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WalkingBack to Health 

A recent study led by Dr Natasha Pocovi (PhD) from Macquarie University focusing on the effectiveness and cost-effectiveness of individualised, progressing walking and education on low back pain has shown promising results. 

The randomised controlled trial findings have recent been published in the Lancet with promising results. 

Reoccurring low back pain is a significant problem and can severely impact the quality of life of those experiencing it. The WalkBack study focused on adults who had recently recovered from an episode of non-specific low back pain that wasn’t attributed to a specific diagnosis with the pain/episode lasting over 24 hours. The randomised control trial randomly assigned participants to one of two groups. Group one was an individualised, progressive walking and education intervention supported by a physiotherapist for 6 months. Group two received no treatment from the study team but were able to seek out any treatment or prevention strategies and use them during the trial. 

The researchers were investigating two effectiveness outcomes: 1. How many days from randomisation (that is being placed in Group 1 or Group 2) to the first recurrence of activity-limiting low back pain lasting at least 24hours and 2. An economic evaluation that included quality-adjusted life-year (QALYs) and costs associated with the delivery of the intervention (including health-care costs, work absenteeism etc.). 

The outcomes of the trial showed that the individualised, progressive walking and education intervention substantially reduced low back pain recurrence compared to no treatment. There were also reductions in back pain-related disability for up to 12 months in the participants who received the intervention. The findings also indicated the intervention had a high probability of being cost-effective. 

This research shows some promising findings that have the potential to help millions of Australians Walk Back to a life free from low back pain. 

For further information on WalkBack click HERE 

Contact our free national Helpline

Call our nurses if you have questions about managing your painmusculoskeletal condition, treatment options, mental health issuestelehealth, or accessing services. They’re available Monday to Thursday between 9am-5pm on 1800 263 265; email (helpline@muscha.org) or via Messenger.

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MeTeOR2 Clinical Trial

The MeTeOR2 Clinical Trial compares meniscal allograft transplant surgery to a type of physiotherapy for people who experience post-meniscectomy pain.
Clinical trials 

Clinical trials are an important part in improving healthcare outcomes. If you are not familiar with what a clinical trial is, you’re not alone! Clinical trials are research studies involving people like you and me, to evaluate if a treatment is safe and helpful. The new treatment under testing may be a medicine, procedure, technique, vaccine, device, or lifestyle/behaviour. Clinical trials are carefully designed and must undergo a thorough review to ensure the procedures have merit, are safe and ethical. Ultimately, clinical trials are essential to help us improve the management of health conditions! 

People participate in clinical trials for various reasons. Some people who are aware of clinical trials understand their participation helps inform how to manage health conditions. However, many may not be aware of the other benefits. These benefits include playing an active role in your healthcare, receiving treatment from leading medical practitioners, and accessing treatments for your condition which may not be possible otherwise. One clinical trial is the MeTeOR2 trial, which compares meniscal allograft transplant surgery to a type of physiotherapy for people who experience post-meniscectomy pain.  

What is a meniscectomy? 

The meniscus is a c-shaped cartilage that distributes loads at the knee joint. A torn meniscus is common, especially among young people engaged in sport activities. Conservative treatments are available including activity modification, medication (e.g., non-steroidal anti-inflammatories, paracetamol), and physiotherapy. Some tears may be surgically repaired depending on the location of the tear. Other tears cannot be repaired, so the torn parts are removed with a keyhole surgery called arthroscopic partial meniscectomy. Although this procedure can improve pain and locking symptoms in most people, some patients may still experience pain and functional limitations after the surgery. This scenario can be very disabling and emotionally distressing, particularly at a young age when people are expected to be active, healthy, and free of disability. When this is the case, only a few treatment options are available. 

Treating pain and functional limitation after a meniscectomy 

For people with considerable pain or functional limitations after meniscectomy, surgical and non-surgical treatment options are available. One surgical option is the meniscal allograft transplant (MAT), which involves inserting a donated meniscus into the injured knee. The MAT surgery is thought to improve symptoms by restoring normal load distribution within the knee, along with the rehabilitation after surgery. Non-surgical management, such as personalised rehabilitation – which consists of many different types of treatment, including exercise, weight management, and lifestyle and activity advice – is also a viable option. Although the mechanisms of how personalised rehabilitation reduces symptoms are unknown, improvements have been observed in people with post-meniscectomy pain. However, it is still unknown which treatment option is better, in terms of safety and cost-effectiveness, to improve health-related outcomes. 

The MeTeOR2 study 

MeTeOR2 is a clinical trial designed for people suffering from pain and/or functional limitations after partial meniscectomy. This study aims to compare two knee treatments – meniscal allograft transplant (MAT) surgery and personalised knee therapy (rehabilitation) and evaluate if one treatment is superior to another in improving knee pain and function. 

