SPINAL DECOMPRESSION AT HOME

Suffering from lower back pain? Consult with your osteopath to determine if spinal decompression is right for you and ensure proper execution of the exercise. Certain conditions may not be suitable for this treatment, so always check with us.

Disclaimer: This information is for educational purposes only and is not a substitute for professional osteopathic care. Users assume all liability for using the content. Content provided does not establish a provider-patient relationship or constitute osteopathic advice, treatment, diagnosis, or services.

Prone Pillow Decompression Stretch

This exercise is to be done off of your bed or a table at home. It will help illicit decompression of the lower back.

1) Get a pillow and lay it on the bed/table.
2) Lie on your stomach and situate the pillow in your pelvic region and situate yourself so that your arms and head are hanging off the bed.
3) Stretch your arms and head downwards towards the floor.
4) Take deep and long breaths when you are doing this exercise.
4) Hold this position for 30-60 seconds. After a couple of days of beginning this exercise if you may hold the exercise for up to 2-3 minutes.
5) Complete this exercise for 20 minutes with 1-2 minute break between stretches.
6) You should feel a nice light stretch in the lower back and this will help allow decompression. If you feel an excessive amount of pain, stop the exercise.
7) If you do not feel the stretch you may add another pillow.
8) If after adding the pillow you still do not feel a stretch then you may add weight and hold onto it as you hang off the table.
9) Complete as needed throughout the day.

Differential Diagnosis

Differential Diagnosis

Abdominal Swelling

Anaemia

Ankle pain

Arthropathy

Axillary swelling

Back Pain

Bleeding

Breast pain

Calf pain

Chest pain

Constipation

Cough

Delirium

Dementia

Diarrhoea

Dizziness

Dyspepsia

Dysphagia

Dyspnoea

Ear pain

Falls

Fatique

Gait Abnormality

Groin pain

Headache

Leg swelling

Limb pain

Low Abdominal pain

Muscles pain and weakness

Muscle weakness

Nausea and vomiting

Neck pain

Neck swelling

Numbness and Parasthesia

Pelvic pain

Pruritis

Seizures

Shoulder pain

Syncope

Tremor

Weight Loss (unintentinal)

Upper Abdominal pain

OSTEOPATHY: WHAT IT IS AND HOW IT WORKS

Osteopathy is a way of detecting, treating and preventing health problems by moving, stretching and manipulating muscles and joints. Osteopathy is based on the principle that the wellbeing of an individual depends on their bones, muscles, ligaments and connective tissue functioning smoothly together.

Osteopathic principles in practice

Structure and function: Health is present in the body when all structures are moving and all forces are balanced. Therefore disease can naturally occur in a body which is restricted in movement. If the parts do not function well together in any machine, those parts can wear abnormally or fail altogether. This is the same with the human body. The architecture of the human body and all the natural world exists the way it does because it fulfills a specific function. Structure determines function and function determines structure. Health emerges when structure and function are perfectly expressed.  You could consider an osteopath to be a “body mechanic”.

The interrelation of each organ system with another: The systems of the body organise into a unified continuous whole. No single part exists independent of the whole. When even a small part of the body undergoes dysfunction, the entire organism is affected. The site of a previous surgery or serious infection can lay down scar tissue that pulls throughout the body, inhibiting the function of other areas of the body.

The body heals itself: There is, within each of us, a healing mechanism that could be thought of as a restorative force or an intelligence. This force is within every cell and it keeps the body well. When a state of dysfunction arises, this healing force acts to restore functional balance and harmony.  In medicine we call this force homeostasis. Osteopathy recognises the body’s ability to heal and seeks to achieve the most optimum function.

The rule of the artery is supreme: When blood and lymphatic fluids flow freely, the tissues of the body can perform their physiological functions without interruption. With the occurrence of trauma (physical or emotional), the tissues can contract, twist and compress disrupting the flow of fluids. Areas of poor circulation can result from this and are considered to be a significant contributor to the onset of disease within these cells. Osteopathic manipulation aims to restore freedom in the tissues and normalise fluid flow so that healthy physiologic function (healing) follows as a result.

Conditions: Neck Pain

Neck pain is a common reason people visit an osteopath. Knowing how your neck normally works and why you feel pain are important in helping you care for your neck. The following resource is designed to inform patients presenting to The Health Boutique with neck pain.

Anatomy

The human spine is made up of 24 spinal bones, called vertebrae. Vertebrae are stacked on top of one another to form the spinal column. The spinal column is the body’s main upright support.

The cervical spine is formed by the first seven vertebrae. We often refer to these vertebrae as C1 to C7. The cervical spine starts where the top vertebra (C1) connects to the bottom edge of the skull. The cervical spine curves slightly inward and ends where C7 joins the top of the thoracic spine. This is where the chest begins.

Each vertebra is formed by a round block of bone, called a vertebral body. A boney ring attaches to the back of the vertebral body. When the vertebrae are stacked on top of each other, the rings form a hollow tube. This boney tube surrounds the spinal cord as it passes through the spine. Just as the skull protects the brain, the bones of the spinal column protect the spinal cord.

As the spinal cord travels from the brain down through the spine, it sends out nerve branches between each vertebrae called nerve roots. These nerve roots join together to form the nerves that travel throughout the body and form the body’s electrical system. The nerve roots that come out of the cervical spine form the nerves that go to the arms and hands. The thoracic spine nerves go to the abdomen and chest. The nerves coming out of the lumbar (lower) spine go to the organs of the pelvis, the legs, and the feet.

One way to understand the anatomy of the cervical spine is to look at a spinal segment. Each spinal segment includes two vertebrae separated by an intervertebral disc, the nerves that leave the spinal cord at that level, and the small facet joints (see below) that link each level of the spinal column.

An intervertebral disc is made of connective tissue. Connective tissue is the material that holds the living cells of the body together. Most connective tissue is made of fibers of a material called collagen. In some cases, the collagen fibers join together to form a structure like a rope. In other cases, the fibers are arranged like a piece of cloth, or knitted materials such as you find in a blanket.

The disc is a specialised connective tissue structure that separates the two vertebral bodies of the spinal segment. The disc normally works like a shock absorber. It protects the spine against the daily pull of gravity. It also protects the spine during activities that put strong force on the spine, such as jumping, running, and lifting.

An intervertebral disc is made up of two parts. The center, called the nucleus, is spongey. It provides most of the ability to absorb shock. The nucleus is held in place by the annulus, a series of strong ligament rings surrounding it. Ligaments are strong connective tissues that attach bones to other bones.

There are two facet joints between each pair of vertebrae, one on each side of the spine. A facet joint is made up of small, boney-like ‘knobs’ that line up along the back of the spine. Where these ‘knobs’ meet, they form a joint that connects the two vertebrae. The alignment of the facet joints of the cervical spine allows freedom of movement as you bend and turn your neck.

