Everything you need to know about osteoarthritis

Osteoarthritis (OA) causes inflammation in the joints and the breakdown and gradual loss of joint cartilage. As the cartilage wears down, a person experiences pain and difficulty with movement.

OA is a common joint disorder. It develops in the hand, for example, in 1 in 12 people over the age of 60, according to the Arthritis Foundation.

OA is a progressive disease, which means that symptoms worsen over time.

There is no cure, but treatment can help manage pain and swelling and keep a person mobile and active.

Symptoms

OA leads to pain and stiffness in the joints.

In the early stages, a person may have no symptoms. Symptoms may occur in one or more joints, and they tend to appear gradually.

When symptoms develop, they can include:

  • pain and stiffness that worsen after not moving the joint for a while
  • swelling
  • difficulty moving the affected joint
  • warmth and tenderness in the joints
  • a loss of muscle bulk
  • a grating or crackling sound in the joint, known as crepitus

The progression of OA involves:

  • synovitis — mild inflammation of the tissues around the joints
  • damage and loss of cartilage
  • bony growths that form around the edges of joints

Effects

Cartilage is a protective substance that cushions the ends of the bones in the joints and allows the joints to move smoothly and easily.

In people with OA, the smooth surface of the cartilage becomes rough and starts to wear away. As a result, the unprotected bones start to rub together, causing damage and pain.

Eventually, bony lumps form on the joint. The medical names for these are bone spurs or osteophytes, and they can lend a knobbly appearance to the joint.

As the bones change shape, the joints become stiffer, less mobile, and painful. Fluid may also accumulate in the joint, resulting in swelling. While OA can develop in any joint, it commonly affects the knees, hips, hands, lower back, and neck.

The knees

OA usually occurs in both knees, unless it results from an injury or another condition.

A person with the condition may notice that:

  • There is pain when walking, especially uphill or upstairs.
  • The knees lock into position, making it harder to straighten the leg.
  • There is a soft, grating sound when they bend or flex the knee.

The hips

A person with OA in the hips may find that any movement of the hip joint, such as standing up or sitting down, can cause difficulty or discomfort.

Pain in the hips is a common feature of the condition. OA in the hips can also cause pain in the knee or in the thighs and buttocks.

A person may experience this pain while resting as well as while walking, for example.

The hands

In the hands, OA can develop in:

  • the base of the thumb
  • the top joint of the other fingers, closest to the nail
  • the middle joint of the other fingers

A person with the condition may notice:

  • pain, stiffness, and swelling in the fingers
  • bumps that develop on the finger joints
  • a slight bend sideways at the affected joints
  • fluid-filled lumps or cysts on the backs of the fingers, which may be painful
  • a bump that develops where the thumb joins the wrist, which can make it difficult to write or turn a key

For some people, the finger pain decreases and eventually goes away, though the swelling and bumps remain.

Anyone who experiences joint stiffness and swelling for more than 2 weeks should see a doctor.

Causes

Doctors do not know the exact cause of OA, but it seems to develop when the body is unable to repair joint tissue in the usual way.

It often affects older people, but it can occur at any age.

Genetic factors

Some genetic features increase the risk of developing OA. When these features are present, the condition can occur in people as young as 20 years old.

Trauma and overuse

A traumatic injury, surgery, or overuse of a joint can undermine the body’s ability to carry out routine repairs and may trigger OA, eventually leading to symptoms.

It can take several years for OA symptoms to appear after an injury.

Reasons for overuse or repeated injury include jobs and sports that involve repetitive movement.

Risk factors

A number of risk factors increase the chances of developing OA.

  • Sex: OA is more common among females than males, especially after the age of 50.
  • Age: Symptoms are more likely to appear after the age of 40, though OA can develop in younger people after an injury — especially to the knee — or as a result of another joint condition.
  • Obesity: Excess weight can put strain on weight-bearing joints, increasing the risk of damage.
  • Occupation: Jobs that involve repetitive movements in a particular joint increase the risk.
  • Genetic and hereditary factors: These can increase the risk in some people.

Other conditions

Some diseases and conditions make it more likely that a person will develop OA.

  • inflammatory arthritis, such as gout or rheumatoid arthritis
  • Paget’s disease of the bone
  • septic arthritis
  • poor alignment of the knee, hip, and ankle
  • having legs of different lengths
  • some joint and cartilage abnormalities that are present from birth

Diagnosis

A doctor will ask about symptoms and perform a physical examination.

No definitive test can diagnose OA, but tests can show whether damage has occurred and help rule out other causes.

Tests may include:

X-rays and MRI: These can reveal bone spurs around a joint or a narrowing within a joint, suggesting that cartilage is breaking down.

Joint fluid analysis: A doctor will use a sterile needle to withdraw fluid from an inflamed joint for analysis. This can rule out gout or an infection.

Blood tests: These can help rule out other conditions, such as rheumatoid arthritis.

Treatment

While no treatment can reverse the damage of OA, some can help relieve symptoms and maintain mobility in the affected joints.

Interventions include exercise, manual therapy, lifestyle modification, and medication.

Medication

Medication can help reduce pain.