How to participate/who to contact 

If you are interested in the study and consent to participate, you will have a 50% chance of being put into one of the two groups. The first group will receive the meniscal allograft transplant (MAT) surgery, while the second group will receive personalised knee therapy (rehabilitation). Participants in both groups will be asked to complete a series of questionnaires at baseline and 3, 6, 12, 18, and 24 months following randomisation. 

 You may be eligible to participate in this study if you have: 

 Inclusion Criteria: 

  • Pain and / or functional limitation from the knee, severe enough to warrant potential meniscal allograft transplant. 
  • Previous meniscectomy ≥ six months ago. 

 Exclusion Criteria: 

  • Symptomatic ligament instability, not previously corrected, as determined by the assessing clinician. 
  • Coronal limb alignment that requires surgical correction, as determined by the assessing clinician. 
  • Age < 16, or if ≥ 16, open growth plate at the proximal tibia as judged by the clinical team on imaging as part of standard care. 
  • Full thickness cartilage loss (exposed bone) > 1 cm2, on routine clinical MRI, prior to surgery, or any other form of clinical imaging or evaluation. 
  • Inflammatory arthritis affecting the study knee as determined by the assessing clinician. 
  • Unable or unwilling to engage in rehabilitation. 
  • Unable to adhere to trial processes. 
  • Previous randomisation in the present trial, (i.e., the other knee). 

If you are interested in being part of this important and exciting clinical trial, please contact the study facilitator: meteor2.study@sydney.edu.au 

Contact our free national Helpline

Call our nurses if you have questions about managing your painmusculoskeletal condition, treatment options, mental health issuestelehealth, or accessing services. They’re available Monday to Thursday between 9am-5pm on 1800 263 265; email (helpline@muscha.org) or via Messenger.

 


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Tips for preventing falls

The 80’s song ‘catch me I’m falling’ could have been my family anthem. We’re clumsy, uncoordinated, and with two left feet, always slipping, tripping, and falling. 😁

It‘s just the way we are. I’ve even gotten to the point of doing a ‘ta-da’ after a trip, extending my arms over my head like a gymnast at the end of a routine.😀

But now, as I’m getting older, it’s not so amusing. I’m conscious of the more serious repercussions of falling. In fact, just last week, I tripped over my cat, whacked the side of my head on the kitchen counter and broke my glasses. Fortunately, I wasn’t seriously injured. But it made me take stock, stop thinking about falls as something I have to put up with and start being more proactive in preventing them.

Because the good news is that falls aren’t inevitable. They can often be prevented, or at the least, any injuries that occur can be minimised.

Let’s start with some facts

Data from the Australian Institute of Health and Welfare shows that falls are Australia’s largest contributor to injuries that require a stay in hospital and are a leading cause of injury deaths.(1) More than half of the hospitalisations were due to broken bones – often hips, vertebrae and wrists.

Falls can happen anywhere and to anyone, but a fall that lands you in hospital is more common in older people and most likely to occur in the home.

The stats are alarming, and like me, you may think these were falls from a height or down stairs. But the truth is, ‘over half of all falls leading to hospitalisation occurred on a single-level surface (for example, by slipping), and only 7% of falls leading to hospitalisation involved stairs or steps.’(1) 😱

And if you have osteoporosis and your bones are already fragile, the risk of breaking a bone due to a fall is much greater.

So to avoid becoming one of these stats, we can’t see falls as an inevitable part of life and getting older. They’re a serious problem, and we all need to take steps to prevent them.

We know that falls can result in broken bones, but they can also cause:

  • Dislocated joints (e.g. shoulder)
  • Head injuries
  • Bruises, scrapes and sprains
  • A loss of confidence which can lead to restricting activities due to the fear of falling. For example, avoiding walks in the park or going into places that are unfamiliar, crowded or have stairs/steps due to fear of falls,

What causes people to fall?

Health issues

  • If you’ve fallen more than once in the past 6 months, you’re more likely to fall again.(2)
  • Medical conditions that lead to reduced strength and endurance (e.g. arthritis), loss of sensation (e.g. diabetic neuropathy), impaired balance (e.g. Parkinson’s disease) and cognitive impairment (e.g. dementia).
  • Medicine side effects, especially if you’re taking several medicines.
  • Poor eyesight and vision problems.
  • Incontinence. Rushing to the toilet can increase your risk of falling, especially at night.

The environment

  • Trip hazards in your home and the community, e.g. clutter, cords and cables, wet and/or slippery floors, uneven footpaths, and pets.
  • Poor lighting.
  • Inappropriate or ill-fitting footwear and clothing.

Reducing your risk

Falls are usually caused by a combination of factors. Changing some of these factors can lower your chances of falling. Or, if you do fall, reduce your risk of serious injury.