The surfaces of the facet joints are covered by articular cartilage. Articular cartilage is a smooth, rubbery material that covers the ends of most joints. It allows the boney ends to move against each other smoothly, without pain.

Two spinal nerves exit the sides of each spinal segment, one on the left and one on the right. As the nerves leave the spinal cord, they pass through a small boney tunnel on each side of the vertebra, called a neural foramen.

Causes of neck pain

There are many causes of neck pain. Below is a brief overview of some of the most common causes of neck pain.

Spondylosis

Most neck problems happen after years of wear and tear on the parts of the cervical spine. At first, these small injuries are not painful. But over time they can add up. Eventually they may begin to cause neck pain. We sometimes call these degenerative changes in the spine spondylosis. Spondylosis can affect the bones and soft tissues of the spine. However, it is important to know that most problems with spondylosis are a normal part of ageing. 

Degenerative Disc Disease

The normal aging process involves changes within the intervertebral discs. Repeated stresses and strains weaken the connective tissues that make up a disc. Over time, the nucleus in the center of the disc may dry out. When this happens, the disc can lose some of its ability to absorb shock. The annulus may also weaken and develop small cracks and tears.

Often these changes are not painful. But larger tears that reach to the outer edge of the annulus can cause neck pain. The body tries to heal the cracks with scar tissue. But scar tissue is not as strong as the tissue it replaces. At some point the disc may finally lose its ability to absorb shock for the spine. Then forces from gravity and daily activities can take even more of a toll on the disc and other structures of the spine.

As the disc continues to degenerate, the space between the vertebrae becomes smaller. This compresses the facet joints along the back of the spinal column. As these joints are forced together, extra pressure builds on the articular cartilage on the surface of the facet joints. This extra pressure can damage the facet joints. Over time, this may lead to arthritis in the facet joints.

These degenerative changes in the disc, facet joints, and ligaments cause the spinal segment to become loose and unstable. The extra movement causes even more wear and tear on the spine. As a result, more and larger tears occur in the annulus.

The nucleus may push through the weakened and torn annulus and into the spinal canal. This is called a herniated or ruptured disc. The disc material that squeezes out can press against the spinal nerves. The disc also emits enzymes and chemicals that produce inflammation. The combination of pressure on the nerves and inflammation caused by the chemicals released from the disc cause pain.

As the degeneration continues, bone spurs can develop around the facet joints and around the disc. No one knows exactly why these bone spurs develop. Mostly we think that bone spurs are the body’s attempt to stop the extra motion between the spinal segment. These bone spurs can cause problems by pressing on the nerves of the spine where they pass through the neural foramina. This pressure around the irritated nerve roots can cause pain, numbness, and weakness in the neck, arms, and hands.

Muscle Strain

People with minor neck pain or stiffness are often told they have a muscle strain. However, unless there was a severe injury to the neck, the muscles probably haven’t been pulled or injured. Instead, the problem may be coming from irritation or injury in other spine tissues, such as the disc or ligaments. When this happens, the neck muscles may go into spasm to help support and protect the sore area.

Mechanical Neck Pain

Mechanical neck pain is caused by wear and tear on the parts of the neck. It is similar in nature to a machine that begins to wear out. Mechanical pain usually starts from degenerative changes in the disc. As the disc starts to collapse, the space between the vertebrae narrows, and the facet joints may become inflamed.

The pain is usually chronic. Chronic pain builds over time and is long-lasting. The pain is typically felt in the neck, but it may spread from the neck into the upper back or to the outside of the shoulder. Mechanical neck pain usually doesn’t cause weakness or numbness in the arm or hand, because the problem is not from pressure on the spinal nerves.

Radiculopathy (Pinched Nerve)

Pressure or irritation in the nerves of the cervical spine can affect electrical signals of the nerve/s. The pressure or irritation can be felt as numbness on the skin, weakness in the muscles, or pain along the path of the nerve. Most people think of these symptoms as indications of a pinched nerve. We call this condition cervical radiculopathy.

Several conditions can cause radiculopathy. The most common are degeneration, disc herniation, and spinal instability.

• Degeneration: As the spine ages, several changes occur in the bones and soft tissues. The disc loses its water content and begins to collapse, causing the space between the vertebrae to narrow. The added pressure may irritate and inflame the facet joints, causing them to become enlarged. When this happens, the enlarged joints can press against the nerves going to the arm as they squeeze through the neural foramina. Degeneration can also cause boney spurs to develop. Boney spurs may put pressure on nerves and produce symptoms of cervical radiculopathy.

• Herniated Disc: Heavy, repetitive bending, twisting, and lifting can place extra pressure on the shock-absorbing nucleus of the disc. If great enough, this increased pressure can injure the annulus (the tough, outer ring of the disc). If the annulus ruptures or tears, the material in the nucleus can squeeze out of the disc. This is called a herniation. Although daily activities may cause the nucleus to press against the annulus, the body is normally able to withstand these pressures. However, as the annulus ages, it tends to crack and tear. It is repaired with scar tissue. Over time, the annulus becomes weakened, and the disc can more easily herniate through the damaged annulus.

If the herniated disc material presses against a nerve root it can cause pain, numbness, and weakness in the area the nerve supplies. This condition is called cervical radiculopathy (see above). And any time the herniated nucleus contacts tissues outside the damaged annulus, it releases chemicals that cause inflammation and pain. If the nucleus herniates completely through the annulus, it may squeeze against the spinal cord. This causes a condition that is even more serious because it affects all the nerves of the spinal cord. This condition is called cervical myelopathy.

• Spinal Instability: Spinal instability means there is extra movement among the bones of the spine. Instability in the cervical spine can develop if the supporting ligaments have been stretched or torn from a severe injury to the head or neck. People with diseases that loosen their connective tissue may also have spinal instability. Spinal instability also includes conditions in which a vertebral body slips over the one just below it. When the vertebral body shifts too far forward, the condition is called spondylolisthesis. Whatever the cause, extra movement in the bones of the spine can irritate or put pressure on the nerves of the neck, causing symptoms.

  Spinal Stenosis (Cervical Myelopathy)

  Stenosis means closed in. Spinal stenosis refers to a condition in which the spinal cord is closed in, or compressed, inside the tube of the spinal canal. Spinal stenosis may be caused by degenerative changes, such as bone spurs pushing against the spinal cord within the spinal canal.

  However, stenosis can also develop when a person of any age has a disc herniation that pushes against the spinal canal. When the spinal cord is squeezed in the neck, we call the condition cervical myelopathy.

  This is an alarming condition that demands our attention. Cervical myelopathy can cause problems with the bowels and bladder, change the way you walk, and affect your ability to use your fingers and hand.