Acetaminophen (Tylenol)

This can relieve pain in people with mild to moderate symptoms. Follow the doctor’s instructions, as overuse can lead to side effects and cause interactions with other medications.

Nonsteroidal anti-inflammatory drugs

If acetaminophen does not help, the doctor may recommend a stronger pain reliever, which may include ibuprofen, aspirin, or diclofenac.

A person can take these orally or topically, applying the medication directly to the skin.

Capsaicin cream

This is a topical medication that contains the active compound in chilies. It creates a sensation of heat that can reduce levels of substance P, a chemical that acts as a pain messenger.

Pain relief can take 2 weeks to a month to fully take effect.

Do not use the cream on broken or inflamed skin, and avoid touching the eyes, face, and genitals after using it.

Intra-articular cortisone injections

Corticosteroid injections in the joint can help manage severe pain, swelling, and inflammation. These are effective, but frequent use can lead to adverse effects, including joint damage and a higher risk of osteoporosis.

Duloxetine (Cymbalta) is an oral drug that can help treat chronic musculoskeletal pain.

Physical therapy

Various types of physical therapy may help, including:

Transcutaneous electrical nerve stimulation (TENS): A TENS unit attaches to the skin with electrodes. Electrical currents then pass from the unit through the skin and overwhelm the nervous system, reducing its ability to transmit pain signals.

Thermotherapy: Heat and cold may help reduce pain and stiffness in the joints. A person could try wrapping a hot water bottle or an ice pack in a towel and placing it on the affected joint.

Manual therapy: This involves a physical therapist using hands-on techniques to help keep the joints flexible and supple.

Assistive devices

Various tools can provide physical support for a person with OA.

Special footwear or insoles can help, if OA affects the knees, hips, or feet, by distributing body weight more evenly. Some shock-absorbing insoles can also reduce the pressure on the joints.

A stick or cane can help take the weight off of the affected joints and may reduce the risk of a fall. A person should use it on side of the body opposite to the areas with OA.

Splints, leg braces, and supportive dressings can help with resting a painful joint. A splint is a piece of rigid material that provides joint or bone support.

Do not use a splint all the time, however, as the muscles can weaken without use.

Surgery

Some people may need surgery if OA severely affects the hips, knees, joints, or the base of the thumbs.

A doctor will usually only recommend surgery if other therapies have not helped or if there is severe damage in a joint.

Some helpful procedures include:

Arthroplasty

This involves a surgeon removing the damaged areas and inserting an artificial joint, made of metal and plastic. Some refer to this procedure as a total joint replacement.

The joints that most often require replacing are the hip and knee joints, but implants can also replace the joints in the shoulder, finger, ankle, and elbow.

Most people can use their new joint actively and painlessly. However, there is a small risk of infection and bleeding. An artificial joint may also come loose or wear down and eventually need replacing.

Arthrodesis

This involves a surgeon realigning, stabilizing, or surgically fixing the joint to encourage the bones to fuse. Increased stability can reduce pain.

A person with a fused ankle joint will be able to put their weight on it painlessly, but they will not be able to flex it.

Osteotomy

This involves a surgeon removing a small section of bone, either above or below the knee joint. It can realign the leg so that the person’s weight no longer bears down as heavily on the damaged part of the joint.

This can help relieve symptoms, but the person may need knee replacement surgery later on.

Complications

Septic arthritis is joint inflammation caused by bacteria. Joint replacement surgery slightly increases the risk of this infection.

This is a medical emergency, and hospitalization is necessary. Treatment involves antibiotic medication and drainage of the infected fluid from the joint.

Lifestyle tips

A range of strategies can help ease the symptoms of OA. Ask the doctor for advice about suitable lifestyle adjustments. They may recommend:

Exercise and weight control

Exercise is crucial for:

  • maintaining mobility and range of movement
  • improving strength and muscle tone
  • preventing weight gain
  • building up muscles
  • reducing stress
  • lowering the risk of other conditions, such as cardiovascular disease

Current guidelines recommend that everyone should do at least 150 minutes of moderate-intensity exercise each week.

A doctor or physical therapist can help develop an exercise program, and it is important to follow their instructions carefully to prevent further damage.

Choose activities that will not put additional strain on the joints. Swimming and other types of water-based exercise are a good way to keep fit without putting additional pressure on the joints.

Assistive devices and adjustments

A loss of mobility due to OA can lead to further problems, such as:

  • an increased risk of falls
  • difficulty carrying out daily tasks
  • stress
  • isolation and depression
  • difficulty working

A physical or occupational therapist can help with these issues. They may recommend:

Assistive devices: Using a walker or cane can help prevent falls.

Adjustments to furniture and home fittings: Higher chairs and devices such as levers that make it easier to turn faucet knobs, for example, can help.

Talking to an employer: It may be possible to make adjustments to the workplace or arrange for more flexible hours.

Supplements

Some research has suggested that people with low vitamin D levels have a higher risk of OA. Also, in people with a low vitamin C intake, the disease may progress more rapidly.

Low levels of vitamin K and selenium may also contribute, but confirming these findings will require further research.