Exercise regularly

Australian physical activity and exercise guidelines recommend that all adults be active most days, preferably every day, for 30 minutes or more. Exercise is vital for good health, maintaining independence, and lowering your risk of falls and fall-related injuries. Physical activity helps to maintain and improve your mobility, strength, posture, coordination, balance and flexibility.

People with better posture, better balance and stronger muscles are less likely to fall or be injured. On the other hand, people who aren’t very active are more likely to fall and be injured than those who are more active.

Talk with your doctor, physiotherapist or exercise physiologist for information and advice about how you can safely become more active.

And read Exercise for preventing falls by The Royal Australian College of General Practitioners for more info.

Look after your health

  • Talk with your doctor about your medicines. Some medicines can help reduce falls, such as pain-relievers that decrease your pain and allow you to move more comfortably and be more active. However, some medicines or combinations of medicines can cause dizziness, drowsiness or confusion, which increases your risk of falling. Understanding your medicines and how they affect you is an important strategy for reducing this risk.
  • Eat a healthy, balanced diet with regular meals throughout the day to avoid feeling lightheaded, weak or dizzy. Stay hydrated and drink plenty of water each day.
  • Limit alcohol intake as it can affect your balance and coordination and increase your risk of falling.
  • Have your eyes tested regularly by an optometrist. If you wear glasses, keep them clean. If you have different glasses for different situations, e.g. reading or distance glasses, make sure you use the appropriate ones for the task. Be careful when going up and down stairs if you wear multifocals.
  • Wear sunglasses outside to minimise glare and squinting and to protect your eyes from UV damage.
  • When moving from a light to a dark space, or vice versa, allow time for your eyes to adjust.
  • See a podiatrist if you have problems with your feet that affect your balance or how you walk; for example, pins and needles, pain, swelling, or poor circulation. They can help you address these issues. They can also give you advice about appropriate footwear.
  • Take time to regain your balance after lying down or standing up after sitting.

Move around safely

  • If you’re unsteady on your feet or have painful feet, hips or knees, you may need some support to get around. A physiotherapist or occupational therapist can help you decide if a mobility aid (e.g. a walking stick or walker) is appropriate for you. They’ll also help you learn how to use it correctly and adjust it to your requirements.
  • Plan your outings to fit how you’re feeling. For example, if you’re at the shopping centre and feel tired or your feet begin to hurt, you might need to sit and rest for a while. Or, avoid going for a long walk if you’re having a day when your pain and fatigue levels are high. Take a shorter walk instead.
  • Be aware of the weather and how it can affect your environment. For example, footpaths are often slippery when wet, especially if there are wet leaves on them. Or, on sunny days, sun glare can make visibility more difficult, and you may not be able to see as clearly as usual.

Choose your clothing and footwear carefully

  • Avoid long trousers or skirts that may get caught underfoot or on furniture.
  • Wear well-fitting, supportive shoes with non-slip soles. Avoid high heels, floppy slippers, shoes with slick soles, and walking around in your socks.
  • Hip protectors may be an option for people with osteoporosis or those who fall often. They’re plastic shields or foam pads that fit into the pockets of specially designed underwear and reduce hip fractures from a fall. Your doctor can give you more information about hip protectors.

Reduce the hazards in your home

  • Make sure mats, rugs and carpet edges are lying flat on the ground and well secured. If they’re loose or curled up, they can cause you to trip.
  • Clean up spills from the floor immediately. If you have balance issues and bending over is a problem, ask someone else to clean the floor or use a light mop.
  • Ensure your walkways are clear of clutter, and you have plenty of space to walk between furniture without anything getting in your way.
  • Remove cords and cables from walkways. Secure them to skirting boards or close to the wall.
  • Install non-slip mats in the bathroom.
  • Pets can be a trip hazard (as I learned the hard way), especially if they like to be close to you or it’s meal time. 😼 So be aware of where they are when you’re up and about. 🐶
  • Make sure your home is well-lit so you can always see where you’re going. If you get up in the night frequently to go to the toilet, make sure you have a bright bedside light or use a torch so you can see clearly. Motion sensor lights are also handy and can be plugged into power points on the way to the toilet.
  • Consider installing a handrail on at least one side of any stairs and next to baths, showers and toilets.
  • Safety strips on the edges of outdoor stairs are also a good idea. They provide additional grip and help you see exactly where the edge of the step is.

What to do if you fall

Sometimes, no matter how careful you are, you can still have a fall.

So if you have a fall, it’s important that you try not to panic (easier said than done 😑). And although your first reaction may be to get up quickly, especially if you’re in public, because you’re embarrassed (been there, done that), take a moment.

  • Assess the situation. Are you hurt? Is it safe to get up? Have you damaged your glasses? Or lost your walking stick?
  • Make a decision whether or not to try to get up. Factoring into your decision will be whether you’re safe where you are, e.g. have you fallen onto a footpath or the road?

