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Sport Medicine & Back Pain

Sport Medicine & Back Pain

A DxD Session with Dr Dinesh Sirisena


Ended on Mon Dec 31 2018
Ended
Have a question to ask?

Get Dr Dinesh Sirisena's opinions on your questions! Only approved questions are displayed.

Top Answers


Here's a previous similar question on ankle sprains and treatment options that I answered.

I thought I would provide you with a little more.

In your case I would consider the following:

1. Consult a Sports/MSK physician who can assess, scan and treat your ankle appropriately

2. Consult a physiotherapist for rehabilitation

3. Consult a podiatrist for rehabilitation or consideration of orthoses

With all three, there are many options that you can consider before more surgical treatments.

Best of luck with your ankle.

BW

Dr Dinesh

2 Jun 2018

There can be different reasons for bow legs - including vitamin D deficiency, degenerative changes in the knees or issues with your hips.  Sometimes when you have an anatomical change, there can be associated weaknesses/tightness in muscle groups. 

If you are having problems with gait, balance, your work or sporting activities, it is worth getting it assessed.  Equally, if you are experiencing pain symptoms, this might require an assessment.

I would suggest seeing a Sports/MSK physician or physiotherapist in the first instance.  They can assess you clinically, advise on conservative treatments, organise investigations and then if needed refer you onwards appropriately.

I hope this helps.

BW

Dr Dinesh 

2 Jan 2019

Thank you for your question and I’m sorry to hear about your symptoms.  Three years is an awfully long time to be experiencing pain symptoms - I presume you have had and MRI scan to confirm the disc herniation?

Options basically fall under two categories - non-surgical (conservative) and surgical. Depending on your symptoms, it might be worth seeking another assessment prior to deciding one way or the other.

Non-surgical options include strengthening the back (particularly the paraspinal muscles) and pain management such as acupuncture or medications, facet joint injections (if there is an element of of this when you are assessed) or alternative therapies.

Surgical is of course more invasive but if conservative measures don’t work and you have clear cut (forgive the pun) nerve symptoms/signs and a positive MRI - it may be necessary.

I would start by visiting a Sports/MSK physician/physiotherapist and see what they can offer.  Reassessment sounds like the key with management of your activities and rehabilitation in the first instance.

I hope this helps.

Bw

3 Sep 2018

 

Thanks for your question. This is indeed problem that many of us will face as we get older and certainly even in young patients this may occur. My only question to you is why you underwent the MRI? Was it for back pain or nerve symptoms in your limbs?

As a Sports/MSK physician, I believe that exercise is a essential.  This will help keep the weight off, maintain your strength and hopefully limit the progression of your wear and tear (degenerative) changes in your back.

Depending on what your chosen sport/activity is, there maybe modifications that can be done to allow you to continue, or you might decide to look for others that do not place pressure on the back and allow you to remain active.  

All in all, I would say yes - continue to exercise and continue to stay fit. This will be far more beneficial to you back rather than complete rest and not being active.

Hope this helps.

Bw

3 Sep 2018

Thank you for your question!  Painkillers are very useful in the management of acute back pain that is limiting function and your ability to take part in normal day-to-day activities, but as the name implies, all that you are doing is settling the symptoms. The World Health Organisation has a “pain ladder”, with medicines that get stronger as you progress up it.  It starts with simple medications such as paracetamol or anarex, before moving onto anti-inflammatories, and then the opiate-based medications.

In general, for acute pain, I tend to go high and then come down as soon as pain is settled, whereas for chronic pain, I suggest the opposite technique and use the weakest possible to control your symptoms.

If your pain is due to bones, paracetamol is a very good starting point, whereas if you have muscle spasm or inflammatory changes, anti-inflammatories are good.  Used in combination, these can help with (neuropathic) nerve-type pain, but those that are more specific to neuropathic pain are usually prescribed by a physician.  These include pregabalin, gabapentin and amitryptilline.  These modulate nerve transmission to dampen down pain responses and hence alleviate your symptoms. 

There are also alternative treatments that you can consider, including acupuncture, massage therapy and TENS.  These can all help with back pain symptoms.

Nevertheless, if your pain is predominantly the type that radiates along your leg, I would suggest that you consider getting it assessed further (if you have not already done so) and consider further investigation if this is deemed necessary.

I hope this helps.

 

4 Sep 2018

Sciatica is classically described as shooting pain that travels from the buttock down to the leg and can be associated with altered sensation or strength in the leg depending on the underlying cause.  The reason this develops is because the sciatic nerve, is irritated somewhere along its pathway and hence you experience either pain or sensory changes.  The commonest reason for sciatica is due to irritation from the spine, either from a bulging or prolapsed disc, or from nerve root irritation from facet joint swelling. This then causes the pain. 

Other causes I have seen in clinic are from irritation of the sciatic nerve at the level of the piriformis, otherwise known as piriformis syndrome, and following a hamstring injury in a footballer.  In this case, it was due to the swelling around the nerve from the torn muscle and hence the sciatica symptoms.

Physiotherapy is a useful method of improving your symptoms; it can improve strength and postural control around the trunk while also relieving tightness in other muscle groups.  If there is a functional element to your back pain, it can help to resolve this.  In more acute cases, physiotherapist can apply traction to your back to take the pressure off the nerve from disc bulges etc.  If you already have a diagnosis of why you are experiencing sciatica, and provided it is nothing that requires further intervention, I would certainly start with physiotherapy.  However, if you do not, it may be worthwhile looking into it further before treating.