Some people use supplements for OA, including:

  • omega-3 fatty acids
  • calcium
  • vitamin D

The American College of Rheumatology note that there is not enough evidence to support the safety and effectiveness of these supplements for OA. They recommend asking a doctor before using them.

Outlook

OA is a common disease that causes joints to deteriorate, leading to pain and stiffness. It tends to appear during middle age or later.

There is currently no cure, but researchers are looking for ways to slow or reverse the damage. Lifestyle remedies and pain relief medications can help manage it.

Osteoarthritis

15 natural ways to lower your blood pressure

High blood pressure is a dangerous condition that can damage your heart. It affects one in three people in the US and 1 billion people worldwide.

If left uncontrolled, high blood pressure raises your risk of heart disease and stroke.

But there’s good news. There are a number of things you can do to lower your blood pressure naturally, even without medication.

Here are 15 natural ways to combat high blood pressure.

1. Walk and exercise regularly

Exercise is one of the best things you can do to lower high blood pressure. Regular exercise helps make your heart stronger and more efficient at pumping blood, which lowers the pressure in your arteries. In fact, 150 minutes of moderate exercise, such as walking, or 75 minutes of vigorous exercise, such as running, per week, can help lower blood pressure and improve your heart health.

What’s more, doing even more exercise than this reduces your blood pressure even further, according to the National Walkers’ Health Study.

Bottom line: Walking just 30 minutes a day can help lower your blood pressure. More exercise helps reduce it even further.

2. Reduce your sodium intake

Salt intake is high around the world. In large part, this is due to processed and prepared foods.

For this reason, many public health efforts are aimed at lowering salt in the food industry.

Many studies have linked high salt intake with high blood pressure and heart events, including stroke.

However, more recent research indicates that the relationship between sodium and high blood pressure is less clear.

One reason for this may be genetic differences in how people process sodium. About half of people with high blood pressure and a quarter of people with normal levels seem to have a sensitivity to salt.

If you already have high blood pressure, it’s worth cutting back your sodium intake to see if it makes a difference. Swap out processed foods with fresh ones and try seasoning with herbs and spices rather than salt.

Bottom line: Most guidelines for lowering blood pressure recommend reducing sodium intake. However, that recommendation might make the most sense for people who are salt-sensitive.

3. Drink less alcohol

Drinking alcohol can raise blood pressure. In fact, alcohol is linked to 16% of high blood pressure cases around the world.

While some research has suggested that low-to-moderate amounts of alcohol may protect the heart, those benefits may be offset by adverse effects.

In the U.S., moderate alcohol consumption is defined as no more than one drink a day for women and two for men. If you drink more than that, cut back.

Bottom line: Drinking alcohol in any quantity may raise your blood pressure. Limit your drinking in line with the recommendations.

4. Eat more potassium-rich foods

Potassium is an important mineral.

It helps your body get rid of sodium and eases pressure on your blood vessels.

Modern diets have increased most people’s sodium intake while decreasing potassium intake.

To get a better balance of potassium to sodium in your diet, focus on eating fewer processed foods and more fresh, whole foods.

Foods that are particularly high in potassium include:

  • vegetables, especially leafy greens, tomatoes, potatoes, and sweet potatoes
  • fruit, including melons, bananas, avocados, oranges, and apricots
  • dairy, such as milk and yogurt
  • tuna and salmon
  • nuts and seeds
  • beans

Bottom line: Eating fresh fruits and vegetables, which are rich in potassium, can help lower blood pressure.

5. Cut back on caffeine

If you’ve ever downed a cup of coffee before you’ve had your blood pressure taken, you’ll know that caffeine causes an instant boost.

However, there’s not a lot of evidence to suggest that drinking caffeine regularly can cause a lasting increase.

In fact, people who drink caffeinated coffee and tea tend to have a lower risk of heart disease, including high blood pressure, than those who don’t drink it.

Caffeine may have a stronger effect on people who don’t consume it regularly.

If you suspect you’re caffeine-sensitive, cut back to see if it lowers your blood pressure.

Bottom line: Caffeine can cause a short-term spike in blood pressure, although for many people, it does not cause a lasting increase.

6. Learn to manage stress

Stress is a key driver of high blood pressure.

When you’re chronically stressed, your body is in a constant fight-or-flight mode. On a physical level, that means a faster heart rate and constricted blood vessels.

When you experience stress, you might also be more likely to engage in other behaviors, such as drinking alcohol or eating unhealthful food that can adversely affect blood pressure.

Several studies have explored how reducing stress can help lower blood pressure. Here are two evidence-based tips to try:

  • Listen to soothing music: Calming music can help relax your nervous system. Research has shown it’s an effective complement to other blood pressure therapies.
  • Work less: Working a lot, and stressful work situations, in general, are linked to high blood pressure.

Bottom line: Chronic stress can contribute to high blood pressure. Finding ways to manage stress can help.

7. Eat dark chocolate or cocoa

Here’s a piece of advice you can really get behind.

While eating massive amounts of dark chocolate probably won’t help your heart, small amounts may.

That’s because dark chocolate and cocoa powder are rich in flavonoids, which are plant compounds that cause blood vessels to dilate.