If you can get up:

  • Take time to recover. Sit and let yourself get over the shock. Drink some water. Take stock of your injuries.
  • Tell someone you’ve had a fall and/or seek medical advice. Don’t just brush it off. Falls can signify that something’s wrong – e.g. medicine side effects, balance problems, or a new health issue.

If you can’t get up:

  • Try sliding or crawling to seek help.
  • Use your phone or personal alarm, call for help or make a loud noise to attract attention.
  • Make yourself as comfortable as possible until help arrives
  • Seek medical advice/or call an ambulance.

Services to help keep you safe

If you’ve done all you can to prevent falls and are still concerned about your risk, there are services available to help you.

  • Falls and balance clinics provide multidisciplinary assessment and management planning for people who’ve had falls and have mobility and balance problems. People receive information on making their homes safer and are referred to physiotherapy, occupational therapy, exercise classes and other allied health professionals. Talk with your doctor about whether this might be an option for you.
  • Personal alarms. There are two basic personal alarm options; a pendant you wear around your neck and a smartwatch worn on your wrist. Pressing the button on the alarm will trigger contact with the service company, who’ll then contact your nominated relative, friend, neighbour or a response service. Some people can access free or reduced-cost personal alarms through government schemes such as the Commonwealth Home Support Program, National Disability Insurance Scheme (NDIS) and Department of Veterans’ Affairs. Visit their websites or speak with your doctor to see if you’re eligible. A variety of private companies provide this service for a fee if you don’t qualify for the free service.
  • Red Cross Telecross is a free service offered by the Australian Red Cross. It aims to provide people who live alone and are at risk of illness or accident the peace of mind that someone is looking out for them. Each morning, every day of the year, trained volunteers make a short call to people’s homes. If the call goes unanswered, Red Cross will take action to make sure that the person is OK. For information about accessing Telecross, call Red Cross on 1300 885 698.

Contact our free national Help Line

Call our nurses if you have questions about managing your painmusculoskeletal condition, treatment options, mental health issuestelehealth, or accessing services. They’re available Monday to Thursday between 9am-5pm on 1800 263 265; email (helpline@muscha.org) or via Messenger.

More to explore

References

(1) Falls, Australian Institute of Health and Welfare, 2022.
(2) Falls and the elderly, healthdirect, 2020.

 

Originally written and published by Lisa Bywaters 2022.


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21/Jun/2023

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 SMARTSpecific, 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 painmusculoskeletal condition, treatment options, mental health issuestelehealth, 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


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16/Nov/2022

We talk a lot about musculoskeletal conditions being invisible. With current treatments, most people diagnosed with a musculoskeletal condition will have no outward signs of their condition. However, someone living with these conditions can feel the pain and fatigue associated with them.

Osteoporosis is a different story. It really is invisible. There are no obvious signs when a person develops osteoporosis, and importantly, they don’t feel any different. Until they break a bone. Then it becomes obvious that something has happened.

So what is osteoporosis?

Osteoporosis is a condition that causes bones to become weak and lose their strength, making them break more easily than healthy bones. It’s more common in women, but men do get it too.

Another condition, osteopenia, is also associated with weak bones. A person with osteopenia has lower than average bone density but it’s not low enough to be diagnosed as osteoporosis.

Your bones

To understand how osteoporosis affects your bones, it’s helpful to know how they work.

Although we often think of them as dry and lifeless, bones are living tissue. They’re made of the protein collagen and are strengthened with the mineral calcium phosphate. They’re constantly changing throughout life. Specialised bone cells (osteoblasts) create new bone, while others (osteoclasts) break down and remove old bone. The rate at which this occurs changes as we age.

From birth to about 25 years of age, 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. Your bones are at their strongest.

After about 50 years of age, 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.

Causes of osteoporosis

Osteoporosis is caused by a loss of bone density. Many things can cause you to lose bone density; some you can change, and others you can’t.

Risk factors you can’t change:

  • Family history of osteoporosis
  • Being female
  • Getting older
  • Early menopause (before 45) which results in reduced levels of oestrogen
  • Use of certain medicines, including long-term use of glucocorticoids (e.g. to treat rheumatoid arthritis or asthma), some chemotherapy drugs, epilepsy drugs, and proton pump inhibitors
  • Other health conditions including rheumatoid arthritis, coeliac disease, inflammatory bowel diseases, and diabetes.

Risk factors you can change:

  • Low levels of calcium in your diet
  • Not getting enough vitamin D
  • Being inactive or sedentary
  • Excessive alcohol intake
  • Smoking
  • Being underweight
  • Poor nutrition.

