JointVibes: by Dr Markandaiya Acharya

A 34-year-old software engineer from Bhubaneswar. Let us call him Debasis; he is not a real patient. He works from home on a dining chair, often for ten hours at a stretch. One Monday he bends to pick up his daughter's school bag and his lower back seizes. He can hardly stand straight. He asks me: "Doctor, should I lie flat in bed until it goes, or are there exercises I can do?" For most people with ordinary low back pain and no warning signs, staying gently active is better than bed rest. The American College of Physicians guideline recommends non-drug treatments such as heat, exercise and yoga as the first step, and most acute back pain improves within a few weeks. The simple stretches below can help you move more comfortably while it settles. First, check the warning signs that need a doctor. Check these warning signs first See a doctor the same day, or go to an emergency department, if back pain comes with any of these: Numbness around the genitals, buttocks or in...

A 45-year-old schoolteacher. Let us call her Mamata. She is not a real patient of mine, but I hear her story in my clinic almost every week. Every morning, her first few steps out of bed feel like stepping on a nail under the heel. After ten minutes of walking it eases. By evening, after hours of standing in the classroom, it is back. She has tried a softer chappal and hot-water soaks, and a neighbour has told her she has a "heel spur" that needs an injection. "Doctor, is a bone growing in my heel? Will I need an operation?" Where heel pain is felt and what it usually means: bottom front of the heel (plantar fasciitis), back of the heel (Achilles tendon), centre of the heel pad (fat pad pain) Bottom, front of heel Plantar fasciitis: worst with first morning steps Back of heel Achilles tendon Centre of heel pad fat pad pain Where your heel hurts points to the likely cause. Illustration: JointVibes. For most people with this pattern, the answer is no...

A 63-year-old retired railway clerk from Cuttack. Let us call him Bhagaban; he is not a real patient. His X-ray report says "moderate osteoarthritis of both knees". A relative has told him that once a knee "wears out", only an operation can help, so he has stopped his evening walk and is simply waiting for surgery. "Doctor, is there anything I can do before a knee replacement, or is it too late?" It is rarely too late. Guidelines from the American College of Rheumatology and from the Osteoarthritis Research Society International (OARSI) both name education, structured exercise and weight management as the core treatment for knee osteoarthritis, at every stage. Surgery is the top step of the ladder, not the first. Steps in treating knee arthritis: education, exercise and weight control for everyone; then pain-relief gels and short medicine courses; injections for some; knee replacement when other treatment has failed Education + strengthening exercise +...

A 42-year-old bank employee. Let us call her Rashmi. She is not a real patient of mine, but you may recognise her. For two years she has hurt "everywhere". Her neck, her shoulders, her lower back, her hips. Some mornings she wakes up feeling as if she has not slept at all. She forgets small things at work. Her X-rays are normal. Her blood tests are normal. One doctor told her it was "just stress". She sits in my clinic and asks quietly: "Doctor, am I imagining this pain?" No, she is not. What she is describing fits a well-recognised condition called fibromyalgia . It is real, it is common, and it can be managed. Here is what every patient and family should know. In fibromyalgia the nervous system amplifies ordinary signals, a process called central sensitisation. Illustration: JointVibes. What is fibromyalgia? Fibromyalgia is a long-term condition that causes widespread body pain , along with tiredness, poor sleep and problems with memory or concentr...

An 18-month-old girl is carried into my OPD by her grandmother. Let us call her Mili; she is not a real patient, but her story is common. She is not yet walking steadily. Her wrists look thick, and her legs bow outwards more than her cousins' did at that age. She has been breastfed, which is good, but she is rarely taken outdoors and has never been given vitamin D drops. "Doctor, will her legs straighten on their own?" Some bowing is normal in toddlers. But bowing that is getting worse, together with thick wrists and late walking, can be nutritional rickets. The 2016 global consensus on nutritional rickets is clear that it is preventable and, when caught early, treatable with vitamin D and calcium under medical supervision. Rickets, a condition that many consider a disease of the past, continues to affect children worldwide, particularly in developed nations where it was once thought to be eradicated. This skeletal disorder, characterized by soft and weakened bones, prima...