A review of studies found that flavonoid-rich cocoa improved several markers of heart health over the short term, including lowering blood pressure.

For the strongest effects, use non-alkalized cocoa powder, which is especially high in flavonoids and has no added sugars.

Bottom line: Dark chocolate and cocoa powder contain plant compounds that help relax blood vessels, lowering blood pressure.

8. Lose weight

In people with overweight, losing weight can make a big difference to heart health.

According to a 2016 study, losing 5% of your body mass could significantly lower high blood pressure .

In previous studies, losing 17.64 pounds (8 kilograms) was linked to lowering systolic blood pressure by 8.5 mm Hg and diastolic blood pressure by 6.5 mm Hg.

To put that in perspective, a healthy reading should be less than 120/80 mm Hg.

The effect is even greater when weight loss is paired with exercise.

Losing weight can help your blood vessels do a better job of expanding and contracting, making it easier for the left ventricle of the heart to pump blood.

Bottom line: Losing weight can significantly lower high blood pressure. This effect is even more significant when you exercise.

9. Quit smoking

Among the many reasons to quit smoking is that the habit is a strong risk factor for heart disease.

Every puff of cigarette smoke causes a slight, temporary increase in blood pressure. The chemicals in tobacco are also known to damage blood vessels.

Surprisingly, studies haven’t found a conclusive link between smoking and high blood pressure. Perhaps this is because smokers develop a tolerance over time.

Still, since both smoking and high blood pressure raise the risk of heart disease, quitting smoking can help lessen that risk.

Bottom line: There’s conflicting research about smoking and high blood pressure, but what is clear is that both increase the risk of heart disease.

10. Cut added sugar and refined carbs

There’s a growing body of research showing a link between added sugar and high blood pressure.

In the Framingham Women’s Health Study, women who drank even one soda per day had higher levels than those who drank less than one soda per day.

Another study found that having one less sugar-sweetened beverage per day was linked to lower blood pressure .

And it’s not just sugar — all refined carbs, such as the kind found in white flour — convert rapidly to sugar in your bloodstream and may cause problems.

Some studies have shown that low carb diets may also help reduce blood pressure.

One study on people undergoing statin therapy found that those who went on a 6-week, carb-restricted diet saw a greater improvement in blood pressure and other heart disease markers than people who did not restrict carbs .

Bottom line: Refined carbs, especially sugar, may raise blood pressure. Some studies have shown that low carb diets may help reduce your levels.

11. Eat berries

Berries are full of more than just juicy flavor.

They’re also packed with polyphenols, natural plant compounds that are good for your heart.

Polyphenols can reduce the risk of stroke, heart conditions, and diabetes, as well as improving blood pressure, insulin resistance, and systemic inflammation.

One study assigned people with high blood pressure to a low-polyphenol diet or a high-polyphenol diet containing berries, chocolate, fruits, and vegetables.

Those consuming berries and polyphenol-rich foods experienced improved markers of heart disease risk.

Bottom line: Berries are rich in polyphenols, which can help lower blood pressure and the overall risk of heart disease.

12. Try meditation or deep breathing

While these two behaviors could also fall under “stress reduction techniques,” meditation and deep breathing deserve specific mention.

Both meditation and deep breathing may activate the parasympathetic nervous system. This system is engaged when the body relaxes, slowing the heart rate, and lowering blood pressure.

There’s quite a bit of research in this area, with studies showing that different styles of meditation appear to have benefits for lowering blood pressure.

Deep breathing techniques can also be quite effective.

In one study, participants were asked to either take six deep breaths over the course of 30 seconds or simply sit still for 30 seconds. Those who took breaths lowered their blood pressure more than those who just sat.

Try guided meditation or deep breathing. Here’s a video to get you started.

Bottom line: Both meditation and deep breathing can activate the parasympathetic nervous system, which helps slow your heart rate and lower blood pressure.

13. Eat calcium-rich foods

People with low calcium intake often have high blood pressure.

While calcium supplements haven’t been conclusively shown to lower blood pressure, calcium-rich diets do seem linked to healthful levels.

For most adults, the calcium recommendation is 1,000 milligrams (mg) per day. For women over 50 and men over 70, it’s 1,200 mg per day.

In addition to dairy, you can get calcium from collard greens and other leafy greens, beans, sardines, and tofu. Here is a list of calcium-rich plant-based foods.

Bottom line: Calcium-rich diets are linked to healthy blood pressure levels. You can get calcium through eating dark leafy greens and tofu, as well as dairy.

14. Take natural supplements

Some natural supplements may also help lower blood pressure. Here are some of the main supplements that have evidence behind them:

  • Aged garlic extract: Researchers have used aged garlic extract successfully as a stand-alone treatment and along with conventional therapies for lowering blood pressure.
  • Berberine: Traditionally used in Ayurvedic and Chinese medicine, berberine may increase nitric oxide production, which helps decrease blood pressure.
  • Whey protein: A 2016 study found that whey protein improved blood pressure and blood vessel function in 38 participants.
  • Fish oil: Long credited with improving heart health, fish oil may benefit people with high blood pressure the most.
  • Hibiscus: Hibiscus flowers make a tasty tea. They’re rich in anthocyanins and polyphenols that are good for your heart and may lower blood pressure.