The International Osteoporosis Foundation has an online risk test you can use to check your risk factors. This isn’t a diagnostic tool, but it can help you understand your potential risks so you can discuss them with your doctor.

Symptoms of osteoporosis

For most people, there are no symptoms that you have osteoporosis. Bones becoming weaker has no visible signs until they become so weak that they break. This can cause pain from a fracture – for example, breaking the wrist or hip after a fall. If the bones in the spine (vertebra) have fractured or collapsed, it can cause back pain, loss of height and a stooped posture.

Diagnosing osteoporosis

If you’re concerned that you may have osteoporosis or be at risk of developing it, you should see your doctor.

Your doctor will assess your risk factors for developing osteoporosis and look at your medical history – including your family history.

Family history is significant because having a parent or sibling with osteoporosis puts you at greater risk of developing osteoporosis.

After assessing your risk factors, your doctor will decide whether you need a bone scan. This scan will measure the density of your bones. The best scan for assessing your bone density is a dual-energy x-ray absorptiometry – often referred to as a DEXA or DXA scan.

A DEXA scan is short and painless. While you lie on your back on a padded table, a scanning arm passes over your body to take images of your hips, spine, and in some cases, the forearm. It takes about 15-30 minutes. A report is sent to your doctor, who will discuss the results with you.

Treating osteoporosis

If you’re diagnosed with osteoporosis, or osteopenia, your doctor will work with you to develop a treatment plan to reduce your risk of fractures by protecting and strengthening your bones. This may include calcium, vitamin D, exercise, medicines and self-care.

Calcium

Most of your body‘s calcium is stored in your bones. That’s why we associate calcium with healthy bones and teeth. But your heart, muscles and nerves also need calcium to function properly.

Because your body can’t make calcium, you need to get it from the foods you eat each day. If you don’t have enough calcium to keep your body functioning properly, it will take it from your bones. Over time, this can lead to bones becoming weaker.

The amount of calcium you needs every day varies depending on your age. Find out about the recommended dietary intake of calcium you and your family need every day.

Calcium is found in many foods, including dairy, oranges, sardines and salmon, almonds, tofu, baked beans, and green leafy vegetables.

Vitamin D

Vitamin D is produced when your skin is exposed to the sun. It’s essential for strong bones because it helps increase calcium absorption, regulates the amount of calcium in your blood, helps strengthen your skeleton, assists with muscle function and reduces your risk of falls.

The main source of vitamin D is sunlight. Exposing your hands, face and arms to the sun daily is essential. But the amount of time you need to do this depends on where you live, the time of the year and your skin’s complexion. You also need to be careful that your exposure to the sun is safe. Healthy Bones Australia has developed a chart to help you work all this out.

Vitamin D can also be found in small quantities in foods such as fatty fish (salmon, herring, mackerel), liver, eggs and fortified foods such as low-fat milk and margarine.

However, it’s unlikely that adequate quantities of vitamin D will be obtained through diet alone.

Exercise

Besides having a calcium-rich diet and ensuring you get enough vitamin D, regular exercise is essential for maintaining healthy bones.

The types of exercise that benefit bone health include:

  • Weight-bearing: such as brisk walking, climbing stairs, tennis, and netball. Your body is carrying its own weight, and gravity exerts a force. Bones become stronger because they’re coping with the force placed on them.
  • High-impact: such as tennis, dancing, jumping or skipping. These exercises place high stresses on the bones of the spine and legs as your feet hit the ground.
  • Resistance training: also known as strength training. This involves using machines (e.g. leg press) or free weights (e.g. dumbbells). 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.
  • Balance training: exercises such as tai chi and yoga improve balance and mobility and reduce your risk of falling. This is essential for preventing fractures.

Before beginning an exercise program, speak with your health professional. Not every type of exercise will be suitable for all people.

If you’ve been diagnosed with osteoporosis, it’s especially important that you discuss any kind of exercise with your health professional before you begin. Some high/moderately high intensity exercises may be unsafe for certain levels of osteoporosis.

Medicines

If you have osteoporosis, your doctor will consider your age, general health, and fracture risk before deciding on the most appropriate medicine.

Most osteoporosis medicines slow down bone loss by reducing the ability of osteoclasts to remove bone and allowing osteoblasts to continue to build bone.

In Australia, the following medicines may be prescribed for osteoporosis:

  • oral bisphosphonates – e.g. alendronate and risedronate – weekly or monthly tablets
  • zoledronic acid – once a year infusion given through a needle into the vein
  • denosumab – twice a year injection into the fat just under the skin
  • teriparatide – daily injection for people with severe osteoporosis.

