apply to overseas services. So ask questions about the company – where’s it located, where’s your data stored, who has access to it.

    Pharmacogenomics in practice.

    We’ve just touched on the briefest of info about pharmacogenomics, so for more comprehensive information about pharmacogenomics in practice in the real world, read this excellent fact sheet from the NSW Government Centre for Genetics Education.

    Finally.

    The field of pharmacogenomics is growing, and it’s an exciting new world. But you also need to weigh up whether this is something that will benefit you now.

    Take the time to do your research, ask questions, and talk with your doctor. These tests aren’t going anywhere. In fact, they’ll likely become more comprehensive and more mainstream as time goes on.

    Contact our free national Help Line

    Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265, email (helpline@msk.org.au) or via Messenger.

    More to explore

    References

    1. A brief guide to genomics, National Human Genome Research Institute
    2. Pharmacogenomics in general practice: The time has come. Australian Journal of General Practice 2019; 48
    CONTINUE READING
    Teeth.jpg
    Lisa Bywaters
    13/Jul/2023
    Health InformationMSK articles

    The importance of good oral health

    Hate going to the dentist? You’re not alone. Many of us become anxious or worried about visiting the dentist.

    But for people with a musculoskeletal condition, taking care of their teeth and gums – including the dreaded visit to the dentist – can also be painful.

    We’ve got some tips to help make this a little easier.

    But first, why should we care about oral health?

    Looking after the health of your mouth, teeth, gums, and the structures that support them helps you keep your teeth healthy and intact for longer as you age. This is important because it makes you feel more confident and comfortable when speaking, smiling, eating, and laughing.

    Poor oral health is also linked to diabetes, heart disease, stroke and respiratory conditions. And in some studies, gum disease has been linked to rheumatoid arthritis.

    So oral health is important. Got it. 👍

    Musculoskeletal conditions and oral health.

    There are various reasons why people with musculoskeletal conditions may have difficulties with their oral health, such as:

    Pain. Pain can affect your ability to open your mouth for the time it takes to clean and floss your teeth or to keep your mouth open during a check-up. It can also affect your ability to hold and use a toothbrush or dental floss.

    Dry mouth. Whether it’s due to a health condition such as Sjogren’s syndrome or taking certain medicines, having a dry mouth reduces the amount of saliva in your mouth. And that’s a problem because saliva washes away food remnants, neutralises the acids in your mouth, helps prevents bad breath, tooth decay and gum disease, and protects your teeth’s enamel.

    Being immunosuppressed or having a weakened immune system due to your condition or medicines can increase your risk of infections, including oral thrush and mouth ulcers.

    Taking care of your oral health.

    Get brushing.

    While it sounds obvious, you need to clean your teeth, tongue and gums twice a day for at least two minutes for good oral health. But according to the Oral Health Tracker, only about half of us do this 😮.

    And yes – I did say brush your tongue. Gently brushing your tongue removes any bacteria, other microbes or bits of food lurking there.

    For more info, check out the Australian Dental Association’s brushing basics.

    Oh – and if you need some help knowing if you’ve brushed for two minutes, or to make it fun for the kids, check out Spotify and YouTube for music to brush your teeth by. There’re plenty of playlists and songs out there! 🎶🎵 Or get creative and make your own. 😉🎵🎶

    Choose your tools.

    Toothbrushes. I don’t know why, but I always thought using a hard toothbrush and giving my mouth a good old scrub was the way to clean teeth. Turns out, a softer brush is the best choice. And you shouldn’t use too much pressure when brushing; it’s bad for your teeth and gums and can aggravate your joint pain. Brushing too hard also wears down the bristles of your toothbrush faster.

    If the handle of your toothbrush is difficult to hold, you can make it thicker and easier to grip by adding some thick rubber or foam tubing to the handle. You can pick this up at the hardware store.

    An electric toothbrush is another option, especially if pain or dexterity affects your ability to brush. Electric toothbrushes also generally have a bigger handle that may be easier for some people to grip; however, they’re also a bit heavier than a standard toothbrush, so you’ll need to consider that.

    Whether you use a standard or electric toothbrush, you need to change the brush regularly. That’s generally every three months or sooner if you notice the bristles falling out or pointing in the wrong direction.

    Toothpaste. There are so many varieties of toothpaste available it can be hard to choose one! The good news is that a Choice article reports that ‘most toothpastes contain essentially the same ingredients’ and do the same thing – remove plaque and prevent tooth decay and cavities. So choose the toothpaste you like.

    But if you have a dry mouth or sensitive teeth and gums, talk with your dentist about the best toothpaste for you.

    Dental floss. Flossing is essential to teeth cleaning as it helps remove food particles and microbes from between your teeth. Not flossing increases your risk of developing tooth decay and gum disease. However, according to the Australian Dental Association, many of us forget to floss our teeth, with only one in four people saying they floss daily 😐.

    But using dental floss can be a challenge if you have sore hands. Talk to your dentist about other options, such as dental floss picks (not toothpicks), interdental brushes, water flossers and electric flossers.

    Mouthwash. Most people don’t need mouthwash, especially if you’re cleaning and flossing regularly and properly.

    Many types of mouthwash kill the bacteria in your mouth, both good and bad. They can also mask bad breath, which may indicate an infection or other problem. And they can be irritating if you have a sensitive mouth.

    But mouthwash may be helpful if you have a dry mouth, as certain types can help stimulate saliva.

    So what to do? Have a chat with your dentist about whether or not a mouthwash is appropriate for you.

    Check yourself out. 😁

    The best way to stay on top of any problems is to regularly check your teeth and gums for changes. That way, if you notice any bleeding, inflammation, signs of infection, or other issues, you can see your doctor or dentist and get on top of it quickly.

    See your dentist regularly.

    You should see your dentist every 6-12 months to ensure good oral health. Or sooner if you have toothache, damage to your teeth and gums, or pain or sensitivity when eating or drinking. When combined with regular brushing and flossing, seeing your dentist regularly will reduce your risk of needing more invasive and costly procedures in the future.