  Symptoms

  Symptoms from neck problems vary. They depend on your condition and which neck structures are affected. Some of the more common symptoms of neck problems are:

  • neck pain

  • headaches

  • pain spreading into the upper back or down the arm

  • neck stiffness and reduced range of motion

  • muscle weakness in the shoulder, arm, or hand

  • sensory changes (numbness, prickling, or tingling) in the forearm, hand, or fingers

  Source and more reading:    https://eorthopod.com/

Conditions: Cervicogenic Headache

Source:  https://eorthopod.com/

Cervicogenic headaches are a common reason people visit an osteopath. The following resource is designed to inform patients presenting to The Health Boutique with cervicogenic headaches. These are often chronic and one sided and tend to refer pain into the head from boney or soft tissue structures of the neck. 

Cervicogenic headaches often arise from the atlanto-occipital and upper cervical joints and may be perceived in one or more regions of the head and/or face. These occur due to a neck disorder or lesion and feature the converging of trigeminal and cervical afferents in the trigeminocervical nucleus within the upper cervical spinal cord.

Cervicogenic headaches can mimic migraines, so it may be difficult to distinguish a cervicogenic headache from a migraine headache. The primary difference is that a migraine headache is rooted in the brain, and a cervicogenic headache is rooted in the cervical spine (neck) or base of the skull region. Some headaches are caused by eyestrain, stress, tiredness, or trauma.

If you feel a headache coming on, you may be able to isolate the cause. Cervicogenic headaches are different because they are caused by problems with the nerves, bones, or muscles in your neck. Although you may feel pain in your head, it doesn’t start there. Instead, the pain you feel is referred pain from another location in your body.

The term cervicogenic headache was coined almost three decades ago, and the general condition of pain located in the head but originating in the cervical spine was described over 100 years ago. It is similar to other non-specific spinal conditions in its relative lack of high level evidence regarding pathoanatomical etiology.

What are symptoms of a cervicogenic headache?

In addition to a throbbing head pain, symptoms of a cervicogenic headache may include:

• pain on one side of your head or face

• a stiff neck

• pain around the eyes

• pain while coughing or sneezing

• a headache with certain neck postures or movement

Cervicogenic headaches can also cause symptoms similar to migraine headaches such as light sensitivity, noise sensitivity, blurry vision, and an upset stomach.

Challenging to diagnose clinically, but often includes symptoms below:

• Unilateral ‘ram’s horn’ or unilateral dominant headache (excluding those with bilateral headache or symptoms that typify migrane headaches)

• Exacerbated by neck movement or posture

• Tenderness of the upper 3 cervical spine joints

• Association with neck pain or dysfunction

• Pain that stays in one spot, like the back, front, or side of your head or your eye

With a cervicogenic headache, pain will often start of in the neck region first, whereas it normally starts in the head with migraine and tension-type headache sufferers. Cervicogenic headaches are also side-specific and do not fluctuate from side to side like a migraine headache can.

Anatomy

The cervical spine consists of 7 vertebrae, C1 to C7. The cervical nerves from C1 to C8. The first two vertebrae have a unique shape and function. The upper vertebrae supports the skull, articulates superiorly with the occiput (the atlanto-occipital joint) and is named the atlas (C1).

This joint is responsible for 33% of flexion and extension.The design of the atlas allows forward and backward movement of the head. Among the atlas is the axis (C2) that allows rotation. The atlantoaxial joint is responsible for 60% of all cervical rotation. Both form the upper cervical spine. The 5 cervical vertebrae that make up the lower cervical spine, C3-C7, are similar to each other but very different from C1 and C2.

Mechanism

Currently we believe the reason neck pain can cause a headache is due to the ‘convergence’ (the coming together) of sensory nerve fibres from the neck and sensory nerve fibres from the trigeminal nerve (the nerve that supply’s the sensation of the face and scalp). This convergence effectively makes it very difficult for the brain to interpret where exactly the pain is coming from and effectively transmits signals related to what we typically feel when we have a headache. This is why it is often called referred pain.

The mechanism which is responsible for the pain consists of a merger of the spinal nerves C1, C2 and C3, and a branch of the 5th cranial nerve, the trigeminal nerve. This merger of nerves makes it possible that upper cervical pain radiates to regions of the head which are innervated by the cervical nerve (auricular and occipital). The merger with the trigeminal afferents allows the pain to radiate to the parietal, frontal and orbital regions.

The trigeminocervical nucleus is a region of the upper cervical spinal cord. Here sensory nerve fibers in the descending tract of the trigeminal nerve converge with sensory fibers from the upper cervical roots. This convergence of nociceptive pathways allows for the referral of pain signals from the neck to the trigeminal sensory receptive fields of the face and head as well as activation of the trigeminovascular neuro-inflammatory cascade. Also relevant to this condition is the convergence of sensorimotor fibers of the spinal accessory nerve (CN XI) and upper cervical nerve roots, which ultimately converge with the descending tract of the trigeminal nerve. These connections may be the basis for the often well-recognised patterns of referred pain, from the trapezius and sternocleidomastoid muscles to the face and head.

Facet Joints

There is some evidence that multiple structures in the upper cervical spine can be the source that is referring pain into the head. The implicated structures are generally centered around C1, C2, and C3 spinal levels. This may include the joints, disc, ligaments, and musculature. The lower cervical spine may play an indirect role in pain production if dysfunctional, but there is no evidence of a direct referral pattern. Through controlled nerve blocking of various structures in the cervical spine, it appears that the zygoapophyseal joints, especially those of C2/C3, are the most common sources of cervicogenic headache pain. This finding is even more common in patients with a history of whiplash.

Epidemiology/Etiology

A whiplash injury or poor sitting posture is one common cause of this type of headache. Arthritis can be a contributing factor. There are as many as 20 muscles in the neck region as well and a dysfunction in how these muscle work collectively in controlling head and neck movement can often cause significant problems.

• About 20 percent of those who have chronic headaches are diagnosed as having the cervicogenic type

• About four times as many women than men suffer from this type of headache

• The frequency and severity of a cervicogenic headache can vary greatly, but those who suffer from this type of headache often experience it on an almost daily basis.

How can Osteopathic Assessment and Treatment help?

A patient’s history and clinical presentation is vital in helping us know whether your symptoms are consistent with cervicogenic headache. We will often ask you questions such as the location, severity, frequency and duration of you headache symptoms. What movements and postures typically bring on a headache episode and what you can do to make things easier.