Other medicines:

  • Menopausal hormone therapy (MHT) – also known as hormone replacement therapy or HRT – is a synthetic version of the hormones oestrogen and progesterone and may be an option for some women around menopause.
  • Selective oestrogen receptor modulators (SERMS) – act on bones in a similar way to oestrogen. Because oestrogen levels drop at menopause, they may be prescribed for postmenopausal women who are at increased risk for osteoporosis or already have it.
  • Supplements – calcium and vitamin D are important for bone health. Your doctor may prescribe a supplement if you’re not getting enough through diet or exposure to sunlight.

What else can I do to manage my condition?

You can do many other things to reduce your risk of developing osteoporosis or the impact it has if you do develop it.

  • Learn about your bone health and osteoporosis.
  • Prevent slips, trips and falls, which can lead to broken bones. Falls are most commonly caused by poor muscle strength, poor vision, problems with balance, and home hazards that lead to tripping. Talk with your doctor for information about falls prevention.
  • Quit smoking – it’s linked to reduced bone density.
  • Consume in moderation (if at all) – alcohol, caffeine and salt, as they can all affect your bone density. Alcohol also increases the risk of falling and the chance of fractures.

Contact our free national Help Line

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

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13/Oct/2022

We get asked this question a lot! But unfortunately, it’s not a simple ‘yes’ or ‘no’ answer.

Arthritis is a general term used to describe over 150 different conditions. The more accurate name for them is musculoskeletal conditions, as they affect the muscles, bones and/or joints.

They include osteoarthritis, back pain, rheumatoid arthritis, fibromyalgia, gout, polymyalgia rheumatica, lupus, osteoporosis and ankylosing spondylitis.

Around 7 million Australians live with a musculoskeletal condition, including kids. So can you avoid becoming one of them?

Maybe? Not really? It depends? 🙄

Because there are many different types of musculoskeletal conditions, the answer depends on various factors.

For conditions like rheumatoid arthritis, juvenile arthritis, ankylosing spondylitis, and lupus, we don’t really know their cause. Without knowing the cause, it’s hard to prevent something from occurring.

What we do know is that they’re autoimmune conditions. That means they occur due to a malfunctioning immune system. Instead of attacking germs and other foreign bodies, the immune system targets joints and healthy tissue, causing ongoing inflammation and pain. We don’t know why this happens, but scientists believe that a complex mix of genes and environmental factors is involved.

At this stage, we can’t change a person’s genetics to prevent them from developing an autoimmune type of arthritis, or conditions like osteoporosis and Paget’s disease, which are also linked to genetics. Many musculoskeletal conditions also become more common as you get older and are more common in women.

Other health issues, such as diabetes, kidney disease, coeliac disease, and even other musculoskeletal conditions 😫, can also increase your risk of developing a musculoskeletal condition. For example, chronic kidney disease can increase your chance of developing gout, and rheumatoid arthritis increases your risk of developing osteoporosis and fibromyalgia.

So that’s the bad news.

The good news is there are things you can do to reduce your risk of developing a musculoskeletal condition. Or, if you develop one, reduce its impact and severity.

Maintain a healthy weight

Excess body weight puts more pressure on your joints and increases the stress on cartilage, especially in weight-bearing joints like your hips, knees, and back. For every kilo of excess weight you carry, an additional load of 4kgs is put on your knee joints.

In addition to putting added stress on joints, fat releases molecules that increase inflammation throughout your body, including your joints. Being at a healthy weight reduces this risk.

Being overweight or obese is strongly linked to developing osteoarthritis (OA), most often in the knees. Hand OA is also more common in people who are overweight.

Back pain and inflammatory conditions such as gout, rheumatoid arthritis, and psoriatic arthritis have also been linked to being overweight.

If you have a musculoskeletal condition, maintaining a healthy weight, or losing weight if you’re overweight, can decrease your pain, allow you to become more active, and decrease your risk of developing other health problems like heart disease and diabetes.

Quit smoking

As well as the obvious links to cancer and lung disease, smoking’s linked to back pain, neck pain, rheumatoid arthritis and osteoporosis. Smoking also causes fatigue and slower healing, which can make pain worse. And it can make some medications less effective.

So quitting smoking has many health benefits. Within weeks of quitting, you’ll breathe easier and have more energy, making it easier to exercise and do your day-to-day activities. Find out more about the impact of smoking and ways to quit for good.

Stay active and exercise regularly

Regular exercise is vital for overall good health and keeps you fit, independent and mobile. Being active helps keep your muscles, bones and joints strong so that you can keep moving. It reduces your risk of developing other conditions such as osteoporosis, heart disease, diabetes and some forms of cancer. It boosts your mood, benefits your mental health, helps with weight control and improves sleep.

Having strong muscles is also essential to reduce your risk of falls.

Look after your mental health

Mental health conditions can increase the likelihood of developing some musculoskeletal conditions. For example, people with depression are at greater risk of developing chronic back pain. And living with a painful musculoskeletal condition can have a significant impact on mental health.