    If you have problems keeping your mouth open for long periods and/or lying in the chair while having a check-up, discuss this with your dentist. There are options to make this less painful, such as:

    • Using pain-relieving medicines or heat/cold packs before and after your visit.
    • Taking breaks. Have an agreed signal with your dentist – for example, raising your hand – if you need to move, close your mouth, or relax your jaw.
    • Distraction, for example, put on some headphones and listen to music, a podcast or a book.
    • Using your supports, for example, a cushion or blanket that helps you relax and get comfortable.
    • Visiting your dentist more frequently but for shorter visits, so you don’t have to spend so much time in one sitting. Though this can become costly, so talk with your dentist about your options.

    Your dentist may also suggest using a mouth prop. Mouth props are rubbery, flexible tools that dentists can place between your teeth to help reduce muscle fatigue caused by keeping your mouth open wide.

    Eat well.

    A healthy diet with a variety of nutritious foods and plenty of water is best for your oral health and general wellbeing. You should also limit your intake of foods high in sugar and snacks between meals.

    Quit smoking.

    Smoking and vaping increase your risk of gum disease.

    Contact our free national Help Line

    Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

    CONTINUE READING
    sunflower.jpg
    Lisa Bywaters
    13/Jul/2023
    Health InformationMSK articles

    Shining bright

    Every year on 29 June, people mark World Scleroderma Day. This year, many landmarks around Australia shone gold like sunflowers in June to support people living with scleroderma.

    What’s the connection between scleroderma and sunflowers? 🌻 🌻 🌻 And what exactly is scleroderma?

    According to Scleroderma Australia, just as sunflowers follow the sun for warmth, people with scleroderma find the warmer weather more comfortable. That’s why sunflowers have become a hopeful symbol representing scleroderma in many parts of the world, including Australia.

    “I want to be like a sunflower; so that even on the darkest days I will stand tall and find the sunlight.” – Unknown

    Scleroderma is a chronic (or long-term) condition that affects your connective tissue. The word scleroderma literally means ‘hard skin’; as you’ll see, it’s an apt name for this condition.

    Connective tissue is the cells and fibres that hold together the millions of cells of your body. It ‘connects’, or supports and holds together your joints, muscles, internal organs, skin and other body tissues. Types of connective tissue include bone, cartilage, fat, blood, and lymphatic tissue.

    The connective tissue of people with scleroderma has too much collagen, which causes it to become hard and tight.

    Anyone can develop scleroderma, but it’s more common between the ages of 30 and 60 and is more common in females.

    There’s no cure for scleroderma, but it can be managed effectively.

    We don’t know the cause.

    Scleroderma is an autoimmune disease. That means it occurs as a result of a faulty immune system.

    Your immune system is designed to identify foreign bodies (e.g. bacteria, viruses) and attack them to keep you healthy. But in the case of scleroderma, your immune system mistakenly targets healthy tissue. This triggers connective tissue cells, especially a cell type called fibroblasts, to make too much collagen and other proteins. This leads to the hardening and scarring of the skin and other tissues.

    We don’t know why this happens. Scientists believe a complex mix of genes and environmental factors may be involved.

    There are different types of scleroderma.

    There are two broad classifications of scleroderma based on the amount of skin and other organs affected.

    Localised scleroderma mainly affects the skin. It can affect both adults and children. There are two types of localised scleroderma, morphea and linear. Both have distinctive signs and symptoms. Localised scleroderma can sometimes restrict normal joint movement due to the hardening of the skin over the joint.

    Systemic scleroderma (or systemic sclerosis) affects internal organs like the heart, lungs, kidneys, and skin. Systemic means it affects several organs and tissues, or the entire body, rather than a single organ or body part. Sclerosis means abnormal hardening of body tissue.

    Systemic scleroderma can also be broken into sub-types depending on the symptoms. They are limited scleroderma and diffuse scleroderma.

    Symptoms vary.

    The symptoms of scleroderma vary from person to person and will depend on the type you have.

    Symptoms can include:

    • thickening and hardening of the skin
    • skin dryness and ulcers
    • sudden constriction of the blood vessels, resulting in pale, blue, or red fingers or toes (Raynaud’s phenomenon)
    • stiffness and pain in the muscles and/or joints.

    If some of your internal organs are involved, you may experience:

    • digestive issues, such as heartburn, bloating, constipation, stomach pain
    • lungs problems, such as shortness of breath
    • heart problems, such as chest pain
    • kidney problems may lead to high blood pressure.

    While these symptoms sound very scary, your doctor and specialist/s will monitor your condition and symptoms to prevent/treat complications.

    “Keep your face to the sunshine and you cannot see the shadow. It’s what sunflowers do.” – Helen Keller

    It can be difficult to diagnose.

    Scleroderma can be a difficult condition to diagnose. Symptoms vary significantly from one person to another and are similar to those of other conditions. They can also change or fluctuate. So, it may take some time to get a definitive diagnosis of scleroderma.

    No single test can diagnose scleroderma, so your doctor will use a combination of tests to confirm your diagnosis. They may include:

    •  Your medical history.
    •  A physical examination.
    •  Blood and urine tests.

    There’s no cure, but there are effective treatments.

    While there’s currently no cure for scleroderma, medicines can help ease your symptoms. Your doctor will develop a treatment plan based on your symptoms. You’ll generally start on the lowest possible dosage and, if necessary, slowly increase the dose until your symptoms are under control. All medicines have side effects, so you should discuss these with your doctor.

    Medicines may include:

    • Topical corticosteroid (steroid) creams that you apply to your skin.
    • Anti-inflammatory medicines to help manage pain and control inflammation.
    • Corticosteroids taken as a tablet, injection, or into the vein (intravenous or IV) act quickly to control or reduce inflammation and may be used in the short term. They aren’t used for long periods as they’re associated with serious side effects.
    • Medicines that suppress your overactive immune system and control symptoms. These medicines may also be in the form of topical creams, tablets, injections, or IV infusions.