Bottom line: Researchers have investigated several natural supplements for their ability to lower blood pressure.

15. Eat foods rich in magnesium

Magnesium is an important mineral that helps blood vessels relax.

While magnesium deficiency is pretty rare, many people don’t get enough.

Some studies have suggested that getting too little magnesium is linked with high blood pressure, but evidence from clinical studies has been less clear.

Still, eating a magnesium-rich diet is a recommended way to ward off high blood pressure.

You can incorporate magnesium into your diet by consuming vegetables, dairy products, legumes, chicken, meat, and whole grains.

Bottom line: Magnesium is an essential mineral that helps regulate blood pressure. Find it in whole foods, such as legumes and whole grains.

Take home message

High blood pressure affects a large proportion of the world’s population.

While drugs are one way to treat the condition, there are many other natural techniques, including eating certain foods that can help.

BACK PAIN

Back pain is a common reason for absence from work and for seeking medical treatment. It can be uncomfortable and debilitating.

It can result from injury, activity and some medical conditions. Back pain can affect people of any age, for different reasons. As people get older, the chance of developing

lower back pain increases, due to factors such as previous occupation and degenerative disk disease.

Lower back pain may be linked to the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, lower back muscles, abdominal and pelvic internal organs, and the skin around the lumbar area.

Pain in the upper back may be due to disorders of the aorta, tumors in the chest, and spine inflammation.

Causes

Problems with the spine such as osteoporosis can lead to back pain.

The human back is composed of a complex structure of muscles, ligaments, tendons, disks, and bones, which work together to support the body and enable us to move around.

The segments of the spine are cushioned with cartilage-like pads called disks.

Problems with any of these components can lead to back pain. In some cases of back pain, its cause remains unclear.

Damage can result from strain, medical conditions, and poor posture, among others.

Strain

Back pain commonly stems from strain, tension, or injury. Frequent causes of back pain are:

  • strained muscles or ligaments
  • a muscle spasm
  • muscle tension
  • damaged disks
  • injuries, fractures, or falls

Activities that can lead to strains or spasms include:

  • lifting something improperly
  • lifting something that is too heavy
  • making an abrupt and awkward movement

Structural problems

A number of structural problems may also result in back pain.

  • Ruptured disks: Each vertebra in the spine is cushioned by disks. If the disk ruptures there will be more pressure on a nerve, resulting in back pain.
  • Bulging disks: In much the same way as ruptured disks, a bulging disk can result in more pressure on a nerve.
  • Sciatica: A sharp and shooting pain travels through the buttock and down the back of the leg, caused by a bulging or herniated disk pressing on a nerve.
  • Arthritis: Osteoarthritis can cause problems with the joints in the hips, lower back, and other places. In some cases, the space around the spinal cord narrows. This is known as spinal stenosis.
  • Abnormal curvature of the spine: If the spine curves in an unusual way, back pain can result. An example is scoliosis, in which the spine curves to the side.
  • Osteoporosis: Bones, including the vertebrae of the spine, become brittle and porous, making compression fractures more likely.
  • Kidney problems: Kidney stones or kidney infection can cause back pain.

Movement and posture

Adopting a very hunched sitting position when using computers can result in increased back and shoulder problems over time.

Back pain can also result from some everyday activities or poor posture.

Examples include:

  • twisting
  • coughing or sneezing
  • muscle tension
  • over-stretching
  • bending awkwardly or for long periods
  • pushing, pulling, lifting, or carrying something
  • standing or sitting for long periods
  • straining the neck forward, such as when driving or using a computer
  • long driving sessions without a break, even when not hunched
  • sleeping on a mattress that does not support the body and keep the spine straight

Other causes

Some medical conditions can lead to back pain.

  • Cauda equina syndrome: The cauda equine is a bundle of spinal nerve roots that arise from the lower end of the spinal cord. Symptoms include a dull pain in the lower back and upper buttocks, as well as numbness in the buttocks, genitalia, and thighs. There are sometimes bowel and bladder function disturbances.
  • Cancer of the spine: A tumor on the spine may press against a nerve, resulting in back pain.
  • Infection of the spine: A fever and a tender, warm area on the back could be due to an infection of the spine.
  • Other infections: Pelvic inflammatory disease, bladder, or kidney infections may also lead to back pain.
  • Sleep disorders: Individuals with sleep disorders are more likely to experience back pain, compared with others.
  • Shingles: An infection that can affect the nerves may lead to back pain. This depends on which nerves are affected.

Risk factors

The following factors are linked to a higher risk of developing low back pain:

  • occupational activities
  • pregnancy
  • a sedentary lifestyle
  • poor physical fitness
  • older age
  • obesity and excess weight
  • smoking
  • strenuous physical exercise or work, especially if done incorrectly
  • genetic factors
  • medical conditions, such as arthritis and cancer

Lower back pain also tends to be more common in women than in men, possibly due to hormonal factors. Stress, anxiety, and mood disorders have also been linked to back pain.