If you’re living with anxiety, depression, or another mental health condition and feel that you’re not coping well, it’s important to seek help as soon as possible. This will ensure you don’t prolong your illness and worsen your symptoms. It becomes harder and harder to climb out of a depressive episode the longer you wait. Similarly, the longer you put off seeking help for anxiety, the more anxious you may become about taking that first step.

There are many different types of treatment options available for mental health conditions. The important thing is to find the right treatment and health professional that works for you. With the proper treatment and support, they can be managed effectively.

Get enough calcium and vitamin D

Calcium and vitamin D are essential to building strong, dense bones when you’re young and keeping them strong and healthy as you age.

Getting enough calcium each day will reduce your risk of bone loss, low bone density, and osteoporosis.

Calcium is found in many foods, including dairy foods, sardines and salmon, almonds, tofu, baked beans, and green leafy vegetables.

Vitamin D is also essential for strong bones, muscles and overall health. The sun is the best natural source of vitamin D, but it can be found in some foods.
If you’re unable to get enough calcium or vitamin D through your diet or safe sun exposure, talk about calcium and/or vitamin D supplements with your doctor.

Protect your joints

Joint injuries increase your risk of getting OA. People who’ve injured a joint, perhaps while playing a sport, are more likely to eventually develop arthritis in that joint. So it’s important to protect against injury by:

  • maintaining good muscle strength
  • warming up and cooling down whenever you exercise or play sport
  • using larger, stronger joints or parts of the body for activities, for example, carrying heavy shopping bags on your forearms, rather than the small joints in your fingers
  • using proper technique when exercising, for example, when using weights at the gym or when playing sports, especially those that involve repetitive motions such as tennis or golf
  • maintaining a healthy weight
  • avoiding staying in one position for extended periods
  • seeking medical care quickly if you injure a joint.

Drink alcohol in moderation

Excessive alcohol consumption contributes to bone loss and weakened bones, increasing your risk of osteoporosis. For people with gout, drinking too much alcohol, especially beer, can increase your risk of a painful attack.

It can also affect your sleep, interact with medicines, and affect your mental health. To find out more about the risks of drinking too much alcohol and how you can reduce your alcohol intake, read ‘Should I take a break from booze?’.

Manage stress

While stress on its own is unlikely to cause someone to develop a musculoskeletal condition, chronic stress or a stressful event may be a contributing factor, especially with conditions such as fibromyalgia and back pain.

It can also cause issues with sleep, mood, increase pain, and make you more prone to flares if you have a musculoskeletal condition. It can then become a cycle of stress, poor sleep, pain and more stress. And this can be a difficult cycle to break.

But there are things you can do to deal with stress. Try relaxation techniques such as meditation, breathing exercises and visualisation, and avoid caffeine, alcohol and cigarettes.

Talk to someone – whether it’s a family member, friend or mental health professional, about what’s stressing you out so you can deal with it.

Talk with your doctor

If you’ve been experiencing joint or muscle pain, it’s important that you discuss your symptoms with your doctor. Getting a diagnosis as soon as possible means that treatment can start quickly, reducing the risk of joint damage and other complications.

Final word

While at this moment in time, we can’t absolutely 100% prevent ourselves from getting a musculoskeletal condition, the good news is that early diagnosis and treatment will give you the best outcomes.

Treatments for many of these conditions have come a long way in recent years, and most people live busy, active lives with musculoskeletal conditions. 😊

Call our Help Line

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

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13/Apr/2022

Rheumatoid arthritis (RA), osteoarthritis (OA) and osteoporosis (OP) have some similarities in their names, but is that where it ends?

This article will explore the similarities and differences of these common musculoskeletal conditions.

First – let’s look at those names

Rheumatoid arthritis – OK, this is a little convoluted, so hold onto your hat 😉. For those that don’t want the history lesson in ancient Greek, essentially it means inflammation of the joints. But for those who do read on…

Rheumatoid comes from rheumatism, which comes from the Greek word rheuma, which describes something that flows. Hippocrates (460-370BC), considered the father of modern medicine, ‘attributed many illnesses, especially those causing muscle achiness to the abnormal flow of body rheums or humors’.(1)

Arthritis – comes from the Greek word arthron for joint and itis, which means inflammation. Put together – inflammation of the joints.

Osteoarthritis – this is much more straightforward. Osteo – means bone and arthritis (inflammation of the joints).

Osteoporosis – another straightforward one 😉. Osteo (bone) and porosis means porous. So we have porous bones.

OK, we’ve had a trip through history and etymology, but what does this mean? I’ll admit rheumatoid had me scratching my head trying to work it all out. It seems to me that the rheuma part isn’t as helpful in the 21st century as it may have been for the ancient Greeks! But the arthritis part obviously is much closer to the mark. And you’ll see that the rest of the names pretty well match up with what’s going on with these conditions.