    As well as seeing your GP, you’ll likely see a skin specialist (dermatologist) and a specialist in joint and muscle conditions (rheumatologist). Other healthcare providers, like respiratory physicians and gastroenterologists, may be involved in your ongoing treatment.

    There are things you can do to manage your condition.

    Learn about scleroderma. Knowing as much as possible about your condition means that you can make informed decisions about your healthcare and actively manage it.

    Lifestyle changes. Avoid exposure to cold temperatures, dress warmly and don’t smoke. This will help you manage Raynaud’s phenomenon.

    Stay active with regular exercise. Exercise will reduce tightness and help keep your joints moving, especially those areas affected by scleroderma, such as the hands and wrists. Exercise will also strengthen your muscles and improve overall health. Talk with a physiotherapist or exercise physiologist about an exercise program tailored to your condition and symptoms.

    See a hand therapist. They’re qualified physiotherapists or occupational therapists with extensive knowledge and skill in understanding and treating problems with the fingers, wrists, elbows and shoulders. They can help you keep your hands and wrists flexible and moving well.

    Aids and equipment. Scleroderma can make some actions difficult, for example, using door handles or getting dressed. An occupational therapist can advise on aids and other gadgets that may help and provide additional solutions to make life easier.

    Eat well. Eating a balanced diet can help provide you with better energy levels, help to maintain your weight, and give you a greater sense of wellbeing.

    Get support from others. Research has shown that people with positive social support cope better with pain and chronic conditions. Family, friends, colleagues, and health professionals can help you manage. A peer support group may be another option. Contact Scleroderma Australia for details on support options in your state or territory.

    “Someone was sitting in front of a sunflower, watching the sunflower, a cup of sun, and so I tried it too.
    It was wonderful; I felt the whole universe in the sunflower. That was my experience. Sunflower meditation.
    A wonderful confidence appeared. You can see the whole universe in a flower.“ – Shunryu Suzuki

    Contact our free national Help Line

    Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

    CONTINUE READING
    Vikings.jpg
    Lisa Bywaters
    21/Jun/2023
    Health InformationMSK articles

    A disease of the bone

    What do a 10th-century Viking/poet, the subject of a 16th-century painting, and an 18/19th-century composer have in common?

    Researchers at one time or another speculated they all had Paget’s disease of bone. That the physical features of Egil Skallagrímsson and the Ugly Duchess, and Beethoven’s deafness resulted from living with untreated Paget’s disease.

    Later research has thrown shade on these speculations. And in reality, we may never know if they did or didn’t have Paget’s disease. And remember, one’s a painting! But it’s an interesting bit of trivia to store away in the back of your brain. You never know when it might come in handy. 😉

    So what is Paget’s disease?

    Paget’s disease of bone is a chronic condition that causes abnormal enlargement and weakening of bones. Any part of the skeleton can be affected, but the most common sites include the skull, spine, pelvis, thigh bone, shin and upper arms. It can affect one bone or many bones.

    Paget’s disease tends to affect people over the age of 50. It affects slightly more men than women.

    Paget’s disease of bone is named after Sir James Paget, a 19th-century English surgeon and pathologist. Paget was quite the go-getter and was the first to describe many medical conditions, several of which bear his name. However, they shouldn’t be confused with Paget’s disease of bone.

    Bones and Paget’s disease

    To understand how Paget’s disease affects bones, it’s helpful to know how bones work.

    Although we often consider them dry and lifeless, bones are living tissue that are constantly changing throughout life. This is called ‘remodelling’.

    Bone cells called osteoblasts build new bone (formation), while other bone cells, osteoclasts, break down and remove old bone (resorption). This process is controlled by hormones such as calcitonin, parathyroid hormone, oestrogen (in women), testosterone (in men), and vitamin D.

    In a person with Paget’s disease, the osteoblasts become overactive, producing too much bone tissue. The abnormal growth results in the affected bones becoming deformed (e.g. bowed leg bone), enlarged and weak. The new bone also contains more blood vessels than normal bone.

    The reason for this accelerated bone growth is unknown. A combination of genetic and environmental factors (e.g. a virus) is suspected.

    Causes, symptoms and diagnosis

    As with most musculoskeletal conditions, we don’t know the cause of Paget’s disease. However, some factors increase your risk of developing it. They include:

    • Genetics. You’re more likely to develop it if you have a family history of Paget’s disease.
    • Ethnicity. It’s more common in people from England, Scotland, central Europe and Greece, and countries settled by European immigrants (e.g. Australia and New Zealand).
    • Age. Paget’s disease becomes more common with age, but it’s rare before age 55.

    Many people don’t realise they have Paget’s disease because they don’t have any symptoms or only mild symptoms. Symptoms vary but may include:

    • bone pain
    • enlarged or misshapen bones
    • warmth over affected bones due to increased blood supply to the bone
    • osteoarthritis.

    Paget’s disease is often discovered by accident when x-rays are taken for another reason or a bone is broken. Diagnosis can be confirmed with further x-rays, bone scans or a blood test that checks for an enzyme crucial to bone growth called alkaline phosphatase.

    Treatment

    There’s no cure for Paget’s disease; however, your symptoms can be effectively managed with medicines and self-care.

    Your doctor may refer you to a specialist, such as a rheumatologist or endocrinologist. Rheumatologists are doctors who specialise in diagnosing and treating problems with joints, muscles, bones and the immune system, while endocrinologists specialise in diagnosing and treating problems of the endocrine system.

    Medicines.

    The types of medicines used for Paget’s disease include:

    Calcium and vitamin D may be recommended as both are essential for good bone health. You can get calcium through your diet and vitamin D through safe exposure to sunlight. If you’re concerned you’re not getting enough calcium and vitamin D, talk with your doctor about whether you need supplements.

    Stay active.

    Exercise helps maintain bone health and joint mobility and strengthens muscles. However, as bones are weaker and more susceptible to fracture, some exercises may not be suitable for people with Paget’s disease. It’s best to talk with a physiotherapist or exercise physiologist about the most appropriate exercise plan for you.

