Knee Pain - A brief understanding

The location and severity of knee pain may vary, depending on the cause of the problem. Signs and symptoms that sometimes accompany knee pain include:

·         Swelling and stiffness

·         Redness and warmth to the touch

·         Weakness or instability

·         Popping or crunching noises

·         "Locking," or inability to fully straighten the knee

When to see a doctor
Call your doctor if you:

·         Can't bear weight on your knee

·         Have marked knee swelling

·         Are unable to fully extend or flex your knee

·         See an obvious deformity in your leg or knee

·         Have a fever, in addition to redness, pain and swelling in your knee

·         Fall because your knee "gives out"

Knee pain can be caused by injuries, mechanical problems, types of arthritis and other problems.

Injuries
A knee injury can affect any of the ligaments, tendons or fluid-filled sacs (bursae) that surround your knee joint as well as the bones, cartilage and ligaments that form the joint itself. Some of the more common knee injuries include:

·         ACL injury. An ACL injury is the tearing of the anterior cruciate ligament (ACL) — one of four ligaments that connect your shinbone to your thighbone. An ACL injury is particularly common in people who play basketball or go downhill skiing, because it's linked to sudden changes in direction.

·         Torn meniscus. The meniscus is formed of tough, rubbery cartilage and acts as a shock absorber between your shinbone and thighbone. It can be torn if you suddenly twist your knee while bearing weight on it.

·         Knee bursitis. Some knee injuries cause inflammation in the bursae, the small sacs of fluid that cushion the outside of your knee joint so that tendons and ligaments glide smoothly over the joint.

·         Patellar tendinitis. Tendinitis is irritation and inflammation of one or more tendons — the thick, fibrous cords that attach muscles to bones. Runners, skiers and cyclists are prone to develop inflammation in the patellar tendon, which connects the quadriceps muscle on the front of the thigh to the shinbone.

Mechanical problems

·         Loose body. Sometimes injury or degeneration of bone or cartilage can cause a piece of bone or cartilage to break off and float in the joint space. This may not create any problems unless the loose body interferes with knee joint movement — the effect is something like a pencil caught in a door hinge.

·         Knee 'locking.' This can occur from a cartilage tear. When a portion of cartilage from the tear flips inside the knee joint, you may not be able to fully straighten your knee.

·         Dislocated kneecap. This occurs when the triangular bone (patella) that covers the front of your knee slips out of place, usually to the outside of your knee. You'll be able to see the dislocation, and your kneecap is likely to move excessively from side to side.

·         Hip or foot pain. If you have hip or foot pain, you may change the way you walk to spare these painful joints. But this altered gait can interfere with the alignment of your kneecap and place more stress on your knee joint. In some cases, problems in the hip or foot can refer pain to the knee.

Types of arthritis

·         Osteoarthritis. Sometimes called degenerative arthritis, osteoarthritis is the most common type of arthritis. It's a wear-and-tear condition that occurs when the cartilage in your knee deteriorates with use and age.

·         Rheumatoid arthritis. The most debilitating form of arthritis, rheumatoid arthritis is an autoimmune condition that can affect almost any joint in your body, including your knees. Although rheumatoid arthritis is a chronic disease, it tends to vary in severity and may even come and go.

·         Gout. This type of arthritis occurs when uric acid crystals build up in the joint. While gout most commonly affects the big toe, it can also occur in the knee.

·         Pseudogout. Often mistaken for gout, pseudogout is caused by calcium pyrophosphate crystals that develop in the joint fluid. Knees are the most common joint affected by pseudogout.

·         Septic arthritis. Sometimes your knee joint can become infected, leading to swelling, pain and redness. There's usually no trauma before the onset of pain. Septic arthritis often occurs with a fever.

Other problems

·         Iliotibial band syndrome. This occurs when the ligament that extends from the outside of your pelvic bone to the outside of your tibia (iliotibial band) becomes so tight that it rubs against the outer portion of your femur. Distance runners are especially susceptible to iliotibial band syndrome.

·         Chondromalacia patellae (patellofemoral pain syndrome). This is a general term that refers to pain arising between your patella and the underlying thighbone (femur). It's common in young adults, especially those who have a slight misalignment of the kneecap; in athletes; and in older adults, who usually develop the condition as a result of arthritis of the kneecap.