NZ Registered Osteopaths have been trained to recognise these findings. We employ appropriate manual therapy techniques to the cervical spine and associated soft tissue structures to regain range of motion and restore normal joint mechanics to the cervical spine. We also instruct our patients in a specific and evidence based exercise program that addresses the deep neck flexors and the stabilising muscles of the scapular area. This helps stimulate the process of healing and repair by facilitating normal movement and loading stresses around the symptomatic joints. Studies have documented nearly 80 percent success with a combination of these treatment interventions, whereby patients reported a more than 50 percent decrease in headache frequency and over 30 percent achieved complete resolution of symptoms following seven weeks of treatment.

Medication for Cervicogenic Headache:

Medication alone seldom serves as an adequate treatment for cervicogenic headache, although medication can sometimes provide a measure of relief. When medication is prescribed, it typically is an antidepressant, and anti-inflammatory, an analgesic, or an antiepileptic drug.

Medication-Induced Headaches:

Medication-induced headaches are more common that you may think and are caused by taking painkillers for migraines or headaches too regularly. It is recognised as the third most common cause of headache. By taking medication such as codeine, ibuprofen, paracetemol and triptans (more specifically used for migraines) too frequently, your body becomes used to the effects of the drugs. A ‘rebound’ or withdrawal headache may then develop if you do not take another one. As a result, you may end up getting stuck in a vicious cycle of having to rely on taking medication every day in order to keep the headache at bay. 

Other types of Headaches

Acute Single Episode

Meningitis – fever, photophobia, stiff neck, rash, coma. At risk – very young. Med emergency

Encephalitis – fever, odd behaviour, fits or redused consciouness, stiff neck. At risk very young and very old, immune compromised. Med emergency

Subarachnoid haemorrhage – sudden headache +/- stiff neck. Med emergency

Tropical illness – e g malaria. +ve travel Hx, flu-like illness

Sinusitis – tender face, cold, post nasal drip. Dull constant ache over affected maxillary sinus or frontal sinus. ethmoid and sphenoid sinus P felt deep in midline at the root of the nose

Head injury – cuts/bruises, reduced consciousness, lucid intervals, amnesia. Pain at side of trauma or generalised. Head sinister signs suggesting subdural or extra dural haemorrhage ie drowsiness and focal signs

Cervical Artery Dissection – severe Pain up cervical complex. Recent Hx of mild or major trauma involving extension and/or rotation may have neurological signs 2Ns and 3Ds

Intoxication – Agg by shaking the head. Viral and other infection, alcohol, enviromental

Acute Recurrent Attacks

Migraine – pre-attack aura? visual aura? vomiting? sensitivity to light, movement, noise? recognised triggers?

Cluster Headache – typically night Pain in one eye for up to eight weeks then OK for next few months  then intermittently repeated. Gaps may be up to 2 years. Thought to be neuralgia suspected hypothalamus involvment. Onset any age but younger men 20 plus 5;1. Pain occures once or twice a day;each episode lasting 15 to 160 mins. Each cluster four to 12 weeks. Rapid onset. Pain around one eye unilateral and  mostly same side, which may become watery and bloodshot. Pupil constriction ,eyelid drop, lacrimation, nasal discharge.

Acute Glaucoma – red eye, sees haloes, fixed big oval pupil, reduced acuity in affected eye. Nausea and vomiting. Red congested eye, cloudy cornea, non responsive pupil. Attacks may be precipitated by sitting in the dark. Mostly elderly. Constant pain around one eye and radiates to forehead

Subacute Onset

Giant Cell Arteritis – Hx of PMR? tender scalp, >50 y o, reduced acuity (late stage). ESR elevated. Tender, thickened, pulseless temporal arteries. Ask about jaw pain when eating

Chronic Headache

Tension Headache – tight band around head, non pulsative. Tension at work/home. low mood. improved by sleep

Cronically elevated ICP ( intracranial pressure) – worse on waking, focal signs. high BP, low HR. headache present in 50 percent of cases. Headache will wake ptn or they will wake with it. Not a severe headache, worsened by lying down. Other signs vomiting, papilloedema, epilepsy, progressive focal neurology, mental change

Medication misuse – from analgetic overuse. Mixed analgetic containing codein or prescribed opiates and triptans, causing episodic headaches to become daily headache.

Headache – Differential Diagnosis

Common causes

• Minor viral infections

• Tension type headache

• Migraine

• Acute sinusitis

• Referred neck pain

• Analgesia induced headache

• Caffeine withdrawal

• Trigeminal Neuralgia

• TMJ syndrome

• Cluster headache

• Post-concussion headache

Must Not Miss

• Raised Intracranial Pressure

  • Subarachnoid haemorrhage

  • Subdural haematoma

  • Brain tumour

  • Brain abscess

  • Meningitis

  • Encephalitis

• Malignant hypertension

• Pre-eclampsia

• Temporal arteritis

• Acute Glaucoma

Easily missed

• Drug & Toxins

• Depression

• Dental problems

• HIV

• Idiopathic-intracranial-hypertension

Red flags

• Severe thunderclap headache

• Neurological symptoms

  • (confusion, persistent focal neurological signs)

• Severe progressive headache

• New onset headache > 50 years of age

• Recent change in normal headaches

• Associated symptoms

  • Petechial rash/neck stiffness

  • Awoken by headaches

  • Early morning headaches

  • Worsened by valsalva manoeuvres

  • Jaw claudication

  • Temporal scalp tenderness

• Systemic symptoms (fever, weight loss)

• HIV infection

• History of cancer

Investigations to consider

• FBC, CRP/ ESR

• U&Es

• Blood & viral cultures

• X-ray (C spine, Skull)

• Lumbar puncture

• CT/MRI

• Temporal artery biopsy

• Intraocular pressure measurements

Source:  https://eorthopod.com/

Conditions. Lower Back Pain

Source:  https://orthopod.com/

The following resource is designed to inform patients presenting to The Health Boutique with low back pain. Low back pain is a common reason people visit an osteopath. For adults over 40 yrs, back pain ranks third as a cause for doctor visits, after heart disease and arthritis. Eighty percent of people will have low back pain at some point in their lives, and nearly everyone who has low back pain once will have it again.

Very few people who feel pain in their low back have a serious medical problem. Ninety percent of people who experience low back pain for the first time get better in two to six weeks. Only rarely do people with low back pain develop chronic back problems. With these facts in mind, you can be assured that back pain is common, that it usually only causes problems for a short period of time, and that you can take steps to ease symptoms and prevent future problems.

Anatomy

The human spine is made up of 24 spinal bones, called vertebrae Vertebrae are stacked on top of one another to create the spinal column. The spinal column gives the body its form. It is the body’s main upright support. From the side, the spine forms three curves. The neck, called the cervical spine, curves slightly inward. The mid back, or thoracic spine curves outward. The outward curve of the thoracic spine is called kyphosis. The low back, also called the lumbar spine, curves slightly inward. An inward curve of the spine is called lordosis:

The lumbar spine is made up of the lower five vertebrae. Doctors often refer to these vertebrae as L1 to L5. The lowest vertebra of the lumbar spine, L5, connects to the top of the sacrum, a triangular bone at the base of the spine that fits between the two pelvic bones. Some people have an extra, or sixth, lumbar vertebra. This condition doesn’t usually cause any particular problems.