    Enjoy a healthy, well-balanced diet.

    This can help you maintain a healthy weight and reduce your risk of other health problems. Make sure you include calcium-rich foods.

    Learn new ways to manage pain.

    There are many ways to manage pain, and different strategies will work for different situations. Read our A-Z guide for managing pain for more information.

    Complications

    For most people, Paget’s disease progresses slowly and can be managed effectively. However, in some cases, complications can arise, including:

    • Osteoarthritis. In joints close to bones affected by Paget’s disease, the cushioning cartilage on the ends of the bones can break down, causing pain and stiffness.
    • Broken bones. The new bone growth is fragile and more susceptible to breaking than healthy bone.
    • Hearing loss may be caused by pressure on nerves in the ear.
    • Numbness or tingling in the spine caused by pinched nerves in the spinal cord.
    • Too much calcium in the blood. When several bones have active Paget’s disease, the increase in bone breakdown can lead to an elevated blood calcium level. This is rare, but it can cause symptoms such as fatigue, weakness, abdominal pain, constipation, and loss of appetite.
    • Very rarely, Paget’s disease can cause heart failure or bone cancer.
    • In severe cases, surgery may be required to relieve pinched nerves or bone fractures or to replace a joint severely affected by arthritis.

    Contact our free national Help Line

    Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

    CONTINUE READING
    Exercise-equipment.jpg
    Lisa Bywaters
    21/Jun/2023
    Health InformationMSK articles

    Exercising for bone health

    We all know regular exercise is essential for good health. It can improve the fitness of your heart and lungs, sleep quality, energy levels and mental wellbeing. And it can reduce your risk of developing conditions such as diabetes.

    Exercise is also vital for the health of your bones.

    Like muscle, bone is living tissue that responds to exercise by becoming stronger. People who exercise regularly have stronger bones and higher bone density than those who don’t. This reduces the risk of developing osteoporosis.

    Exercise also increases your balance, coordination and flexibility, which improves your ability to prevent trips and falls. DYK, falls are Australia’s largest contributor to injuries that require a stay in hospital and are a leading cause of injury deaths? More than half of the hospitalisations were due to broken bones (fractures).(1)

    Bones need exercise.

    To understand why exercise is important for bone health, it helps to know how bones work.

    Throughout your life, your bones are constantly changing. This is called ‘remodelling’. Bone cells called osteoblasts build new bone, while other bone cells (osteoclasts) break down and remove old bone. This process is controlled by hormones such as calcitonin, parathyroid hormone, oestrogen (in women), testosterone (in men), and vitamin D.

    From birth to about 25, you build more bone than you lose. Your bones are not only getting bigger as you grow, but they’re also developing their density. This determines how strong they are.

    From about 25 to 50, your bones break down and rebuild at about the same rate. They’re in a state of balance. This is when you’ve achieved your ‘peak bone mass’. Your bones are at their strongest.

    After about 50, you break down more bone than you rebuild. While this means everyone will experience some bone loss as they age, it doesn’t mean everyone will develop osteoporosis.

    Women commonly experience a period of rapid bone loss after menopause. This is due to a drop in oestrogen levels. It’s estimated that the average woman loses up to 10% of her bone mass in the first five years after menopause.(2)

    For good bone health, exercise is vital for everyone – from the very young to the very old.

    A combination of different exercises is best for bone health.

    Different exercises challenge and strengthen your bones and muscles in different ways, so you should include the following in your exercise plan:

    Weight-bearing exercises or activities where your body carries its own weight. These exercises put stress on your bones, making them stronger and denser. It also strengthens the muscles around your bones, providing support and reducing the risk of fractures. Weight-bearing exercises include brisk walking, climbing stairs, tennis, and netball.

    High-impact exercises such as jogging, running, jumping, and skipping rope. They’re also weight-bearing exercises, but they place greater stress on the bones of the spine and legs as your feet hit the ground. This can provide more bone-strengthening benefits; however, these exercises aren’t suitable for everyone.

    Resistance training, also known as strength training, uses resistance or weights to strengthen your muscles by working them harder than you do in everyday life. The strong muscle contractions required to move a heavy weight place stress on the bone where the muscle attaches. When bone feels this strain repeatedly, it responds by becoming stronger. Resistance training uses equipment like free weights (e.g. dumbbells), gym machines, elastic resistance bands or your body weight (e.g. push-ups, squats).

    Balance and flexibility exercises such as tai chi and yoga improve balance and mobility and can reduce your risk of falling. This is important for preventing fractures.

    Before beginning an exercise program, speak with your health professional. Not all types of exercise are suitable for everyone. This is especially important if you have other health conditions, including osteoporosis. A physiotherapist or exercise physiologist can assist you with a safe exercise program that targets your specific needs and reduces your risk of injury.

    Exercise must be regular and ongoing.

    You need to exercise regularly to have a significant benefit, so you should choose activities you enjoy. This will make it easier to exercise consistently.

    Australian physical activity and exercise guidelines recommend that all adults be active most days, preferably every day, for 30 minutes or more. This includes at least two sessions of strength training every week. However, when you’re just beginning, this can seem daunting.

    That’s why it’s good to know you don’t have to do all your exercise in one session. For example, a 30-minute brisk walk can be broken up across your day into shorter, more achievable sessions, such as three 10-minute or six 5-minute walks.

    You can do other things to make exercise a regular, ongoing activity.

    Exercise with a group or a partner. This can improve your motivation to exercise and provides an opportunity for socialising with others.

    Exercise SMART and set goals. A clear goal can motivate you to stay on track with your exercise program. But they must be realistic and specific to your abilities, needs, and health issuehttps://muscha.org/goals/s. So, ensure your goal is SMART – Specific, Measurable, Achievable, Realistic and has a Timeframe.

    For example, a good SMART goal for resistance training for stronger bones and muscles could be: “I will perform resistance exercises, such as lifting weights or using resistance bands, for 30 minutes, twice a week, for the next three months.”

