Take Charge of Your Health
An article by Dr. Kirtland Culmer

Back Pain and Common Muscular and Joint Problems
When a person cannot normally manipulate the upper half of his body, this becomes a very aggravating and sometimes incapacitating problem. It is no wonder then that so many patients with this condition are seen even in the general and family practitionerís offices. This nuisance problem is also a large cause of absenteeism from the workplace. There are also a large number of painful disorders occurring in other joints and their surrounding structures that show up in high numbers in primary care practices. If your doctor has a good knowledge and the ability to recognize the important patterns of pain and physical signs to make a correct diagnosis, X-rays and lab studies are not necessary in most cases. Diagnostic studies must be interpreted in the light of existing clinical findings, and, if used judiciously, can reduce the high cost resulting from unnecessary tests.

Most of these rheumatic disorders respond to local, conservative treatments such as heat or cold applications, splinting, and, if necessary, injections of glucocorticoids. Non-steroidal anti-inflammatory agents or mild pain medications can also be helpful. For more serious conditions, there may be a need for surgical referral. In cases such as intervertebral disc disease, spinal stenosis with nerve entrapment or spinal cord compression, it is most important to move quickly with the surgical intervention. Chiropractic therapy, physical therapy and occupational therapy are useful in many conditions, and especially those that seem to take forever to resolve.

Neck pain may result from degenerative changes in the bones, discs, muscles and ligaments of the neck. However, we see a lot of neck pain due to whiplash injuries in road traffic accidents perpetrated by the alarmingly increasing number of idiot drivers on the road. Recovery from whiplash injuries is often incomplete, so it is important that you are treated by the proper medical and ancillary personnel. The approach to the treatment of neck pain should be the same as indicated in the previous paragraph. If it is a simple neck sprain, then the conservative approach is adequate. If, on the other hand, it is a herniated disc in the neck with symptoms of radiculopathy (pain, numbness or weakness radiating down the arm), then a surgical approach may or may not be indicated.

Back pain may be acute or chronic. Low back pain is the most common musculoskeletal complaint requiring medical attention. It is the fifth most common reason for all physician visits according to U.S. statistics. Over half of the population will seek medical attention for back pain at some point in their life. Males are more at risk than females, and other causes are smoking, frequent lifting of children or heavy loads, poor general health and conditioning, and certain occupational and sports activities.

For patients with acute back pain, the doctor will take a good history, do an initial physical examination including flexion and straight leg raising to decide whether he is dealing with serious underlying conditions such as fracture, infection, tumor, or major neurological problems. Barring these serious abnormalities, acute low back pain will improve within a month in 90% of patients. Very good results will follow from a few short days of rest, activity to the extent of not causing additional pain, and analgesics.

Patients whose pain persists for 4 to 6 weeks of conservative treatment need to be reassessed for serious problems as indicated above. They should have the necessary tests which may include lab tests, x-rays, MRIís or other investigations as indicated. These are the folks with chronic back pain. In addition to the specific treatment for these persons with chronic back pain, there should be a program of rehabilitative exercise and education.

Shoulder pain is another one of the most common musculoskeletal problems seen in the doctorís office. Most shoulder pain results from conditions involving structures surrounding the joint. True arthritis of the shoulder joint is very uncommon. Plain X-rays are seldom helpful, and some specialized tests like arthrography, arthroscopy and MRI may be necessary to make the diagnosis- especially for lesions that may require surgery. There are many types of syndromes that cause shoulder pain. Rotator Cuff Tendinitis, Calcific Tendinitis, Bicipital Tendinitis, Frozen Shoulder and Myofascial Shoulder Pain Syndrome are some of conditions mentioned.

Space would not allow me to go into details of the Chest Wall Pain, Elbow Pain, Hand and Wrist Pain, Hip Girdle Pain, Knee and Lower Leg Pain, and Ankle and Foot Pain. It is sufficient here to point out that treatment for conditions affecting all of these areas require the same general approach of conservative or surgical depending on the severity of the situation.

The concluding challenge is how to take charge in all of these painful situations. If there is evidence of aging, a history of cancer, glucocorticoid or immunosuppressive drug treatment, weight loss, fever, pain increased by rest, bowel or bladder dysfunction, numbness or progressive muscular weakness, then underlying conditions must be suspected, investigated and treated as indicated by your doctor. If surgery is suggested, be as certain as you can that the opinion is the best that you can obtain, then go with it. To be certain that you are in the best condition to handle any eventuality, stay as fit as possible with the appropriate lifestyle considerations including proper nutrition and exercise.