Each vertebra is formed by a round block of bone, called a vertebral body. The lumbar vertebral bodies are taller and bulkier compared to the rest of the spine. This is partly because the low back has to withstand pressure from body weight and from daily actions like lifting, carrying, and twisting. Also, large and powerful muscles attaching on or near the lumbar spine place extra force on the lumbar vertebral bodies:

A bony ring attaches to the back of each vertebral body. When the vertebrae are stacked on top of each other, these rings form a hollow tube. This bony tube surrounds the spinal cord as it passes through the spine. Just as the skull protects the brain, the bones of the spinal column protect the spinal cord. The spinal cord extends down to the L2 vertebra. Below this level, the spinal canal encloses a bundle of nerves that goes to the lower limbs and pelvic organs. The Latin term for this bundle of nerves is cauda equina, meaning horse’s tail:

As the spinal cord travels from the brain down through the spine, it sends out nerves on the sides of each vertebra called nerve roots. These nerve roots join together to form the nerves that travel throughout the body and form the body’s electrical system. The nerve roots that come out of the lumbar spine form the nerves that go to the lower limbs and pelvis. The thoracic spine nerves go to the abdomen and chest. The nerves coming out of the cervical spine go to the neck, shoulders, arms, and hands.

It is sometimes easier to understand what happens in the spine by looking at a spinal segment. A spinal segment includes two vertebrae separated by an intervertebral disc, the nerves that leave the spinal cord at that level, and the small facet joints that link each level of the spinal column. The intervertebral disc normally works like a shock absorber. It protects the spine against the daily pull of gravity. It also protects the spine during heavy activities that put strong force on the spine, such as jumping, running, and lifting.

An intervertebral disc is made up of two parts. The center, called the nucleus, is spongy. It provides most of the disc’s ability to absorb shock. The nucleus is held in place by the annulus, a series of strong ligament rings surrounding it. Ligaments are strong connective tissues that attach bones to other bones.

Between the vertebrae of each spinal segment are two facet joints. The facet joints are located on the back of the spinal column. There are two facet joints between each pair of vertebrae, one on each side of the spine. A facet joint is made of small, bony knobs that line up along the back of the spine. Where these knobs meet, they form a joint that connects the two vertebrae. The alignment of the facet joints of the lumbar spine allows freedom of movement as you bend forward and back.

The surfaces of the facet joints are covered by articular cartilage. Articular cartilage is a smooth, rubbery material that covers the ends of most joints. It allows the bone ends to move against each other smoothly, without pain:

Two spinal nerves exit the sides of each spinal segment, one on the left and one on the right. As the nerves leave the spinal cord, they pass through a small bony tunnel on each side of the vertebra, called a neural foramen:

The lumbar spine is supported by ligaments and muscles. The ligaments are arranged in various layers and run in multiple directions. Thick ligaments connect the bones of the lumbar spine to the sacrum (the bone below L5) and pelvis.

The muscles of the low back are also arranged in layers. Those closest to the surface are covered by a thick tissue called fascia. The middle layer, called the erector spinae, has strap-shaped muscles that run up and down over the lower ribs, chest, and low back. They blend in the lumbar spine to form a thick tendon that binds the bones of the low back, pelvis, and sacrum.

The deepest layer of muscles connects along the back surface of the spine bones. The muscles also connect the low back, pelvis, and sacrum. These deepest muscles coordinate their actions with the muscles of the abdomen to help hold the spine steady during activity:

The middle layer, called the erector spinae, has strap-shaped muscles that run up and down over the lower ribs, chest, and low back. They blend in the lumbar spine to form a thick tendon that binds the bones of the low back, pelvis, and sacrum.

The deepest layer of muscles connects along the back surface of the spine bones. The muscles also connect the low back, pelvis, and sacrum. These deepest muscles coordinate their actions with the muscles of the abdomen to help hold the spine steady during activity.

Causes of back pain

There are many causes of low back pain. We will make every effort to ensure that your symptoms are not from a serious medical cause, such as cancer or a spinal infection. The vast majority of back problems are a result of wear and tear on the parts of the spine over many years. This process is called degeneration. Over time, the normal process of ageing can result in degenerative changes in all parts of the spine. Injuries to the spine, such as a fracture or injury to the disc, can make the changes happen even faster. There is strong evidence that cigarette smoking also speeds up degeneration of the spine. Scientists have found links among family members, showing that genetics plays a role in how fast these changes occur.

Degeneration

The intervertebral disc changes over time. At first, the disc is spongey and firm. The nucleus in the center of the disc contains a great deal of water. This gives the disc its ability to absorb shock and protect the spine from heavy and repeated forces. The first change that occurs is that the annulus around the nucleus weakens and begins to develop small cracks and tears. The body tries to heal the cracks with scar tissue. But scar tissue is not as strong as the tissue it replaces. The torn annulus can be a source of pain for two reasons. First, there are pain sensors in the outer rim of the annulus. They signal a painful response when the tear reaches the outer edge of the annulus. Second, like injuries to other tissues in the body, a tear in the annulus can cause pain due to inflammation. With time, the disc begins to lose water, causing it to lose some of its fullness and height. As a result, the vertebrae begin to move closer together.

As the disc continues to degenerate, the space between the vertebrae shrinks. This compresses the facet joints along the back of the spinal column. As these joints are forced together, extra pressure builds on the articular cartilage on the surface of the facet joints. This extra pressure can damage the facet joints. Over time, this may lead to arthritis in the facet joints. These degenerative changes in the disc, facet joints, and ligaments cause the spinal segment to become loose and unstable. The extra movement causes even more wear and tear on the spine. As a result, more and larger tears occur in the annulus.

The nucleus may push through the torn annulus and into the spinal canal. This is called a herniated or ruptured disc. The disc material that squeezes out can press against the spinal nerves. The disc also emits enzymes and chemicals that produce inflammation. The combination of pressure on the nerves and inflammation caused by the chemicals released from the disc cause pain.

As the degeneration continues, boney spurs develop around the facet joints and around the disc. No one knows exactly why these boney spurs develop. Most doctors think that bone spurs are the body’s attempt to stop the extra motion between the spinal segment. These boney spurs can cause problems by pressing on the nerves of the spine where they pass through the neural foramina. This pressure around the irritated nerve roots can cause pain, numbness, and weakness in the low back, buttocks, and lower limbs and feet.