    This goal is Specific (focuses on resistance training), Measurable (30 minutes, twice a week), Achievable (realistic for most people), Relevant (aimed at improving bone and muscle strength), and has a Timeframe (three months).

    Constantly evaluate your goals, adjust them as needed and reward yourself for your successes.

    Add variety. Vary where you exercise and the type of exercise you do. Include recreational activities such as bushwalking or dancing. This will help keep your mind fresh and your motivation high. Find activities that are enjoyable to you so that you’ll be motivated to continue doing them.

    Exercise within your capabilities. Often, people drop out of exercise programs because they exercise at a level beyond their current capabilities. Ensuring your exercise program suits your current abilities will decrease your risk of injury and increase your enjoyment and motivation to continue your exercise program.

    Challenge yourself. Increase the intensity of your exercise as your fitness improves. It’ll make your exercise more interesting and also has greater health benefits.

    Stop if you have pain. Don’t continue exercising if you experience pain or severe discomfort. Talk with your fitness professional for advice to ensure you’re not doing an exercise incorrectly.

    Bone health doesn’t happen in a vacuum.

    As well as exercise, you need to also to eat a nutritious diet with calcium-rich foods, get sufficient sun exposure for vitamin D, take medicines or supplements as prescribed by your doctor, quit smoking, and moderate your use of alcohol, caffeine, and salt intake, as they can impact bone density.

    Contact our free national Help Line

    Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

    References

    (1) Falls. Australian Institute of Health and Welfare.
    (2) Osteoporosis, Australasian Menopause Society

    CONTINUE READING
    Test-image-clock.jpg
    Lisa Bywaters
    21/Jun/2023
    Health InformationMSK articles

    16 ways you can maximise micro-moments

    It’s hard to believe we’re already halfway through 2023 😮.

    I don’t know about you, but after years of forced-slowness I’m finding life incredibly busy and fast! Catching up with friends and family, working in the office, weekend adventures, professional development, hobbies, looking after my health – it can be a bit overwhelming. And when I’m feeling overwhelmed, I feel more pain, fatigue and anxiety.

    Which is a problem 😕.

    But I know from experience that having someone tell me to just relax or breathe 😑 isn’t going to help at the time. Especially if I’m already feeling time-poor and stressed.
    What I have found works is taking advantage of micro-moments for self-care. Small pockets of time when I can look after myself.

    Using these small moments for ‘me time’ is much more achievable than trying to shoehorn 30 minutes of yoga into my crowded mornings or planning and cooking MasterChef-worthy dinners every night 👩🍳. Using these moments for small acts of self-care to do what I need has really helped. I’m finding improvements in my anxiety, sleep quality, and pain.

    But don’t just take my word for it. The World Health Organization (WHO) says the “sustained adoption of quality, evidence-based self-care interventions can reduce mortality and morbidities and improve health and wellbeing”. (1)

    You too can maximise these micro-moments and reap the benefits of regular self-care. They can be done anywhere, anytime, and won’t cost you a thing. Here are some of our ideas for embracing micro-moments.

    Get physical.

    We talk about exercise a lot, but it really is a great way to look after your physical, mental and emotional wellbeing. Small bursts of activity can be added to your existing exercise routine for fun and to mix things up 🏃🤸🚴. Or if you’re not exercising regularly, they can help ease you back into becoming more active.

    Exercise is so adaptable. You can do it on your own or with others. You can take two minutes to stretch and move at your desk or dance in your lounge for an entire song. You can take a short walk in your local park, mow your front lawn (unless it’s enormous – in which case, mow a section), clean out a cupboard, or do a five-minute cardio blast. Whether it’s structured or incidental exercise, it all adds up. And as they’re micro-moments, they aren’t large blocks of time. So you’re more likely to fit them into your day, less likely to become fatigued or strain yourself, and still reap some of the benefits of being active. And you may have a tidy cupboard or freshly mown lawn at the end! 😉

    Breathe.

    I know, I know. At the start of this article, I said that when someone tells me to breathe, it doesn’t work. But that’s usually regarding a ‘just breathe, Lisa’ when someone cuts me off in traffic 😣.

    Now I’m referring to focused and controlled breathing. It’s a simple and effective technique to relieve pain and stress that can be done anywhere and at any time. You can do it at home, at work, on a train, in a waiting room, or in your car in traffic 😉. It’s useful when you’re trying to sleep or waiting for your pain meds to kick in. We take breathing for granted and often forget how effectively it relieves stress and anxiety. So remember to breathe…

    “Breathing in, I calm body and mind. Breathing out, I smile.
    Dwelling in the present moment I know this is the only moment.”
    Thich Nhat Hanh

    Use your senses.

    I love this one 💜 and use it a lot. It’s where you use your five basic senses – touch, sight, hearing, smell and taste – to identify things in your current space that relate to those senses. You can find one thing per sense – for example, I can feel the warmth of my heat pack on my shoulder, I can see leaves falling outside my window, I can hear my cat running around the house like a lunatic🐈, I can taste my tea, and I can smell the orange oil in my candle.

    Or you can try the 5, 4, 3, 2, 1 method. For example, 5 things you can hear, 4 things you can see, 3 things you can feel, two things you can smell, and one thing you can taste. And mix up the senses and numbers of things you’re finding depending on your situation. For example, when eating lunch, switch it to 5 things you can taste, 4 things you can smell, etc. It’s a great way of focusing on what you’re doing at that time.

    Do a body scan.

    The body scan is a type of meditation where you mentally scan your body from head to toe, paying attention to how each part feels. It helps you relax, become more aware of your body, and brings a sense of calm to your mind. Check out our short body scan script to help you get started.

    Use your imagination.

    What works for me won’t necessarily work for you. Plus, you don’t want things to become stale and boring. So mix it up. Read a chapter of a book, make balloon animals, do some guided imagery, call a friend, plant a herb garden, knit, paint, sculpt, fly a kite, breathe deep of your first morning coffee… whatever makes you happy, relaxes you, brings you into the moment, and sharpens your attention. Do it.

    Focus on the moment and savour the experience.

