In anticipation of snowfall and freezing temperatures causing icy conditions on roads, noted Orthopaedician Dr. Fiaz Dar warns against running or taking shortcuts, emphasizing the potential for serious injuries. Dr. Dar, expressing a cautious stance on Traditional Bone Setting (TBS), notes the risk of inadvertently worsening injuries, which can result in complications and potential long-term disabilities due to the lack of standardized training and adherence to modern medical principles. In a comprehensive interview with Farooq Shah, Dr. Dar delves into various aspects of bone health.
Excerpts:
If we pay a casual visit to the Bone and Joint Hospital, there is a substantial uptick of bone-related accidents during the winter months. What factors are responsible for such a sudden escalation of bone-related issues?
Various orthopaedic issues tend to increase during winter, primarily due to slips and falls on icy surfaces such as steps, porches, and sidewalks, resulting in ankle, wrist, hip, and back fractures. Snow-covered roads decrease friction and vehicle manoeuvrability, elevating the risk of road accidents, exacerbated by poor visibility and reduced daylight. Shovelling ice to clear roads commonly leads to back strains and disc problems. Winter’s low physical activity, atmospheric pressure changes, and reduced sunlight contribute to a rise in arthritis cases. Insufficient Vitamin D from reduced sunshine and intake further increases bone and joint ailments.
As an orthopaedic attending to patients daily, what are the prevailing bone-related challenges frequently encountered by the Kashmiri population, and are there distinct factors contributing to these issues?
In my clinical experience, bone-related issues among the general Kashmiri population align with global patterns, but conditions like Knee Osteoarthritis and Osteoporosis appear to be more prevalent. This heightened occurrence can be attributed to cultural practices such as sitting cross-legged and a notably low intake of calcium and minerals, particularly among females.
Are there specific factors that render females more susceptible to spine damage, and what proactive measures can be undertaken to mitigate these risks?
Females are generally more susceptible to orthopaedic conditions like some fractures and arthritis-related ailments. The cause seems to be low bone mineral density seen in this group because of hormonal changes seen after menopause. Arthritis related ailments seem to be immune mediated and genetic factors are believed to be the most likely factor of this disease being more common in females, I think proper diet, good in calcium and minerals , adequate amount of vitamin D3 and good physical activity seem to be the way forward to deal with osteoporosis. In addition hormone replacement therapy and some medications used in post-menopausal women have brought a dramatic decline in osteoporosis seen in this population.
In what ways does an improper diet contribute to bone health issues, and what dietary guidelines do you propose to enhance and preserve skeletal well-being?
Consuming a diet abundant in empty calories, processed foods, and high-fat meals, coupled with a low intake of green leafy vegetables, heightens the risk of various health problems, including issues related to bones and joints. Adopting a balanced diet that includes ample fibre, proteins, minerals, and vitamins can significantly decrease the occurrence of skeletal-related ailments. Regular, brief exercises each day also prove beneficial in reducing orthopaedic-related issues.
How significant is weight management in preventing orthopaedic complications, and what advice would you offer to individuals grappling with concerns related to weight and joint health?
The consensus is widespread that the increased burden on the skeletal system observed in the obese population changes body mechanics, adversely impacting joint function. Obesity stands out as a primary risk factor for the onset and advancement of joint-related issues, particularly in weight-bearing joints such as the knee, hip, and ankle. Obesity is believed to induce a chronic, low-grade pro-inflammatory state, contributing to heightened joint pain. Addressing obesity in orthopaedics requires a multidisciplinary approach. Regular physical activity for a few minutes each day and adherence to a well-balanced, healthy diet have demonstrated significant efficacy in managing orthopaedic issues related to obesity.
Could you elaborate on the consequences of calcium deficiency on bone health and outline practical steps for addressing and preventing such deficiencies?
Calcium is a crucial mineral within the body, playing a key role in the formation of robust bones and teeth. Its significance extends to the proper functioning of the heart and other muscles. Insufficient calcium intake elevates the risk of disorders like osteoporosis, osteopenia, and other conditions related to calcium deficiency. Inadequate calcium in children may hinder their full growth potential.
Ensuring the recommended daily calcium intake is essential, achievable through dietary sources, supplements, or vitamins. Women, in particular, should prioritize increased calcium intake earlier than men, with meeting the necessary calcium requirements becoming especially crucial as women approach menopause.
For the elderly population, what are the prevalent bone-related issues such as deterioration, desiccation, orthopraxis, and osteoarthritis, and what strategies can be employed to manage these conditions effectively?