·         Osgood-Schlatter disease. This condition affects the softer area of bone near the top of the shinbone, where bone growth occurs. It's most common in boys who play games or sports that involve running or jumping. The discomfort can last a few months and may continue to recur until the child's bones stop growing.

·         Osteochondritis dissecans. Caused by reduced blood flow to the end of a bone, osteochondritis dissecans is a joint condition in which a piece of cartilage, along with a thin layer of the bone beneath it, comes loose from the end of a bone. It occurs most often in young men, particularly after an injury to the knee.

A number of factors can increase your risk of having knee problems, including:

·         Age. Certain types of knee problems are more common in young people — Osgood-Schlatter disease and patellar tendinitis, for example. Others, such as osteoarthritis, gout and pseudogout, tend to affect older adults.

·         Sex. Teenage girls are more likely than are boys to experience an ACL tear or a dislocated kneecap. Boys, on the other hand, are at greater risk of Osgood-Schlatter disease and patellar tendinitis than girls are.

·         Excess weight. Being overweight or obese increases stress on your knee joints, even during ordinary activities such as walking or going up and down stairs. It also puts you at increased risk of osteoarthritis by accelerating the breakdown of joint cartilage.

·         Mechanical problems. Certain structural abnormalities, such as having one leg shorter than the other, misaligned knees and even flat feet, can make you more prone to knee problems.

·         Lack of muscle flexibility or strength. A lack of strength and flexibility are among the leading causes of knee injuries. Tight or weak muscles offer less support for your knee because they don't absorb enough of the stress exerted on the joint.

·         Certain sports. Some sports put greater stress on your knees than do others. Alpine skiing with its sharp twists and turns and potential for falls, basketball's jumps and pivots, and the repeated pounding your knees take when you run or jog all increase your risk of knee injury.

·         Previous injury. Having a previous knee injury makes it more likely that you'll injure your knee again.

·         Not all knee pain is serious. But some knee injuries and medical conditions, such as osteoarthritis, can lead to increasing pain, joint damage and even disability if left untreated. And having a knee injury — even a minor one — makes it more likely that you'll have similar injuries in the future.

A headache is NOT a headache!

There are days when you barely pay any attention to that headache and then there are days when you feel like it could kill you.

'Headache' is an umbrella term under which many kinds exist. For the various types - migraine, cluster, tension-type, ice cream and symptomatic - there are different kinds of treatments. For instance, acute pain can be treated by a simple analgesic or painkiller, as prescribed by a doctor. However, it is essential to address the root cause of the pain, as it will reoccur if not treated properly. Dr Sangeeta Ravat, Head of Neurology department, KEM, tells us how to distinguish one headache from another. While you take aid of prescribed medicines, here are a few home remedies.

MigraineMigraine is a severe headache type and can have a considerable impact on the daily life of sufferers. It may occur in half of the head called the hemi cranial; this is usually preceded by an aura or the premonitory system. "You may see a coloured halo or bright light, which is called a visual aura. The character of the headache is throbbing. It feels as if someone is hammering your headache along with nausea and vomiting. The migraine patient tends to be photophobia (more sensitive to light) and phonophobia (more sensitive to noise). They cannot bear bright light and loud music. They can't even tolerate people talking loudly. It's that bad," says Ravat. TRIGGERS: Migraines can be genetically linked. However, disturbed sleep pattern, emotional meltdown, hormonal disturbances, physical exertion, weather changes, strong odour, smoking, poor eating pattern, consumption of alcohol, artificial sweeteners, too much caffeine, and food such as nuts, chocolates, and cheese may further exacerbate the migraine problem. RELIEF: Apart from medicines prescribed by the doctor, the herb Kava is known to be a very useful alternative for migraine. Its properties allow a sedative feeling and relax the mind. These effects reduce migraine headaches as well as improve sleep. Garlic is also a strong detoxifier.

Cluster
Cluster headache is an excruciating condition that is rare. It is characterised by frequently recurrent, short lasting headache and autonomic symptoms. Cluster headache type is easily recognisable. The episodic form occurs in bouts (clusters). A sort of unilateral intense pain around the eye develops once or more daily, commonly at night. This headache type is sudden in onset and can last for almost three hours and can occur between once a day, and sometimes even eight times a day. The eye is red and waters, the nose runs or is blocked on that side, and ptosis (drooping eyelid) may occur. As the name suggests this sort of pain, which stems from the migraine family, occurs in a cluster. "It may last for almost two weeks and may occur twice or thrice a year, but unlike migraine, this could go on continuously for two weeks without any symptom free period," says Ravat.