    With such busy, active lives, we often miss some of the small joys and experiences. So slow down and focus. For example, when you’re eating an apple, savour the feeling of the first crunchy bite and the taste as the juices burst into your mouth. Or when you head outside for a walk, breathe in the cool, crisp smell of winter… what can you smell? When you’re catching up with a friend, really listen to what they’re saying and enjoy their company – remember it wasn’t so long ago that we couldn’t meet in person 😔. Focus on the moments and enjoy them.

    “What day is it?” “It’s today,” squeaked Piglet.
    “My favourite day,” said Pooh
    Piglet & Winnie the Pooh

    Drink water.

    When you’re busy, it’s easy to forget to hydrate. But it’s vital for our health and wellbeing. Water lubricates and cushions your joints, aids digestion, prevents constipation, keeps your temperature normal and helps maintain blood pressure. It carries nutrients and oxygen to your cells, flushes out toxins, and cushions the brain and spinal cord. It can also help prevent gout attacks, boost energy levels and fight fatigue. It’s practically magic! ✨ Make sure you grab your glass or water bottle and drink up throughout your day.

    Go to the toilet.

    I’m sure it’s not just me who gets caught up in work or another activity and thinks, “I’ll go to the loo as soon as I finish X, Y or Z”. But before you know it, you don’t just need to go, you really NEED to go 😶. And even though I’m pretty sure it’s a physical impossibility, I always have visions of Grandpa Simpson’s kidneys exploding from not going to the toilet. So please, just go to the toilet when your body tells you it’s time 😊.

    Reflect.

    When cleaning your teeth, think about your day. What are you looking forward to? What are two things you really want to achieve? What went well in your day? What two things are you thankful for? Take a small moment to reflect on your upcoming day or the day that’s been.

    “Learn from yesterday, live for today, look to tomorrow, rest this afternoon.”
    Charles M. Schulz

    Leave your phone at home.

    Relax!! I don’t mean all the time. (I had palpitations reading that too 😂😉)

    Our phones are so much a part of our lives that it‘s hard to imagine not having them with us. But every now and then, leave your phone at home when you go outside. You won’t be distracted by the constant ring, dings, alerts and chirps it makes. And you can focus on the world and people around you.

    Declutter.

    Feel like you’ve got clutter and mess invading all of your spaces? Spend five minutes tidying one area and putting things back in their place. Do this once daily, and you’ll soon feel calmer and more relaxed. Don’t like cleaning? Pop on some music and do what you can in the space of one or two songs. Then stop cleaning, go do something else and enjoy the calm.

    “Out of calmness comes clarity.”
    Trevor Carss

    Stretch.

    Another one of my faves. Stretching is great for loosening up tight, stiff muscles and joints that have been in one position for long periods. I love stretching my arms above my head or arching my back when I’ve been sitting at my desk for some time and feeling stiff… bliss. It doesn’t take long, and it feels so good 😊

    Versus Arthritis have some videos with various stretches for you to try. They’re a bit longer than a micro-moment but worth checking out. Watch them and find the ones that work for you. Or speak with a physio about stretches you can do daily to ease muscle tension and pain.

    Hug someone.

    Being able to touch or hug others reduces stress, anxiety, and depression and makes you feel good. And here’s a tip from me to you: don’t save your hugs for when you’re feeling down. Hug each other when you feel happy, excited, or just because it’s Wednesday 😍.

    “A hug a day keeps the demons at bay.”
    German Proverb

    Plan a meal or two for your upcoming week.

    Having an idea about what to cook during the week can be challenging and often stressful. But pre-planning a meal or two (or more if you’re able) can help immensely. Think about your week ahead – what are your time commitments and responsibilities? Do you have time to be creative and adventurous with your meal planning? Or do you need to keep it basic and simple? What do you have in the fridge, freezer and pantry? Once you’ve established all that, write down some meal ideas, pick up any extra ingredients you need, and you’re on your way!

    Give yourself time.

    Hands up if you’re often rushing from pillar to post, trying to get everything done in the shortest amount of time ✋✋✋. It can be hectic and exhausting.

    When you can, build some extra time into your work commute and school drop-off/pick-up to allow for the inevitable traffic issues, lost schoolbooks, and forgotten lunches, so you can arrive at your destination as calmly as possible. Do the same at work – avoid back-to-back meetings when you can so you can catch your breath, write down your thoughts, drink water, have a snack, review your notes etc. This will make you more productive and less stressed.

    Get changed.

    Is there anything more wonderful at the end of a long day than getting changed out of your work clothes and getting into something relaxing and comfy? Especially now that winter is here? Whether it’s your favourite trackies, or the most relaxing of all, your oldest, softest pyjamas 😊, when you’re at home and in the cosiest clothes, all feels calm and right in the world.

    Finally.

    As with any changes to your habits and behaviours, you need to start small. Pick one of these ideas, or one of your own, and start adding it to your day. Just a micro-moment here and there. Over time you can add others and/or more time to the ones you’re doing.

    Changing the way you do things takes time, patience and practice. But it’s worth persevering to reap the rewards of these small acts of self-care 💚.

    Oh, one last thing.

    It’s important to recognise that self-care can’t and won’t solve everything. Sometimes we need help – whether for an exercise program, mental health, housework, or whatever. This help may be from our family or friends, or it may be professional help. Don’t be afraid to ask for it.

    Contact our free national Help Line

    Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

    Reference

    (1) Self-care interventions for health, WHO, 2022.

    CONTINUE READING
    dodgy-knee.jpg
    Lisa Bywaters
    18/May/2023
    Health InformationMSK articles

    Got dodgy knees? Find out what helps.

    Do you have osteoarthritis in your knees? Does the pain sometimes interfere with your ability to be as quick or mobile as you’d like? If so, you’re not alone – it’s a big club!

    Osteoarthritis (OA) is the most common type of arthritis, affecting 1 in 11 Australians. It can develop in any joint but commonly occurs in weight-bearing joints like your knees. And because it’s so common and causes lots of pain and distress, we’re all looking for effective treatments to manage the pain and keep moving.