Rheumatoid arthritis (RA) vs osteoarthritis (OA) – what are the similarities and differences?

We know they’re both a type of arthritis. That’s the easy part. People who have these conditions will have some common symptoms – inflammation, joint pain and stiffness.

That’s about where the similarities end.

Rheumatoid arthritis is an ongoing health condition that causes pain, stiffness and swelling in your joints.rheumatoid arthritis

It’s the result of your immune system working in a faulty way. This is an autoimmune condition.

Your immune system is designed to look out for and attack foreign bodies – like bacteria and viruses – that can make you sick. For reasons that we don’t fully understand, when you have RA, your immune system gets confused. It targets your joints and healthy tissues as if they were foreign bodies.

This causes ongoing inflammation and pain.

Symptoms:

  • swelling, pain and heat in the joints, usually the smaller joints of the hands or feet
  • stiffness in the joints, especially in the morning
  • persistent mental and physical tiredness (fatigue)
  • same joints on both sides of the body are usually affected (symmetrical).

Less often, RA may also affect other systems in your body, like your eyes and lungs.

RA can affect people of any age but most often appears between 30 and 60. It affects women more often than men. However, when women reach menopause, the incidence of RA becomes the same for men and women.

How RA develops and how severe it is will be different for each person. Symptoms can develop gradually or can start with a sudden, severe attack. Your symptoms can change from day to day, and at times they can become much worse (called a flare). At other times, your symptoms may go away (called a remission).

The good news is that modern treatments for RA are extremely effective at controlling the disease and reducing its impact on people’s lives.

Osteoarthritis is the most common form of arthritis and affects the cartilage covering your bones’ ends.osteoarthritis

Healthy cartilage acts like a slippery cushion absorbing shock and helping your joints move smoothly. With OA, the cartilage becomes brittle and breaks down. Some pieces of cartilage may even break away and float around inside the joint. Because the cartilage no longer has a smooth, even surface, the joint becomes stiff and painful to move. Eventually, the cartilage can break down so much that it no longer cushions the two bones. Your body tries to repair this damage by creating extra bone. These are bone spurs. Bone spurs don’t always cause symptoms, but they can sometimes cause pain and restrict joint movement.

OA is most likely to develop in people over 45, but it can also occur in younger people.

Symptoms:

  • joint stiffness
  • joint swelling (inflammation)
  • grinding, rubbing or crunching sensation (crepitus)
  • joint pain
  • muscle weakness.

It was once thought to be an inevitable part of ageing, a result of a lifetime of ‘wear and tear’ on joints. However, it’s now understood that OA is a complex condition and may occur due to many factors. The good news is that many of these factors can be prevented.

Treating RA and OA

Both rheumatoid arthritis and osteoarthritis can be managed effectively. Things you can do – whether you have RA or OA – include exercising regularly, maintaining a healthy weight (or losing weight if required), and taking any medicines as prescribed.

Treatment for rheumatoid arthritis will also focus on controlling your overactive immune system and preventing joint damage.

What about osteoporosis (OP)?

Osteoporosis doesn’t affect the joints as OA and RA do. It affects the bone itself.

Bones are living tissue that’s constantly growing, rebuilding, replacing and repairing. From birth to about 25 years of age, you build more bone than you lose. Your bones are not only getting bigger as you grow during this time, but they’re developing their density. This determines how strong they are.

From about 25 to 50 years of age, 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 years of age, you start to break down more bone than you rebuild. While this means that we’ll all experience some bone loss, it doesn’t mean that everyone will develop osteoporosis.

Women commonly experience a period of rapid bone loss after the onset of menopause. After this time, there’s a steady but less rapid loss of bone.

When a person develops osteoporosis, their bones become more porous, lose strength and become fragile. Osteoporotic bones break (or fracture) more easily than normal bones. Even a minor bump or fall can cause a serious fracture.

Many people with osteoporosis don’t know they have it. It doesn’t have any obvious signs or cause pain unless a bone has broken.

Common risk factors for osteoporosis include a family history of OP, having conditions such as RA, coeliac disease or diabetes, smoking, and not getting enough calcium or vitamin D. You can check if you’re at risk of OP by using the Know Your Bones online tool.

Treating osteoporosis

OP can also be effectively managed and involves regular weight-bearing exercise and a healthy diet incorporating calcium-rich foods. Depending your age, general health and fracture risk, your doctor may prescribe medicines to help slow down bone loss or increase the amount of bone that’s made. Find out more about OP and the ways it’s treated.

Contact our free national Help Line

Call our nurses if you have questions about managing your painmusculoskeletal condition, treatment options, mental health issues, COVID-19, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

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Reference

(1) How rheumatism got its name
The Rheumatologist


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