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Joint Injuries & Other Aches & Pains
Dr. Judith Paley, MD

There###s an old saying that "what doesn###t kill you makes you strong." I###m sure you###ll agree, however, that the chronic pain of joint injuries or arthritis may not kill you but can certainly ruin your outlook and your day. My files with useful information on just such troubles are bulging, so periodically I will dedicate an issue of Femailhealthnews to health tips for the walking wounded.

It###s a Wrap!

If a heating pad is your idea of heaven when you###re down and out with cramps or back pain, you###ll soon be good to go with wearable heat wraps. Recent studies confirmed that warmth on the run reduces muscle tension and relieves pain whether it###s from your neck, your low back, or your monthly misery. The soon-to-be-marketed, over-the-counter wraps for shoulders and backs provide up to 10 hours of heat, generated by oxidation of iron pellets embedded in light-weight mesh. Researchers found that pain relief from such a toasty neck wrap lasted for up to 3 days after shedding the wrap. The ultra-thin mesh device used to alleviate menstrual cramps sticks to the inside of the underwear, and women so-outfitted rated the pain relief equal to that from ibuprofen, without drug-related side effects. Those lucky ladies in the heated undergarment group also noted a reduction in symptoms such as headache and water retention! The after-glow continued into the following day when, despite a return to old cold underwear, test subjects noted ongoing pain relief.

Why Old Ladies Don###t Eat Pickles

It###s not that they can###t eat pickles. The problem is that more than 20% of postmenopausal women have evidence of osteoarthritis (OA) at the base of the thumb, which can lead to pain, decreased grip strength, and an inability to open the pickle jar on their own. The strength and function of the thumb (which differentiates us from our primate ancestors) is rooted in the basal joint, just above the wrist, upon which the rest of thumb rotates. Gripping objects, whether babies or dishrags or briefcases, puts a significant load on this joint. After years of grabbing this and that through our long workdays, we may lose our grip altogether as progressive OA causes pain and deformity in this critically important joint.

The knee, another joint prone to OA, is supported and protected by the quadriceps muscle in the thigh, and strengthening this muscle group can slow the progression of arthritis. In contrast, the thumb has no such stabilizing muscles. In fact, the muscular forces asso-

ciated with the use of the hand tend to pull this joint out of alignment. As the supporting ligaments loosen with age (perhaps aggravated by estrogen deficiency), the long bone of the thumb slips off its base in the wrist and may become permanently dislocated. A splint can decrease pain and prevent joint deterioration. Patients with lots of ligamentous laxity but not much joint destruction may get relief from surgical intervention to reconstruct the ligaments. Exercise does not have a place in the treatment of OA of the thumb joint; in fact, it may make it worse.

When you###ve got two thumbs down from aging, hire someone else to do your floors.

Nutritional Advice for Joint Health

Scientists have found that high blood levels of vitamins C and D are useful in preventing the progression of osteoarthritis (OA) in the knee. The good citizens of Framingham Massachusetts, who have been measured and studied every which way, are the subjects of this investigation on nutritional supplements and arthritis.

No matter what the townfolks took in the way of vitamins, their risk of having arthritic changes noted on the first round of knee x-rays was not affected. However, those who dutifully downed their vitamin C (in pill or fruit form) had much less progression of the joint destruction when observed on follow-up x-rays. This makes sense because vitamin C is involved in the production of cartilage. A "C" deficiency may affect the quality of this important cushioning tissue that lines and protects the joint space. Likewise, those with the lowest vitamin D levels, as measured by either dietary intake or blood levels, had a threefold increased risk of downhill joint deterioration. Vitamin D is crucial to normal bone metabolism.

Dr. Tim McAlindon, a Boston researcher involved in the Framingham study, notes that just one orange a day plus 400 units of vitamin D (as found in most multivitamin pills) is sufficient to raise those with high-risk deficiencies to a lower risk group.

Don###t Rest Your Case...In Bed

Extended bed rest was once the standard of care for acute low-back pain. Gentle activity, with a fairly rapid resumption of normal activities, may be the best option for most back pain patients. Dr. Richard Deyo conducted a study comparing seven days of bed rest to

just two with respect to long-term pain relief and return to daily functioning. He found that there was no difference in short or long-term outcome, even when further studies looked at no bed rest at all. In fact, he notes, "The only factor that predicted the duration of the patient###s absence from work was our recommendation for how long to stay in bed."

Dr. Judith Paley is the author of Femailhealthnews, a weekly women’s health newsletter. To subscribe, send a blank email to join-femailhealthnews@lists.dundee.net

She welcomes comments and questions at her JAPaley@aol.com address.