    The good news is there’s strong evidence about the most effective treatments for knee OA, those that aren’t effective, and those that don’t have enough evidence to support their use.

    And yet, a recent study has shown an increasing number of people with OA are investigating some less effective treatments such as stem cells, platelet-rich plasma, and Botulinum toxin.

    There are likely many reasons for this.

    We’ve become much more familiar with searching online for information during the pandemic.

    Information about the effectiveness (or not) of treatments isn’t always translated for consumers. And unfortunately, to access much of this information, you need access to journals and databases that are often behind a paywall.

    Another problem is that it’s easy for anyone to create a video, blog, or social media post about the latest and greatest treatment without using current evidence. Their reasons for doing so can be many – from sharing personal experiences in the hopes of helping others to purely commercial gain. This info is everywhere online, easily accessible and often looks legitimate.

    So you need to weigh any information carefully, be cautious and discuss your options with your doctor.

    Here’s a snapshot of what we know works (or doesn’t) for knee OA

    Staying active and exercising regularly

    You had to know this was coming 😉. Research has repeatedly shown that exercise is key in managing knee OA (and other musculoskeletal conditions). A tailored exercise program developed by a physiotherapist or exercise physiologist can help reduce knee pain and improve knee function. If pain prevents you from exercising, you may find that warm water exercise is a good starting point. Warm water pools offer the comfort of warmth and the buoyancy of the water to ease the load on your joints.

    Managing your weight

    Being overweight or obese is directly related to the risk of developing knee OA. It’s also likely to speed up how quickly your OA develops or progresses. Evidence shows a relationship between weight loss and relief of symptoms such as pain and stiffness. But weight loss can be a long process for many people. And it’s challenging, especially when pain affects your ability to be as active as you’d like. However, it’s good to know that any weight loss can reduce your pain and increase your ability to exercise. So making small, achievable changes to your eating and exercise habits can bring big results. If you’d like to lose weight to improve your symptoms, your doctor and/or dietitian can assist you in losing weight safely.

    Dealing with stress and your emotions

    It’s natural to feel stress, anxiety and frustration when living with chronic pain. However, if you’re always fearful or worried about it, it can worsen your pain. That’s because pain isn’t just a physical sensation – it also involves your perceptions, feelings and thoughts.

    The worse you think your pain will be, the worse it can feel. It can affect your sleep, and you become less active. These feelings, thoughts and behaviours can become a vicious cycle.

    Talking with a family member, close friend, or a health professional about how you’re feeling can get it out in the open so you can start dealing with these feelings and hopefully break this cycle.

    Strategies like breathing exercises, cognitive behavioural therapy (CBT), meditation, heat, and gentle activities like tai chi, walking, swimming, and cycling can also help you control your stress and anxiety.

    What about medicines?

    No medicine can affect the underlying disease process of OA. Still, combined with self-care and lifestyle changes, medicines may provide temporary pain relief and help you stay active.

    There are a variety of medicines used in the management of knee OA, and each comes with varying degrees of evidence to support their use. They may be taken by mouth as a tablet or capsule (orally), applied directly to the skin in the form of gels and rubs (topical), or injected into the joint (intra-articular). Discuss the benefits and risks with your doctor if you’re interested in the following medicines.

    Non-steroidal anti-inflammatory medicines or NSAIDs (e.g. Nurofen, Celebrex, Voltaren). Depending on the dosage and other ingredients, NSAIDs are available over-the-counter or with a prescription. Oral NSAIDs are the preferred first-line drug treatment for OA and have been shown to reduce pain and symptoms in knee OA.

    It’s important to note that NSAIDs are designed to be taken at low doses for short periods. Always talk to your doctor before starting NSAIDs, as they can cause harmful side effects, especially in older people.

    Paracetamol (e.g. Panadol, Panamax). Research has shown that paracetamol provides only low-level pain relief and, in some cases, no pain relief compared to a placebo in knee OA. However, some people report that it helps reduce their pain so they can be more active. If you can’t take NSAIDs, they may also be an option. Before using paracetamol, talk with your GP to see if it’s appropriate.

    Some medicines aren’t effective

    Other medicines have been used for OA in the past that we now know aren’t effective and may have harmful side effects.

    Opioids. Opioids are powerful pain-relieving medicines. They’re effective at reducing acute pain (or the pain resulting from an injury or surgery), but evidence shows they have little effect on OA pain. Opioids also have many potentially serious side effects. That’s why they’re not recommended in the management of knee OA.

    Capsaicin. Capsaicin is the active ingredient in chilli peppers – it makes them ‘hot’. Capsaicin in creams and lotions has been used to help reduce OA pain, and some people report beneficial effects. However, evidence for its effectiveness in knee OA is low, and it’s generally not recommended. It also has side effects when applied, such as a burning sensation, which can take several uses to wear off.

    Glucosamine and chondroitin. Studies have found no benefit from taking glucosamine and/or chondroitin for osteoarthritis.

    The pointy end of the stick – intra-articular injections

    Intra-articular injections are given directly into the knee joint. They include steroids, platelet-rich plasma, stem cells, hyaluronic acid and Botulinum toxin. Let’s look at them a bit more closely.

    Corticosteroid injections. If you have persistent knee pain and haven’t had relief from oral medicines or other treatments (e.g. exercise, weight loss), your doctor may suggest a corticosteroid (steroid) injection. However, the duration of pain relief can vary from a few days to a few weeks, and the number of injections you can have is limited due to potential harm. There’s also emerging evidence that long-term use of these injections may cause OA to worsen in the affected joint.

    Hyaluronic acid injections. The benefits of hyaluronic acid joint injections (also known as viscosupplementation or hyaluronan injections) are uncertain. Research findings have been inconsistent, and although some people find the treatment helpful, it can be expensive and isn’t generally recommended. The Australian Rheumatology Association states, “emerging evidence indicates that the effect of hyaluronic acid could be smaller than previously reported.”

