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Body aches and joint pain

   Dr Amir Ijaz, an Orthopedic surgeon at Ittefaq Hospital Lahore sheds light on common causes of body aches and joint pain. Also talks about knee replacement surgery and tips to maintain good bone health

SN: What do orthopedic surgeons deal with?sni

Orthopedic is a very vast field. It covers all the bones, soft tissues and limbs of the body expect for head and brain. In foreign countries every orthopedic surgeon is specialized. For example, if he is a knee surgeon he will only deal with knee, etc. But in Pakistan things are different. Here, almost every doctor is dealing with everything.sni

SN: Which bone and joint problems are common in Pakistan?sni

I have seen trauma or neglected trauma patients most commonly. People go to pehalwans for such problems and then come to us after the problem has worsened. Backache comes next in the list. Due to lack of health awareness people do not get their calcium and vitamin D levels checked regularly. GPs should recommend blood tests of patients and make sure their levels are alright. Lack of these minerals causes body aches and pains.sni

Young females are also deficient in calcium, especially those who breastfeed their kids. Moreover, women in menopausal age have hormonal problems due to which they suffer from generalized body aches and pains and osteoporosis. There is no trend of exercising in Pakistan. Every person should walk for 30 minutes, three times a week. But people are just busy with their work and lack of physical activity also causes bone weakness. Dietary habits and lifestyle play a key role.sni

SN: Why are bone and joint problems more common in women?sni

Osteoporosis, weakness of the bones, is highly common in women. Dietary, hormonal and age being the reasons. Generally, women in Pakistan do not do any exercise and keep putting on weight. And then complain about backaches and knee pain. Obesity is also common in women here. The health status of women abroad is much better. They are well aware and are physically active. Even 70-80 year old women walk three to four miles a day. Contrarily, women of this age group in our country do not go out of their house. They just lie in bed and family members are pressing their legs.sni

There is no trend of exercising in Pakistan. Every person should walk for 30 minutes, three times a week. But people are just busy with their work 

SN: Even youngsters nowadays complain of body aches and joint pains. What can be the reason?sni

Unhealthy eating habits and physical inactivity are the culprits. Children nowadays just sit glued to their computer screens and play games with least physical activity. What bone growth do you expect them to have? If you assess the bone of a Pakistani and a European child, you will know the difference. I had the opportunity to put a plate in a 15 year old’s leg. I was shocked to see his bone quality. His bone was very soft.sni

I consulted my colleagues who told me the bone quality I am looking for will rarely be found here. Parents definitely have a role to play in this. What will they teach their children when they do not have awareness and are not into any sort of physical activity? Some parents tell their kids that all they need to do is study. This is so wrong. Everything needs to be done in a balance. Lack of playgrounds is also a big problem here and even schools do not have them.sni

SN: Since which age should people be conscious about bone health and what can be done to improve it?sni

Firstly, it is the responsibility of parents to introduce healthy foods to their children. Then as they grow they should not be told to just focus on studies. Physical activity of some sort is highly important. So as grown ups they should be well aware about what they should do to improve their health. People, especially kids nowadays are more into fancy foods, which should be avoided. Keep life simple.sni

SN: What is your take on injections that are recommended to patients for knee joint pain?sni

There are a lot of controversies regarding this. There are actually two types of injections, one is for pain relief in which local anesthetics and steroids are given for temporary relief. I tell my patients that it may help you but there is no guarantee. Pain relief can be for few months or weeks or there may be no improvement at all. The injection can be effective for a maximum of three months.sni

If it is mechanical pain due to arthritis then definitely it will help relieve the pain. The injection should not be given more than thrice in a year. It is the doctor’s responsibility to explain to the patient what treatment is being done, why and what outcomes it will have.sni

A patient may find no relief if the injection is given for the wrong reason, is not administered in the appropriate place or the patient is resistant to drugs. 90 percent patients with mechanical symptoms should get some relief if applied in the right place. And if it is advance osteoarthritis, then the injection will have some level of effect but then the patient would require a transplant.sni

A patient may find no relief if the injection is given for the wrong reason, is not administered properly or the patient is resistant to drugs

SN: Why is the concept of going to pehalwans for bone and joint problems common in our culture?sni

Socio-economic conditions and beliefs are the reasons why people go to them. People have been going to them for generations that is why they have firm belief in them. Earlier people did not have options. Now people have options and treatment availability as well. In healthy people, undisplaced fractures naturally heal on its own with time. And pehalwans get the credit for it.sni

Recently, a two year old kid was brought to me who had been to a pehlawan and who had supposedly fixed his shoulder joint. He had wooden planks around it. This is because of lack of education.sni

SN: Other than calcium, what else do we need to make bones strong?sni

Bones are made up of calcium and phosphate. Vitamin D is required to absorb calcium. If you eat normal balanced diet you will not be deficient of these minerals.sni

SN: How effective is oil massage for pain?sni

Massage with any lubricant is effective for muscles. It increases blood flow, removes toxic agents and relieves pain.sni

SN: Is it true that bones build a new skeleton every three months?sni

When a child grows and reaches maturity then the length stops increasing. After that stiffness and strength of the bones depends on the amount of physical activity of the individual. Remodeling or wear and tear of the bones keeps occurring that causes the changes. The structure however, remains the same. They keep becoming strong and weak depending on the physical activity and age.sni

Bones are made up of calcium and phosphate. If you eat normal balanced diet you will not be deficient of these minerals

SN: Can every joint of the body be replaced through surgery?sni

Yes it can be replaced. But according to evidence, successful joint replacements are of knee and hip joints. Shoulder and elbow joints come next. Replacement of ankle and wrist joints is not much successful. Fusion (permanently joining together two or more bones so there is no movement between them) is a better option in such cases.sni

SN: When is knee replacement surgery required?sni

Individual who has pain to an extent that it disturbs the lifestyle and makes it impossible for him to sleep during the night. Moreover, the individual is unable to walk or perform daily activities like going to the washroom and there is a need to take painkillers frequently. And before that he has tried every possible treatment like injections, etcetera but in vain. Then the patient is counseled for surgery and is informed about its pros and cons.sni

SN: How much time does it take to heal the wound?sni

Normally, with physiotherapy and no complication, hospital stay can be around five days after the surgery. After that the patient should be able to walk and in six weeks time should be able to come back to normal life.sni

Education level of general population is low. They need to be made aware, especially through media. Moreover, unhealthy habits should be changed

SN: How long do these artificial joints last?sni

Longest survival is around 40 to 50 years. But normally we tell patients they will last around 10-15 years. After that revision surgery is required.sni

SN: Anything left at the end that you would like to add?sni

The education level of our general population is low. They need to be made aware, especially through media. Moreover, unhealthy eating habits should be changed. Normal simple diet and physical activity can keep you away from many health problems.sni

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