A collapsed spinal segment eventually becomes stiff and immobile. Thickened ligaments and facet joints, scarred and dried disc tissue, and protruding bone spurs prevent normal movement. Typically, a stiff joint doesn’t cause as much pain as one that slides around too much. So this stage of degeneration may actually lead to pain relief for some people.

Mechanical and Neurogenic Pain

To best understand the cause of your pain, spine specialists sometimes divide low back pain into two categories:

• mechanical pain

• neurogenic pain

Mechanical Pain

Mechanical back pain is caused by wear and tear in the parts of the lumbar spine. This type of pain is similar in nature to a machine that begins to wear out. Mechanical pain usually starts from degenerative changes in the disc. As the disc begins to collapse and the space between the vertebrae narrows, the facet joints may become inflamed. Mechanical pain typically gets worse after activity due to strain on the moving parts of the spine. Mechanical pain is usually felt in the back, but it may spread into the buttocks, hips, and thighs. The pain rarely goes down past the knee. Mechanical back pain usually doesn’t cause weakness or numbness in the leg or foot, because the problem is not from pressure on the spinal nerves.

Neurogenic Pain

Neurogenic pain means pain from nerve injury. Neurogenic pain occurs when spinal nerves are inflamed, squeezed, or pinched. This can happen when a disc herniates or when a nerve gets pinched where it leaves the spine. Recently it has also become known that when a disc ruptures, chemicals are released that inflame the nerves even if there is no pressure directly on the nerve. Neurogenic symptoms concern doctors more than mechanical pain because they can signal damage to the nerves and lead to weakness or numbness in the lower extremities.

The nerve pressure causes symptoms in the areas where the nerve travels, rather than in the low back. This happens because pressure on the spinal nerve affects structures away from the spine, such as the muscles. As a result, a person’s back may not hurt, yet the person feels pain, numbness, or weakness in the leg or foot. This indicates there’s a problem with the body’s electrical wiring. The pressure on the nerve affects how the body functions. Muscles weaken. Reflexes slow. Sensations of pins, needles, and numbness may be felt where the nerve travels.

Spine Conditions

The effects of spine degeneration or back injury can lead to specific spine conditions. These include

• annular tears

• internal disc disruption

• herniated disc

• facet joint arthritis

• segmental instability

• spinal stenosis

• foraminal stenosis

Annular Tears

Our intervertebral discs change with age, much like our hair turns gray. Perhaps the earliest stage of degeneration occurs due to tears that occur in the annulus. These tears can result from wear and tear over a period of time. They can also be the result of a sudden injury to the disc due to a twist or increased strain on the disc that overpowers the strength of the annulus. These annular tears may cause pain in the back until they heal with scar tissue.

Internal Disc Disruption

Multiple annular tears can lead to a disc that becomes weak. The disc starts to degenerate and collapse. The vertebrae begin to compress together. The collapsing disc can be the source of pain because it has lost the ability to be a shock absorber between the vertebrae. This condition is sometimes referred to as internal disc disruption. This type of problem causes primarily mechanical back pain due to inflammation of the disc and surrounding structures.

Herniated Disc

A disc that has been weakened may rupture or herniate. If the annulus ruptures, or tears, the material in the nucleus can squeeze out of the disc, or herniate. A disc herniation usually causes compressive problems if the disc presses against a spinal nerve. The chemicals released by the disc may also inflame the nerve root, causing pain in the area where the nerve travels down the leg. This type of pain is referred to as sciatica. Even a normal disc can rupture. Heavy, repetitive bending, twisting, and lifting can place too much pressure on the disc, causing the annulus to tear and the nucleus to rupture into the spinal canal.

Facet Joint Arthritis

The facet joints along the back of the spinal column link the vertebrae together. They are not meant to bear much weight. However, if a disc loses its height, the vertebra above the disc begins to compress toward the one below. This causes the facet joints to press together. Articular cartilage covers the surfaces where these joints meet. Like other joints in the body that are covered with articular cartilage, the facet joints can develop osteoarthritis as the articular cartilage wears away over time. Extra pressure on the facet joints, such as that from a collapsing disc, can speed the degeneration in the facet joints. The swelling and inflammation from an arthritic facet joint can be a source of low back pain.

Segmental Instability

Segmental instability means that the vertebral bones within a spinal segment move more than they should. In the lumbar spine, this can develop if the disc has degenerated. Usually the supporting ligaments around the vertebrae have also been stretched over time.

Segmental instability also includes conditions in which a vertebral body begins to slip over the one below it. When a vertebral body slips too far forward, the condition is called spondylolisthesis. Whatever the cause, this extra movement in the bones of the spine can create problems. It can lead to mechanical pain simply because the structures of the spine move around too much and become inflamed and painful. The extra movement can also cause neurogenic symptoms if the spinal nerves are squeezed as a result of the segmental instability.

Spinal Stenosis

Stenosis means closing in. Spinal stenosis refers to a condition in which the tissues inside the spinal canal are closed in, or compressed. The spinal cord ends at L2. Below this level, the spinal canal contains only spinal nerves that travel to the pelvis and legs. When stenosis narrows the spinal canal, the spinal nerves are squeezed inside the canal.

The pressure from the condition can cause problems in the way the nerves work. The resulting problems include pain and numbness in the buttocks and legs and weakness in the muscles supplied by the nerves. Because these nerves travel to the bladder and rectum, weakness in the these muscles can cause problems with control of the bladder and bowels.

Foraminal Stenosis

Spinal nerves exit the spinal canal between the vertebrae in a tunnel called the neural foramen. Anything that causes this tunnel to become smaller can squeeze the spinal nerve where it passes through the tunnel. This condition is called foraminal stenosis, meaning the foramen is narrowed. As the disc collapses and loses height, the vertebral body above begins to collapse toward the one below. The opening around the nerve root narrows, squeezing the nerve. Arthritis of the facet joints causes bone spurs to form and point into the foramen, causing further nerve compression and irritation. Foraminal stenosis can cause a combination of mechanical pain and neurogenic pain from the irritated nerve root.

Symptoms

Symptoms from low back problems vary. They depend on a person’s condition and which structures are affected. Some of the more common symptoms of low back problems are

• low back pain

• pain spreading into the buttocks and thighs

• pain radiating from the buttock to the foot

• back stiffness and reduced range of motion

• muscle weakness in the hip, thigh, leg, or foot

• sensory changes (numbness, prickling, or tingling) in the leg, foot, or toes

Rarely, symptoms involve changes in bowel or bladder function. A large disc herniation that pushes straight back into the spinal canal can put pressure on the nerves that go to the bowels and bladder. The pressure may cause symptoms of low back pain, pain running down the back of both legs, and numbness or tingling between the legs in the area you would contact if you were seated on a saddle. The pressure on the nerves can cause a loss of control in the bowel or bladder.

This is an emergency!