Symptoms

The main symptom of back pain is an ache or pain anywhere in the back, and sometimes all the way down to the buttocks and legs.

Some back issues can cause pain in other parts of the body, depending on the nerves affected.

The pain often goes away without treatment, but if it occurs with any of the following people should see their doctor:

  • weight loss
  • fever
  • inflammation or swelling on the back
  • persistent back pain, where lying down or resting does not help
  • pain down the legs
  • pain that reaches below the knees
  • a recent injury, blow or trauma to the back
  • urinary incontinence
  • difficulty urinating
  • fecal incontinence, or loss of control over bowel movements
  • numbness around the genitals
  • numbness around the anus
  • numbness around the buttocks

When to see a doctor

You should seek medical help if you experience any numbness or tingling, or if you have back pain:

  • that does not improve with rest
  • after an injury or fall
  • with numbness in the legs
  • with weakness
  • with fever
  • with unexplained weight loss

Diagnosis

A doctor will usually be able to diagnose back pain after asking about symptoms and carrying out a physical examination.

An imaging scan and other tests may be required if:

  • back pain appears to result from an injury
  • there may be underlying cause that needs treatment
  • the pain persists over a long period

An X-ray, MRI, or CT scan can give information about the state of the soft tissues in the back.

  • X-rays can show the alignment of the bones and detect signs of arthritis or broken bones, but they may not reveal damage in the muscles, spinal cord, nerves, or disks.
  • MRI or CT scans can reveal herniated disks or problems with tissue, tendons, nerves, ligaments, blood vessels, muscles, and bones.
  • Bone scans can detect bone tumors or compression fractures caused by osteoporosis. A radioactive substance or tracer is injected into a vein. The tracer collects in the bones and helps the doctor detect bone problems with the aid of a special camera.
  • Electromyography or EMG measures the electrical impulses produced by nerves in response to muscles. This can confirm nerve compression, which may occur with a herniated disk or spinal stenosis.

The doctor may also order a blood test if infection is suspected.

Other types of diagnosis

  • A chiropractor will diagnose through touch, or palpation, and a visual examination. Chiropractic is known as a direct approach, with a strong focus on adjusting the spinal joints. A chiropractor may also want to see the results of imaging scans and any blood and urine tests.
  • An osteopath also diagnoses through palpation and visual inspection. Osteopathy involves slow and rhythmic stretching, known as mobilization, pressure or indirect techniques, and manipulation of joints and muscles.
  • A physical therapist focuses on diagnosing problems in the joints and soft tissues of the body.

Chronic or acute pain?

Back pain is categorized into two types:

  • Acute pain starts suddenly and lasts for up to 6 weeks.
  • Chronic or long-term pain develops over a longer period, lasts for over 3 months, and causes ongoing problems.

If a person has both occasional bouts of more intense pain and fairly continuous mild back pain, it can be hard for a doctor to determine whether they have acute or chronic back pain.

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What to know about ADHD

A person with untreated attention deficit hyperactivity disorder (ADHD) has difficulty maintaining attention, managing energy levels, and controlling impulses.

In the United States, around 8.4% of children and 2.5% of adults have ADHD. In some children, ADHD characteristics begin as early as 3 years of age.

Ways of treating ADHD include medication, behavioral management techniques, and other practical strategies.

Below, we explore what ADHD is, how it affects a person, and which treatments can help.

What is ADHD?

People with ADHD have difficulty focusing on tasks and controlling their attention, which can make completing a project, for example, challenging. ADHD can limit a person’s ability to study or work, and it can lead to stress, anxiety, and depression.

Some people with ADHD also find it hard to sit still. They may be quick to act on impulse and become easily distracted. 

While children of any age can experience distraction and impulsiveness, these traits are more noticeable in those with ADHD.

Features

ADHD may develop in one of three ways. A doctor may find that the disorder has:

  • a predominantly hyperactive and impulsive presentation
  • a predominantly inattentive presentation
  • a combined presentation

People with ADHD experience hyperactivity, impulsivity, and inattention in varying degrees.

Inattention

Below are some behaviors related to inattention that a person might notice in someone with ADHD:

  • daydreaming
  • becoming distracted and having difficulty focusing on tasks
  • making “careless” mistakes
  • appearing to not listen while others are talking
  • having difficulty with time management and organization
  • frequently losing everyday items
  • avoiding tasks that need prolonged focus and thought
  • having difficulty following instructions

Hyperactivity and impulsivity

Some or all of the following may be apparent in someone with ADHD:

  • seeming constantly “on-the-go” and unable to sit still
  • running or climbing at inappropriate times
  • having difficulty taking turns in conversations and activities
  • fidgeting or tapping the hands or feet
  • talking and making noises excessively
  • taking unnecessary risks

In adults

Adults and children tend to experience the same symptoms of ADHD, and these can create difficulties in relationships and at work.

The effects of these features vary widely from person to person, and a person may find that their experience of ADHD changes over time.

Not everyone with ADHD is noisy and disruptive. A child may be quiet in class, for example, while facing severe challenges that they do not express.

