Synopsis: 08

METABOLIC REASONS OF BONE AND JOINT PAIN - DIFFERENTIAL DIAGNOSIS CHALLENGES FOR PHYSIOTHERAPISTS

Dr. Harish S. Krishna

Laxmi Memorial College of Physiotherapy,

Mangaluru

Osteoporosis is a clinical manifestation of bone atrophy resulting in low trauma fractures. It decreases quality of life. Prolonged bed rest, immobility, ageing, diet and life style are the most common risk factors which causes osteoporosis.

Challenges for physiotherapists-

Knowledge about musculoskeletal risk factors which mimics mechanical pain especially low back pain, osteoarthritis, neck pain is essential for physiotherapists which require consultation with medical personal before starting with exercises or training. Osteoporosis mainly causes low back pain , neck pain and thoracic pain due to weak vertebrae . This in turn leads to loss of height and stooped posture. The age of the patient, associated medical conditions along with the type of pain, onset of pain, pattern of pain helps physiotherapists from differentiating pain due to osteoporosis and other mechanical causes of back / neck pain.

The talk is centering on three areas were a physiotherapist should take extreme caution while prescribing exercises to patients who have risk factors for osteoporosis-

1. Low back pain rehabilitation

2. Post-operative fracture management

3. Tenoperiostel avulsions exhibiting as mechanical pain.

1. Low back pain rehabilitation-

Physiotherapists indulging in treating low back pain with exercises should not give explosive abdominal exercises , spine torsions, and avoid high impact aerobic exercises. Endurance training and low impact aerobics will be beneficial for the patients.

2. Post-operative fracture management

Another area of concern for physiotherapists regarding osteoporotic bones are at Post-operative rehabilitation for fractures. Usage of stress shielding devices which causes secondary callus formation and there by a weak bone should be treated with caution once the implant is removed.

3. Tenoperiostel avulsions exhibiting as mechanical pain.

Teno periostel site avulsions /pulling is a common cause of musculoskeletal pain. Lateral epicondylitis is a common clinical presentation. A strengthening program for the forearm muscles should aim on endurance training.

Conclusion-

Physiotherapists to be more cautious on exercises prescription keeping a weak bone in mind because of increased public awareness of physiotherapy as a drug free treatment for various ailments and dysfunctions.