If the pressure isn’t relieved, it can lead to permanent paralysis of the bowel and bladder. This condition is called cauda equina syndrome. Immediate surgery may be recommended, to remove pressure from the nerves.

Source:  https://eorthopod.com/

Arthritis + Nutrition

Nutrition and Arthritis. By Margaret Rayman and Alison Callaghan. Blackwell Publishing Ltd., Oxford, 2020.

ARTHRITIS ACTION FACTSHEET: diet + arthritis

The most important thing you can do if you have arthritis is to eat a wellbalanced diet and keep to a healthy weight. Contrary to popular belief, there are no particular diets or types of food that will make arthritis better or worse.

Healthy Eating

Several different diets have been tested clinically for rheumatoid arthritis (RA), including the vegan or vegetarian diet, the elemental diet, the exclusion diet and the Mediterranean diet. No particular diet has been shown to help with RA, though the National Institute of Health and Care Excellence (NICE) guideline for rheumatoid arthritis stated that the Mediterranean diet could be an option. Evidence suggests that the Mediterranean diet can reduce the risks of cardiovascular diseases, such as strokes and heart attacks, which can affect people with RA.

A number of studies have shown that people with osteoarthritis (OA) may experience less cartilage damage when following a Mediterranean diet. In terms of nutrients, studies have found people with OA who had a diet high in total and saturated fats experienced damage in the cartilage, compared to those with a moderate or lower-fat diet. As there is no definite evidence that any particular diet can affect arthritis, eating a healthy and well-balanced diet is the most sensible approach.

Weight Management & Arthritis

The most important link between diet and OA is body weight. Being overweight increases the risk of OA and worsens the pain in many joints, especially in the knees, hips and feet. Every 5kg of weight gain confers to nearly 50 percent increased risk of knee OA. Being overweight can also increase the risk of developing gout. A 10 percent of weight loss can reduce pain significantly, especially in the knees, and is one of the most important things you can do to help yourself. For instance, if you weigh 100kg (15 stone 10 pounds), losing just 10kg (22 pounds) can make a big difference to your pain and improve physical function. If you have rheumatoid and psoriatic arthritis, being overweight means that your arthritis is much less likely to respond to medicines and go into remission. People with rheumatoid and psoriatic arthritis also have a higher risk of cardiovascular disease, so keeping to a healthy weight is even more important for them.

Acidic Foods

Some people believe that eating so-called acidic foods, such as oranges, can make their arthritis worse. In fact, no foods can change the acidity in our bodies and there is no evidence suggesting that eating acidic foods makes arthritis any worse, or that avoiding these foods can help treat arthritis.

Nightshade Family of Vegetables

Another popular belief is that foods from the nightshade family, such as tomatoes, potatoes and peppers, can make arthritis worse. There is no evidence that this is the case or that avoiding these foods can help treat arthritis. If anything, these foods have high levels of antioxidants which may help reduce the risk of arthritis progression,
especially OA.

Food Allergies & Intolerance

The connection between food allergy or intolerance and arthritis is controversial. Research has shown that less than 5 percent of people with RA have definite sensitivity to certain foods, a percentage no different to the general population. Interestingly, nonsteroidal anti-inflammatory drugs (NSAIDs) and alcohol can increase the permeability of the gut which might affect food sensitivity. Provided you have a balanced diet, there is no harm in avoiding certain foods to see if this makes a difference to your arthritis, but make sure that you speak to your GP before trying this.

Gout & Diet

Gout is caused by too much uric acid in the blood. Only a small amount of uric acid comes from our diet. High uric acid is sometimes caused by genetic factors but more often by certain drugs, drinking too much alcohol, and being overweight. If you have gout, the most important thing you can do to help yourself is to keep to a healthy weight, reduce your alcohol intake – especially beer – and stay well-hydrated. Do not try to lose weight too quickly by fasting, using fad diets or completely cutting out carbohydrates. Doing this can actually increase uric acid levels in the body and make gout worse. Drinking cherry extract and increasing your intake of low-fat dairy products such as skimmed milk may also help reduce uric acid levels and the risk of acute gout attacks respectively.

Supplements

Many people with arthritis use dietary supplements albeit there is not much evidence that they work. Omega-3 polyunsaturated fatty acids may help people with inflammatory arthritis such as RA and psoriatic arthritis, but not in OA. There is no evidence that cod liver oil can reduce the symptoms of arthritis. Caution must be taken to not take cod liver oil in excess, especially in women who are pregnant or breastfeeding. People with OA often take glucosamine sulphate or chondroitin tablets, which are made from shellfish. Studies have not shown convincing evidence that they help, and they are not recommended in current guidelines. Many people with arthritis have also tried rosehip and turmeric (curcumin). Trials of these supplements have often shown conflicting results, however, some people with arthritis may find a small benefit.

Vitamin D deficiency

Vitamin D is essential for bone and muscle health and the main source of Vitamin D is sunlight. Current Department of Health guidelines recommend that all adults should consider a Vitamin D supplement of 10 micrograms (400 IU) daily between October and the end of
March, when there is not enough sunshine. People at risk of Vitamin D deficiency (those with dark skin or in care homes) should consider a supplement all year round.

References

Dyer J, Davison G, Marcora S & Mauger A (2020) Effect of a Mediterranean type diet on inflammatory and cartilage degradation biomarkers in patients with osteoarthritis. J.Nutr Health Ageing. Available at: http://link.springer.com/article/10.1007/s12603-016-
0806-y). Accessed 8 September 2020.

Estruch R, Ros E et al. (2017) Primary Prevention of Cardiovascular Disease with a Mediterranean Diet. N Engl J Med 368:1279-1290

Goff L. and Barasi M (2019) An assessment of the diets of people with rheumatoid arthritis. Journal of Human Nutrition and Dietetics 12: 93–101

Hliddal B, Leeds A & Christensen R (2020) Osteoarthritis, obesity and weight loss: Evidence, hypotheses and horizons – a scoping review. Obes Rev 15(7): 578–586

Rosato, V., Temple, N.J., La Vecchia, C. et al. Eur J Nutr (2020) Mediterranean diet and cardiovascular disease: a systematic review and meta-analysis of observational studies. Eur J Clin Nutr DOI: 10.1007/s00394-017-1582-0

Veronese N, Stubbs B, Noale M, Solmi M, Luchini C, Maggi S. (2019) Adherence to a Mediterranean diet is associated with lower prevalence of osteoarthritis: Data from the osteoarthritis initiative. Clin Nutr 36(6):1609-1614

Veronese N, La Tegola L, Crepaldi G, Maggi S, Rogoli D, Guglielmi G. (2019) The association between the Mediterranean diet and magnetic resonance parameters for knee osteoarthritis: data from the Osteoarthritis Initiative. Clin Rheumatol DOI: https://doi.org/10.1007/s10067-018-4075-5

ARTHRITIS ACTION FACTSHEET: osteoarthritis

Arthritis is a condition that causes joint pain. This Food Fact Sheet is about the role diet has in managing symptoms of the most common arthritic condition, osteoarthritis (OA).