In females

Females with ADHD may be more likely to have difficulty paying attention, while males may be more likely to experience hyperactivity and impulsivity.

This may be one reason why more males than females receive diagnoses of ADHD. Hyperactivity can be easier to spot than inattention.

Diagnosis

Most children with ADHD receive a diagnosis while they are in elementary school, but some may not do so until adolescence or adulthood.

No single test can identify ADHD, and the symptoms can overlap with those of other conditions. This can make it difficult to diagnose.

A doctor will conduct examinations to rule out other potential causes, such as hearing or vision problems.

Other conditions that can lead to similar behaviors include:

  • trouble hearing or seeing
  • anxiety
  • depression
  • learning disabilities
  • sleep disorders

A doctor will often ask questions to learn more about the person’s behavioral patterns. They may speak with the individual, members of their family, and any other caregivers, such as teachers.

Many children experience hyperactivity and inattention. For a diagnosis of ADHD, the symptoms must meet specific criteria, including having a significant impact on daily life and schoolwork.

how much physical activity do you need?

Physical activity or exercise can improve your health and reduce the risk of developing several diseases like type 2 diabetes, cancer and cardiovascular disease. Physical activity and exercise can have immediate and long-term health benefits. Most importantly, regular activity can improve your quality of life.

A minimum of 30 minutes a day can allow you to enjoy these benefits.  

Benefits of regular physical activity

If you are regularly physically active, you may:

  • reduce your risk of a heart attack 
  • manage your weight better 
  • have a lower blood cholesterol level 
  • lower the risk of type 2 diabetes and some cancers 
  • have lower blood pressure 
  • have stronger bones, muscles and joints and lower risk of developing osteoporosis 
  • lower your risk of falls 
  • recover better from periods of hospitalisation or bed rest 
  • feel better – with more energy, a better mood, feel more relaxed and sleep better. 

A healthier state of mind 

A number of studies have found that exercise helps depression. There are many views as to how exercise helps people with depression:

  • Exercise may block negative thoughts or distract you from daily worries. 
  • Exercising with others provides an opportunity for increased social contact. 
  • Increased fitness may lift your mood and improve your sleep patterns. 
  • Exercise may also change levels of chemicals in your brain, such as serotonin, endorphins and stress hormones.  

Aim for at least 30 minutes a day 

To maintain health and reduce your risk of health problems, health professionals and researchers recommend a minimum of 30 minutes of moderate-intensity physical activity on most, preferably all, days. 

Physical activity guidelines

Australia’s physical activity and sedentary behaviour guidelines state that:

  • Doing any physical activity is better than doing none. If you currently do no physical activity, start by doing some, and gradually build up to the recommended amount.
  • Be active on most, preferably all, days every week. 
  • Accumulate 150 to 300 minutes (2 ½ to 5 hours) of moderate intensity physical activity or 75 to 150 minutes (1 ¼ to 2 ½ hours) of vigorous intensity physical activity, or an equivalent combination of both moderate and vigorous activities, each week. 
  • Do muscle strengthening activities on at least two days each week.

Ways to increase physical activity

Increases in daily activity can come from small changes made throughout your day, such as walking or cycling instead of using the car, getting off a tram, train or bus a stop earlier and walking the rest of the way, or walking the children to school.  

See your doctor first

It is a good idea to see your doctor before starting your physical activity program if:

  • you are aged over 45 years 
  • physical activity causes pain in your chest 
  • you often faint or have spells of severe dizziness 
  • moderate physical activity makes you very breathless 
  • you are at a higher risk of heart disease 
  • you think you might have heart disease or you have heart problems 
  • you are pregnant. 

Pre-exercise screening is used to identify people with medical conditions that may put them at a higher risk of experiencing a health problem during physical activity. It is a filter or ‘safety net’ to help decide if the potential benefits of exercise outweigh the risks for you. 

Medical myths: Vegetarian and vegan diets


Following a plant-based diet is becoming increasingly popular. While this is widely regarded as a healthful choice, many myths abound. In this edition of Medical Myths, we dig into the details.

Until fairly recently, vegetarianism was generally considered a fringe lifestyle choice in the United States, and veganism even more so. Anything on the fringes of society tends to inadvertently encourage myths and misconceptions.

Also, deciding to avoid animal products sparks rage in some people. This anger manifests for a range of reasons, which are beyond the scope of this article. Suffice it to say that if a sizable group of the population is against something, conditions are ripe for myths and half-truths.

1. Plant-based diets are always healthful

In recent decades, an increasing number of studies have demonstrated links between red meat consumption and poorer health outcomes. For instance, processed and red meat intake is associated with colon cancer, obesity, heart disease, and diabetes.

This might suggest that a diet without meat is better for the body. But, just as not all meat is red, not all vegetarian or vegan diets are healthful.

To use an extreme example, if an individual only ate potato chips, they would be vegan, but certainly not brimming with vitality, energy, and health.

As with any other diet, it depends entirely on what an individual consumes.

Additionally, lean white meat and fish are not associated with the same health issues as processed and red meats.

And certain meat substitute products can be high in salt.