    Platelet-rich plasma (PRP) injections. Platelets are small cell fragments in the blood that help form blood clots to slow or stop bleeding and help wounds heal. PRP is a concentrated version of a person’s platelets injected into the affected joint. An Australian clinical trial led by researchers at the University of Melbourne, University of Sydney and Monash University has found that PRP was no better than a placebo at reducing symptoms in people with knee OA.

    Stem cell injections. Despite being commercially available, there’s no evidence for using stem cell injections in treating knee OA. The International Society for Stem Cell Research and the Australian Rheumatology Association do not support using stem cell injections for osteoarthritis.

    Botulinum toxin injections. The American College of Rheumatology/Arthritis Foundation Guidelines states that the small number of trials that have looked at the use of botulinum toxin in knee and hip OA ”suggest a lack of efficacy”.(1)

    What about surgery?

    Surgery may be an option for some people with knee OA when all non-surgical treatment options have failed, and knee pain and reduced function impact their quality of life. In this case, your doctor may refer you to an orthopaedic surgeon to discuss your options.

    A total joint replacement of the knee is the most common type of surgery for knee OA. However, having an artificial knee means there will still be some limitations. An artificial knee won’t have the same sideways movement as a natural knee. It won’t bend fully, so getting down and up from kneeling is more likely to be challenging.

    Arthroscopy is a surgical technique that involves the insertion of small surgical instruments, including a camera, into the knee. This allows the surgeon to examine the inside of the joint and cut, shave and remove material from the inside of the knee joint. “The Australian Government and most orthopaedic surgeons recommend against using arthroscopy for osteoarthritis of the knee. Research shows that doing an arthroscopy for this condition isn’t effective. Arthroscopy should only be used for knee OA if other treatments fail, such as losing weight, exercising and taking pain relievers.” (2)

    Contact our free national Help Line

    Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

    References

    (1) Kolasinski, S.L., et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis & Rheumatology (2020).
    (2) Arthroscopy, Healthdirect

    CONTINUE READING
    blog-heat-wraps.jpg
    Lisa Bywaters
    18/May/2023
    MSK articles

    Let’s wrap this up!

    Low-level heat wraps:
    The gentle solution for managing musculoskeletal pain

    By: Dr Peter McCann MRes (c), MAppSc, BAppSc, FASLM, FAICE

    Musculoskeletal conditions such as arthritis, back pain, tendonitis, and the pain and stiffness they cause can be debilitating, causing a significant impact on a person’s quality of life.

    Fortunately, many treatments are available to help manage these symptoms and improve overall wellbeing. This article will explore one such option – low-level continuous heat wraps and their benefits for people with musculoskeletal conditions.

    How do they work?

    Low-level continuous heat wraps provide gentle, consistent heat therapy to pain-affected areas. Unlike traditional heat products such as wheat bags or hot water bottles, which can quickly become too hot and uncomfortable, heat wraps use low-level heat, penetrating deep into the affected area without causing discomfort. This helps increase blood flow to the region, reducing inflammation and promoting healing. Heat wraps can help relieve pain and stiffness by reducing inflammation and promoting blood flow, making it easier to move and enjoy your daily activities. Unlike other heat therapy options requiring frequent reheating or readjustment, heat wraps provide continuous heat for up to 10 hours, allowing for long-lasting relief without constant reheating.

    What are the benefits?

    The benefits of low-level continuous heat wraps for musculoskeletal conditions are numerous. First and foremost, they provide immediate pain relief, making it easier to manage discomfort and carry out daily activities.

    Additionally, heat wraps have been shown to increase the range of motion and improve joint function, making it easier to move and engage in physical activity. This is key to promoting recovery from back pain.

    Heat wraps keep you mobile, unlike a wheat bag or hot water bottle that requires you to sit or lay down. By reducing inflammation, these wraps can enhance healing, speeding up the recovery process and helping to prevent further injury.

    Heat wraps may reduce the need for medication, making it possible to manage symptoms without relying on potentially addictive or harmful drugs.

    Finally, heat wraps can significantly improve your quality of life by relieving pain and stiffness, allowing you to focus on the activities and experiences that bring you joy and fulfilment.

    What’s the evidence?

    The Australian Clinical Care Standard for low back pain recommends using heat wraps as a first-line approach alongside other treatments, such as regular physical activity, to relieve back pain. Heat wraps are Australian Physiotherapy Association and Osteopathy Australia Association endorsed products and are registered medical devices used in major hospitals for pain relief.

    How are they used?

    Using low-level continuous heat wraps is simple. To begin, remove the wrap from its packaging and gently unfold it. Next, open one or two heat patches. They activate on exposure to air, taking 20 – 30 minutes to warm up.

    Insert the patches into the wrap and apply them over the affected area, ensuring it covers the entire region of pain or stiffness.

    Finally, secure the wrap using the included Velcro strips, careful not to apply too much pressure. Once in place, the wrap will provide low-level continuous heat therapy, which can be used for up to eight hours.

    For best results, using heat wraps regularly as part of a comprehensive treatment plan that includes exercise, medication, and other therapies as needed is recommended.

    The ingredients are non-toxic and eco-friendly, so they can be disposed of in the garden as a soil improver.

    Are there any precautions?

    Users should also be aware of any precautions or warnings associated with using the wraps, such as avoiding use on open wounds or irritated skin and sleeping with the heat wrap on. Before use, read the information provided carefully, or discuss this with your pharmacist.

    The wrap-up 😉

    In conclusion, low-level continuous heat wraps are safe and effective for managing musculoskeletal conditions such as arthritis, back pain, fibromyalgia and the pain and stiffness they cause.

    By providing low-level continuous heat therapy, heat wraps can offer immediate pain relief, increased range of motion, improved joint function, reduced inflammation, enhanced healing, and improved quality of life.

    Heat wraps can be used alongside other treatments to create a comprehensive care plan. I encourage readers to try these heat wraps and experience the benefits firsthand.

    Talk with your doctor, pharmacist, physiotherapist or exercise physiologist for more information.

    Contact our free national Help Line

    Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

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