What is osteoarthritis?

OA commonly affects the large joints such as the knees and hips but frequently occurs in the hands, the base of the big toe and the spine. It is a condition that affects the whole joint, where cartilage breakdown and inflammation can lead to pain, discomfort and a reduced quality of life. In the UK, it is the fastest growing cause of disability. OA may run in families or can develop as a result of injury. It largely affects people later in life and obesity is a major risk factor.
There is currently no cure for OA, so treatment options are generally limited to the management of pain and symptoms. Though there is no evidence that elimination diets are effective in OA, there are a number of dietary strategies that may help you to ease its symptoms, as explained below.

Maintaining a healthy weight

The most important relationship between diet and OA is weight. Not only does being obese or overweight increase the strain on joints, but excess fat causes inflammation which can exacerbate symptoms. There is strong evidence that losing weight can reduce pain and improve physical function and mobility. If you are overweight or obese, losing 10 percent of your body weight will give optimum benefit, not only for symptoms but for overall health. This can be achieved by eating a healthy diet with plenty of fruits and vegetables. Incorporating exercise helps to maintain muscle while losing weight. OA has been linked to type 2 diabetes and cardiovascular disease; losing excess weight will also help to prevent or manage these conditions.

What fats should I be consuming?

The long-chain omega-3 polyunsaturated fatty acids found in oily fish have anti-inflammatory properties that may well be of benefit in OA. Aim to consume at least one portion of oily fish a week, preferably two, e.g. sardines, mackerel, salmon and tuna (though not tinned tuna). If this is not possible, consider a trial of fish-oil capsules; 1-2 capsules should supply 450 mg EPA+DHA per day. Although, strictly speaking, this is not enough to produce anti-inflammatory effects, it is the dose that improved pain and function in a trial on knee OA patients and the dose recommended for reducing cardiac death. Omega-6 polyunsaturated fats (found in sunflower safflower, corn and grapeseed oils) are somewhat pro-inflammatory so may make symptoms worse, as may saturated fats. Replace them by oils and spreads rich in mono-unsaturated fats such as rapeseed oil and olive oil.

Cholesterol reduction

OA patients are more likely to have raised blood cholesterol than those without OA. There is some suggestion that lowering blood cholesterol will improve OA. In any case, if blood cholesterol is raised, it is important to make dietary changes to lower it – this will also benefit cardiovascular health. Collective dietary measures include:
• 2g/day of plant stanols/sterols – these can be found in proprietary fortified drinks, spreads, and yogurts;
• reducing the intake of foods high in saturated fat;
• increasing the intake of oats and other soluble fibres;
• eating nuts (30g /day);
• consuming soy protein (25g /day) e.g. tofu, soy milk, soy beans /edamame beans.

Antioxidants

Antioxidants, found in certain animal and plant products, protect the body from damaging oxidation, so-called ‘oxidative stress’ which may be involved in the development and progression of OA. Antioxidants that may be relevant include vitamins A, C and E. Though evidence for the effect of these vitamins in OA is weak, it would be wise to ensure an adequate daily intake as part of a healthy balanced diet (Table 1 gives rich sources). Getting these nutrients from food as opposed to supplements is always preferable because they come with other nutrients.

The importance of vitamin D

Vitamin D is essential for bone and cartilage health. Between the months of April and October in the UK, sunlight is the primary source of vitamin D although it can also be obtained from dietary sources (Table 1 below). Studies have shown that it may have a positive effect on muscular strength and balance. However, most people consume only small amounts in their diet. Taking a daily vitamin D supplement (e.g. 10-25 μg/day), especially during the winter months, will help to ensure sufficient status throughout the year. Maintaining a healthy weight may also improve the ability of your body to access vitamin D as it is sequestered in fat.

Should I be having more vitamin K?

Vitamin K may influence OA through its role in making bone and cartilage. Although evidence of benefit in OA is suggestive but currently limited, there is some suggestion that increasing vitamin K may be of benefit to those who are deficient, hence it is important to obtain it as part of a healthy balanced diet. Certain fats and oils (e.g. olive oil, margarine) contain small amounts of vitamin K and may also help its absorption from foods.

Food Avoidance

Several popular diet books on arthritis advocate avoiding foods such as dairy products or the nightshade vegetables (tomatoes, potatoes, bell peppers and aubergines). Though there is some evidence that food avoidance may help rheumatoid arthritis patients, there is no evidence of benefit in OA patients.

Dietary supplements

There is no good trial evidence to show that glucosamine, chondroitin, rose hip or turmeric help OA symptoms; studies claiming beneficial effects are more likely to be published than those that don’t. Recent analysis of patient data has failed to find any support for glucosamine. However, if your diet is restricted or your appetite is poor, you should consider taking a multivitamin/mineral supplement containing the recommended intake amounts (RNI or RDA) of the nutrients listed in Table 1.

Table 1: Key recommendations for OA

Aim for a healthy BMI, i.e. between 18.5 and 25 kg/m2.

If you are overweight or obese, take action to reduce your body weight by 10 percent.

Regular exercise is likely to help symptoms by preserving muscle strength.

Consume 1-2 portions of oily fish a week. If you cannot do that, consider trialling a fish-oil supplement (≥ 1.5 g fish-oil/day).

Use oils rich in mono-unsaturates (e.g. rapeseed oil and olive oil).

Take dietary action to reduce your blood cholesterol, if elevated.

During the summer months, aim for daily sunlight exposure (10-15 minutes without sunscreen) to increase vitamin D.

Take a vitamin D supplement of 10-25 μg /day, when there is no sun exposure.

Consume rich sources of vitamin K and the antioxidants, A, C, and E as part of a healthy balanced diet.

Summary

If you are overweight or obese, combining regular exercise with healthy eating to achieve weight loss is the most effective strategy to reduce joint pain. Increasing intake of long-chain omega-3 fatty acids and reducing blood cholesterol may be of some benefit and will improve cardiovascular health. To optimise intake of relevant micronutrients, eat food sources shown in Table 1 (above).

Useful links

MOH: https://www.health.govt.nz/your-health/healthy-living/food-activity-and-sleep/healthy-eating
Arthritis NZ: https://www.arthritis.org.nz
Arthritis Action: https://bpac.org.nz/2018/osteoarthritis.aspx
Further information: Food Fact Sheets on other topics including Weight loss, Omega-3, Cholesterol, Vitamin D and Healthy eating are available at www.bda.uk.com/foodfacts