Triggers: There is genetic susceptibility and is caused due to neurotransmitter imbalance. Relief: There is no relief unless you seek medical advice. "In the case of cluster headaches, the doctor may have to give certain steroids and stronger painkillers to relieve the patient. Nasal oxygen mask can relief the attack, as the oxygen saturation of the blood improves and the brain is able to get more oxygen. In migraine, the blood vessels are in spasm. If the spasm is severe, the area of the brain may suffer from lack of blood supply that may lead to some neurological deficit. It's essential to consult your doctor," says Ravat.

Tension-type
This is perhaps the most common type of primary headache. It is a non-specific headache, which is not vascular related to organic disease. It is related to muscle tightening in the back of the neck and/or scalp. There are two general classifications of tension-type headache: episodic and chronic, differentiated by frequency and severity of symptoms.

Episodic tension-type headache occurs randomly and is usually triggered by temporary stress, anxiety, fatigue or anger. Withdrawal from the source of stress or a relatively brief period of relaxation or meditation can help relieve the pain. On the other hand, chronic tension-type headache is a continuous headache, which may have some variability in the intensity of the pain during a 24-hour cycle.

Both are characterised as dull, aching and non-pulsating pain and affect both sides of the head. Symptoms for both types are similar and may include muscles between head and neck contract, a tightening band-like sensation around the neck and/or head. The pain primarily occurs in the forehead, temples or the back on head and/or neck. Ravat says, "But unlike migraine, this type of pain is less severe. It is also known as muscle contraction tension headache. It is very common among young professionals who have stressful jobs."

Triggers: Emotional as well as physical stress cause tension-type headache. There could be an underlying psychological illness such as depression and anxiety. That apart, spending too much time in front of the television and computer can also generate this kind of headache.

Relief: It is advisable for people who have stress-related headaches to practise breathing exercises. Take three deep breaths, all the way in and all the way out, slowly. This works, especially, when you feel a headache coming on. Meditate, as it helps to relax the body and stop the headache. Identify stressors in your life and learn to steer clear from it.

Ice-cream headache
This headache occurs briefly, but the throbbing headache may occur after you eat food that is icy cold. Some people also describe ice cream headaches as brain freeze effects, which are a result of having ice cream, slushy drinks, golas and other frozen food. Even though the pain that is experienced during an ice cream headache is intense, these headaches are rarely serious.

This typically happens among young as well as middle aged people when they've eaten something cold. Sometimes, ice-cream headache involves one eye and bruised after the pain has gone.

Triggers: Consuming cold food such as ice-cream, ice-candies or golas can trigger the pain. Some patients find cold foods trigger the pain. While anybody can suffer from ice cream headaches, people who suffer from migraine are more prone to them. People who have had a prior head injury are also more likely to experience ice cream headaches, as compared to the others.

Relief: There is no particular remedy or treatment for ice cream headache. Normally, soon after you consume the food or the drink that has caused the problem, the problem subsides. If you're prone to this, avoid cold food altogether.

Symptomatic headache
It is a headache, which is secondary to another organic condition such as meningitis, intracranial tumours, and subarachnoid haemorrhage (headache is often described as the worst ever, and is usually but not always) of sudden or ictal onset. Neck stiffness may take hours to develop. In elderly patients particularly, classic symptoms and signs may be absent. Ravat says, "In this case, along with the excruciating pain, the person may also have frequent bouts of blackouts as well as projectile vomiting."

Triggers: Since the headache here serves as a signpost to a bigger problem, it is imperative to investigate the cause of the pain problem or disease.

Relief: One has to treat the root cause under strict medical supervision.

9 Things never to say to your child

Being a parent is difficult and so is coming off as a proud child. It's only human to give vent to your rage by using harsh words. However, when the recipient of your outrage is your own child, it might have uncertain and unmanageable repercussions.

We list 9 insensitive things that you should avoid saying to your child.