2. Vegetarianism guarantees weight loss

Sadly, no. As the section above makes clear, not all vegetarian and vegan diets are equally healthful. It is incredibly easy to consume thousands of calories each day without any of them being associated with animals.

The key to weight loss is a healthful diet and regular exercise, and neither requires the avoidance of animal products.

It is still worth noting, though, the evidence that following a plant-based diet is associated with weight loss. For instance, a review published in Translational Psychiatry

explains:

“We found robust evidence for short- to moderate-term beneficial effects of plant-based diets versus conventional diets on weight status, energy metabolism, and systemic inflammation.”

This finding held true for healthy participants, people with obesity, and individuals with type 2 diabetes.

To give another example, another review, published in BMJ Open Diabetes Research and Care, looked at the impact of plant-based diets on people with diabetes. Among other benefits, the authors found that these diets were associated with a “significant improvement” in weight.

3. Vegetarians and vegans cannot get enough protein

This is perhaps the most common of all the myths that we cover today. But it is still a myth. In the world of food, protein abounds.

For people who eat them, dairy products and eggs are high in protein. Vegans also have an array of options, including seitan, tofu, lentils, chickpeas, many types of bean, spelt, spirulina, quinoa, oats, wild rice, seeds, and nuts.

Even some vegetables contain protein, including spinach, asparagus, broccoli, artichokes, potatoes, peas, brussels sprouts, and sweet potatoes.

4. You can’t build muscle without meat

This myth follows on from the protein myth above. In short, the most important nutrient for building muscle is protein, which can easily be found in abundance beyond the animal kingdom.

5. Dairy is essential for strong bones

Dairy is not essential for strong bones, but calcium is. In fact, calcium is important for a number of bodily functions, including maintaining blood pressure, muscle contraction, transmitting signals along nerves, and blood clotting.

Vegans, therefore, need to ensure that they take in enough calcium from plant-based sources. 

As with protein, there are plenty of places to pick up calcium, including soy-based foods, beans, lentils, peas, spinach, turnips, figs, flax, chia, sesame seeds, seaweed, and some nuts — almonds, in particular.

6. You cannot get B12 from a vegetarian diet

This is a myth. While vegans often take B12 supplements to ensure that they have adequate levels, vegetarians have a wealth of other options.

Vegetarians can derive B12 from eggs and milk products, including cheese.

Meanwhile, a range of vegan-friendly foods are fortified with B12, including some cereals, tofu, nondairy milks, and spreads.

B12: An interesting aside

Cows need B12, too, and they rely on gut bacteria to produce it.

To produce B12, gut bacteria need cobalt, which a cow normally derives from grazing. However, many cows destined to become meat only spend the beginning of their lives in pasture before being brought inside where they are fed on grain.

Because of this unnatural diet, their gut bacteria are starved of cobalt and cannot produce B12.

But the cow still needs B12 to thrive, so farmers must provide them with either cobalt or B12 supplements.

So even a staunch, dyed-in-the-wool red meat fanatic is likely to derive their B12 from supplements — but in their case, it’s via a cow.

7. Soy increases the risk of breast cancer

As it stands, there is no convincing evidence that eating soy-based foods increases the risk of breast cancer in humans.

This misunderstanding might stem from earlier studies in rodents. Scientists showed that when these animals received large amounts of soy compounds called isoflavones, they were more likely to develop breast cancer. However, humans process soy differently from rodents.

A study published in February 2020 searched for associations between soy, dairy intake, and breast cancer risk. The scientists had followed 52,795 cancer-free women in the U.S. for an average of 7.9 years.

They found no clear association between soy intake and breast cancer, but they did identify a link between dairy milk and breast cancer.

However, the full picture is, perhaps, slightly more complex. Some women use soy-based supplements as a natural alternative to hormone therapy during menopause. One large study investigated whether these supplements might be associated with breast cancer risk.

The researchers found “no association between past use of soy supplements and breast cancer.” But, they also found that taking soy supplements, for some women, might increase the risk of breast cancer, particularly for those with a family history.

Overall, as the American Cancer Society explain:

“The evidence does not point to any dangers from eating soy in people, and the health benefits appear to outweigh any potential risk. In fact, there is growing evidence that eating traditional soy foods may lower the risk of breast cancer, especially among Asian women.”

8. Pregnant people need meat and dairy

During pregnancy, it is important to take in all the nutrients that a growing baby needs. But, as we have seen along the way, plant-based foods can provide the vast majority of them.

Someone who is vegetarian or vegan may need to do a little extra planning to be sure that have enough nutrients, especially at the beginning of pregnancy. 

As we mentioned above, it is important to ensure an adequate intake of vitamin B12, through supplements or fortified foods, and this is especially true during pregnancy and breastfeeding. The American Dietetic Association recommend vitamin B12 supplementation throughout pregnancy and breastfeeding for people with vegan or vegetarian diets.

As the authors of a review of research about plant-based diets during pregnancy explain, “The available evidence shows that well-planned vegetarian and vegan diets may be considered safe during pregnancy and lactation, but they require a strong awareness for a balanced intake of key nutrients.”

Excited cheerful young couple cooking healthy salad while sitting at the kitchen