As individuals age, their joints undergo the aging process, leading to a condition known as Osteoarthritis. The advancement of this ailment can be effectively decelerated through appropriate physical exercises and weight control. Additionally, the adequate consumption of calcium, minerals, and vitamins plays a supplementary role in reducing the occurrence and progression of such conditions.
What proactive strategies would you advise to forestall the onset of osteoarthritis, particularly in populations exposed to challenging environmental conditions?
Osteoarthritis is a condition affecting the cartilage in joints and can be addressed through preventive measures and early treatment. The disease typically begins to manifest over a span of 10 to 15 years, impacting daily activities and work capabilities. Unfortunately, healthcare providers often delay intervention until joint degeneration necessitates hip or knee replacement. Alternatively, osteoarthritis should be regarded as a chronic ailment where preventive and comprehensive early care align with established practices for other chronic diseases. Modifiable risk factors like joint injury, obesity, and impaired muscle function can be targeted through primary and secondary preventive strategies. Choosing interventions that are likely to be acceptable to the patient is essential for optimizing adherence and persistence with the treatment regimen.
How does regular exercise contribute to maintaining robust bone health, and could you suggest specific exercises tailored for individuals residing in hilly terrains?
Bone, as a living tissue, exhibits a strengthening and densifying response to physical activity. Exercise enhances the generation of cells constituting bone tissue. Weight-bearing exercises, specifically advantageous for fostering robust bones, exert stress on the skeletal system. Examples of such exercises encompass walking, jogging, running, and stair climbing. Additionally, weight-bearing exercises offer benefits in strength training, incorporating the use of weights and resistance bands.
In terms of spine health, how does posture impact overall well-being, and what practical tips can be offered to ensure good posture and prevent spine-related complications?
We’ve likely all been advised to stand or sit up straight at some point. While it may have seemed somewhat bothersome in the moment, the guidance was surely given with good intent. The fact is, posture does matter for back health. Maintaining good posture is crucial for the health of many structures in the back and spine by keeping them properly aligned. Correct posture, along with adequate back support, helps reduce the incidence of back and neck pain. For a healthy back, it’s important to keep the chin parallel to the floor, with knees and feet facing straight ahead. Ideally, a straight line should be drawable from the earlobes through the shoulders, back, hips, and knees, extending all the way to the middle of the fingers.
Why do certain individuals experience heightened joint pain during cold weather, and what measures can be adopted to alleviate discomfort and maintain joint functionality?
In my practice, I frequently encounter patients who report stiffness, aches, and pains, particularly when the weather changes, especially in the winter months. However, I acknowledge that these effects are not universal. The Bone & Joint pains during winter appear to lack a singular explanation. One theory suggests a correlation with the drop in barometric pressure, causing the expansion of tendons, muscles, and other soft tissues, leading to increased pain. Additionally, adverse weather conditions can influence an individual’s mood, with a tendency to feel more depressed in cloudy and cold weather compared to a normal sunny day. To mitigate these risks, individuals are advised to dress in layers for warmth, engage in muscle and bone-strengthening exercises, and maintain a healthy weight. Staying active indoors, ensuring a good night’s sleep, following a nutritious diet, and maintaining a positive outlook are also recommended strategies.
Considering the heightened risk of falls on icy roads, what specific precautions can individuals take to minimize the likelihood of slipping and sustaining injuries, especially when the snow freezes?
Consider your route to the destination and allocate some extra time for travel. Avoid running and taking shortcuts over areas with snow or ice. Choose suitable footwear, steering clear of heeled shoes. Utilize handrails whenever available. Take small steps to maintain your centre of balance. Refrain from carrying heavy shopping bags. Keep both hands free for balance instead of placing them in your pockets. Ensure the path is clear of debris to minimize risks.
Bone setters with questionable qualifications claim expertise in addressing bone-related problems. To what degree is it prudent to seek their aid for conditions like fractures, dislocated joints, or sprained ankles?
Our observational study underscores the need for educational and social awareness to convey potential risks associated with traditional bone setting. Rather than outright criticism, there’s a call to educate and encourage bone setters to follow basic fracture management principles. Proposals include integrating Traditional Bone Setting (TBS) into primary health care, offering basic training for safe splint application, and encouraging their role as orthopaedic assistants in rural trauma departments through programs designed by medical regulatory bodies.
Having said that, TBS may inadvertently exacerbate injuries, leading to complications that render individuals temporarily or even permanently handicapped. The lack of standardized training and adherence to modern medical principles can contribute to adverse outcomes.
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