1. I was much more responsible when I was your age
Comparing your child and giving him an example of what all you were capable of when you were a kid is the first big mistake parents make. Their irritation stems from 'expectations' - expectations of bringing up the 'perfect' kid. Try and recall your shortcomings as a child and what all troubles you bothered your parents with. You are the elder one in the relationship hence you ought to know more. A statement such as this will break your child's confidence.

2. You always end up taking wrong decisions
Don't penalise your kid for being immature. Everyone is allowed to make mistakes and it is in fact a part of the learning process. He might have taken up a field of study that doesn't interest you or perhaps working with a company that you're not very proud of, but that doesn't mean you accuse him of the decisions. Your job as a parent is to guide him, not force him to obey your opinions.

3. Why can't you be more like your brother/sister?
This is once again an unreasonable comparison and a common one at that. Avoid seeding in animosity between your children by comparing their abilities. Doing so may create a fissure between the siblings. You don't want your kid to harbour negative feelings for you, hence avoid assessing your kids.

4. Leave me alone!
Adults have huge responsibilities to take care of, responsibilities that children are innocently oblivious of. And there are times when we want to be left alone too. Kids are incapable of understanding the gravity of such situations. An impatient outburst of 'Leave me alone!' can make your child feel neglected, unwanted and depressed at the same time. Show some patience and avoid saying something bad to him.

5. You should be ashamed of yourself
This statement is outright harsh and saying such an awful thing to any child is simply 'bad'. Yes, there are mischievous kids who go about pestering people with a devil-may-care attitude but that does not mean you reprimand him like this. There are better and milder ways to make the child understand the difference between good and bad.

6. You're just like your father/mother
Not all married couples are happy living together and the bitterness in their relationship often translates into exchange of unkind words against each other. Some relationships end in separation too. Either ways, kids are a witness to this mutual hostility and criticism. So when you shower your partner's animosity on your kid, that's when he begins to lose respect.

7. You always find ways to hurt me
There are times when children hurt their parents' sentiments by going against their wishes. Most times it is unintentional but there are kids who do so on purpose. However, saying something like the above statement would make your child feel guilty about his/her decision. He might comply with your demands to make you happy but you'd be taking away his right to happiness in the long run. Let your children take their own decisions and let them live a guilt-free life.

8. It's better to be childless than have a kid like you
The above statement is mostly an extreme emotional outburst but can have grave consequences on the kid. Unquestionably, it is the most hurtful thing you can ever say to your child. No matter what the crisis is, saying something like this could make you regret for life.

9. Get rid of the bad company of your friends
We (read adults) don't think before making friends. Neither do children. The only difference is that we know how to stay away from bad company and children don't. Their friends mean the world to them and therefore you cannot just order them to get a new set of 'good' friends.

Home remedies for heartburn and acidity

Heartburn is a painful, burning feeling in your chest or throat that occurs due to the regurgitation of stomach acid into your esophagus.

Although this may indicate a hazardous underlying condition like GERD and hiatus hernia; most of the times it occurs due to improper food consumption and lifestyle habits. However, the good news is that with a little change in your daily habits and some simple natural home remedies; you can easily combat this condition and avoid the uncomfortable burning sensation. Today, we bring you a list of some home-remedies right from your own kitchen to give you instant relief.

Add spice to your life: These traditional spices have been used in Indian society for a long time to provide instant relief from acidity and indigestion. According to Chris D. Meletis' "Complete Guide to Safe Herbs", spices like cinnamon, cardamom and ginger help inhibit the occurrence of heartburn due to the presence of volatile oils. These oils reportedly increase the flow of gastric juices in the stomach. Besides this, they also have carminative and anti-spasmodic properties that provide relief from heartburn associated with flatulence.

Right after-meal body posture: There is a close association between body postures and acidity, particularly before going to bed. According to Mayo Clinic, if you frequently experience heartburns during the night or while asleep, it is advisable to put gravity to work for you. Always place your head at a higher level than the rest of your body while sleeping. This can be achieved by elevating the headboard side of the bed thereby letting your head be at an elevation. You can also add wedges between your mattress and box spring. Apart from this, it is best to wait for a minimum of 1-2 hours after a meal to go to bed.

Frequent apple consumption: An easy and effective way to neutralize the acidic stomach contents is by eating apples; either fresh or in the form of desserts. You can also prepare this simple remedy of apple honey where you peel and slice a number of fresh apples and simmer with a little water for 3-4 hours. As the mixture gets thick and brown, place it inside the refrigerator and have a few spoons whenever you feel the need. Apart from apples, a mixture of honey and cinnamon can also be used as an effective heartburn treatment remedy.

Home-made antacids: Instead of opting for prescription and over-the-counter drugs, you can also prepare your own home-antacid with a few simple ingredients. In half glass of water, add half teaspoon of baking soda and use as an instant remedy. However, avoid this if you experience any kind of nausea, gas, stomach cramps or distention. Alternately, you can also use a mixture of half teaspoon of tartar cream with half teaspoon of baking soda in a glass of water.

Avoid smoking: Avoid any kind of nicotine products like cigarettes if you are experiencing frequent heartburns and acidity. This is primarily due to the fact that nicotine affects and irritates the valve between the stomach and esophagus leading to heartburns. Moreover, these products also weaken a person's nervous system. Ultimately, this leads to improper functioning of the mucous membrane of the stomach and intestine.

The right drink: To avoid these conditions, it is important to slow down on soda, alcohol and caffeine containing beverages. Recent researches have indicated that the oils contained in caffeinated products may play a role in heartburn. Besides this, alcohol consumption makes the condition worse as it increases the production of stomach acids. Moreover, it relaxes the lower esophageal sphincter to allow the stomach contents to reflux back into the esophagus.
Stress and acidity: Have you ever experienced frequent symptoms of acidity while studying during examinations. This is probably due to the fact that stress and strain act as major acidity triggers. Stress causes the inhibition of vagus nerve leading to the formation of hydrochloric acids (stomach acids).

Tips to beat that back-ache

Between being on a long-haul flight and working in your office, guess what's the common hazard?

It results in back-ache, impacts your back -specifically, the spinal cord, as a result of wrong posture. Shilpa Pandya offers a few suggestions on avoiding back-aches.

Most back-aches and related problems are illeffects of wrong posture, which manifest after hours of incorrect posture while standing, moving around while working or even while seating. "Sometimes, long hours of office work results in poor posture and causes strain to the lower back," says Dr Aruna Deshmukh, a physiotherapist. "Most people work sitting in an office chair that does not properly suit their body and does not provide enough lower back support," she adds.

"Over a period of time," explains Dr Sandeep Shet, an expert on Ayurvedic Medicine who also conducts Yoga classes, "bad postures while standing or sitting in sloppy chairs or even by sleeping in cushioned beds create a situation where the spine tends to become crooked, as the supporting muscles have been weakened. Wrong postures and curvatures of spine alter the line of weight transmission. This creates greater pressure/ strain on some muscles that fall in this wrong line of weight transmission," he explains.

It is not just seating in the work-place or sleeping in a cushioned bed that does not support your back properly, back-ache can also occur in relation to your annual holiday, says Dr Aruna Deshmukh.

So, most instances of pain in the spine due to underlying injuries is caused has a major contribution by the add-on in form of 'postural muscle spasm', says Dr Sandeep Shet. Acute injuries with severe pain can be treated with rest, local heat, painkillers etc. for a period of a week to four weeks.

"The major concern here," adds Dr Sandeep Shet, "is the problem of recurrent and chronic pain - this is the major concern. This happens when the patient returns to the same life style - sedentary working in wrong postures."

Ensuring that you have the correct posture is the simplest way to keep away most of the causes of back-ache, says Dr Aruna Deshmukh.

"This goes beyond mere cosmetic stuff -good posture and back support are critical to reducing the incidence and levels of back pain and neck pain. Back support is especially important for patients who spend many hours sitting in an office chair or standing throughout the day," she adds. The simplest add-on solution is to use an ergonomic office chair; this provides better support than a regular chair and in some cases, might be more comfortable for the patient."Correct posture means keeping each part of the body in alignment with the adjoining parts. Proper posture keeps all parts balanced and supported.

In the 'ideal' scenario, appropriate posture when standing is loosely defined as it being possible to draw a straight line from the earlobe, through the shoulder, hip, knee, and into the middle of the ankle," she explains.

Yoga exercises are among the 'alternate therapy' options for a patient suffering from back-aches, but the ideal scenario is one where the patient learns the correct posture and avoids the back-ache in the first place," he concludes.