I hope this helps.

4 Sep 2018

I am sorry to hear about your back pain symptoms - there can be many causes for pain in the back, but by far the most common is probably posture and conditioning.  If you, like most of us, spend long hours in front of the computer at work or at home, and then perhaps use your smartphone on the MRT or your tablet in bed, its these things which as likely to be the main culprits for your back pain.  The posture we adopt while using these items can lead to weakness in the back muscles, tightness in the fascia and all can generate pain.  One can also develop degenerative changes along the way.

The easiest thing to manage this is to look at your activities and see if there are any changes that you can make.  This might be better positioning of your devices, regular stretching and perhaps taking up some exercise.  There are, of course, other reasons for pain, such as joint, disc or nerve issues in the back, but there are often other symptoms to go with it.

I would suggest getting this looked by a Sports Physiotherapist, Therapist or Physician in the first instance.  They can take a detailed history, ask about possible risk factors and organise investigations as appropriate.  Treatments will be based on findings but can include exercise, physical therapy or other interventions.

I hope this helps.

4 Sep 2018
I am sorry to hear about your back pain. There can be many causes of back pain, from discs and nerves, to joints and bones in the back. Sometimes it can be difficult to differentiate between one problem and another based on one symptom alone.
 
Nevertheless, when patients complain of pain at night, I am always concerned about issues with the bones and joints, particularly as lying down tends to be the most comfortable position for people with disc, nerve and muscle related back pains. In your case, I would certainly recommend an assessment by a primary care or Sports/MSK physician.
 
They can take a thorough history and examine your spine. Depending on what their suspicions are, they might then organise investigations such as an X-ray or MRI. Certainly an X-ray it the minimum that I would feel comfortable with.
 
Things to consider in the interim:
  1. Have you experienced any untoward weight loss?
  2. Have you lost your appetite?
  3. Has there been any trauma to your back?
These might be nuggets of information that you might be asked for during a consultation.
 
Please do get your symptoms checked.
 
Hope this helps.
17 Sep 2018
It sounds like you are having a challenging time with your back symptoms and certainly walking should be an easy task that does not lead to aching.
 
There can be many different reasons for back pain and it maybe worthwhile getting your back assessed prior to undertaking an exercise program. This might elicit the areas that require work and certainly if there are any points of concern, these can also be addressed.
 
If you are keen to look into the strengthening as a first line, then options include seeing a Sports Physician/Physiotherapist or a personal trainer with experience in dealing with back pain.
 
The important elements to consider are:
 
  1. Managing weight - so cardiovascular exercises are useful
  2. Strengthening the “core” muscles - this has become a big buzz word in strength and conditioning, but essentially it means strengthening the muscles around your midriff and re-learning how to appropriately engage them. There are many different exercises that have been developed to enable this and simple examples are the plank (and variations to this) and breathing exercises.
  3. Focussed exercises for areas of deficiency
There are many online programs that are also available, but please take case as doing them without supervision or if done incorrectly, it can lead to injury and further symptoms.
 
I hope this helps.
 
BW
17 Sep 2018
Thanks for your question. It's an interesting one! Constipation has an interesting relationship with back pain as acute back pain, with prolapse of an intervertebral disc and compression of nerves can lead to an alteration in bowel habits, which includes constipation.
 
Equally, some people can develop back ache symptoms as a consequence of constipation. Remember, you are three dimensional and hence if you are experiencing pain in the abdomen it can be felt in the back too.
 
Sometimes people can also develop back pain while straining when trying to pass motion. This is similar to when people develop back pain when coughing or sneezing - the sudden increase in pressure can lead to an intervertebral disc suddenly being force beyond its normal constraints and hence back pain can develop.
 
Importantly, do you have any other symptoms of a significant back pain? This can include numbness, tingling or weakness in the limbs or numbness around the back passage (anus). If you do, it’s definitely worth getting yourself assessed.
 
I hope this helps.
 
Bw
 
Dr Dinesh
17 Sep 2018
Thanks for your question. This is very important as often people are diagnosed with muscular back pain and turn out to have a disc problem and vice versa.
 
The reason is that is can be very difficult to differentiate the different causes of back pain as there can often be quite an overlap. In situations with a disc or nerve problem, the lower back muscles can become tight and go into spasm. Equally, with a muscle pull in the back, there can be pain shooting I tot he legs etc.
 
Symptoms to look out for are
  1. Pain predominantly with movement (could be more muscular)
  2. A change in bladder or bowel habits or numbness, tingling and pain shooting into a limb (could be more disc/nerve related)
  3. If there is night pain (could be bone related)
I hope this helps and perhaps if you have further concerns then getting assessed would be a good idea.
 
Bw
 
Dr Dinesh
17 Sep 2018
Thanks for your question. It’s certainly an interesting one! Typically with normal healthy discs you tend to be “taller” in the morning once they have had a chance to recover from the rigours of the previous day.
 
They tend to absorb fluid and hence are fuller - giving the impression of increased height. Often by the end of the day, with muscle fatigue and a degree of dehydration, intervertebral discs tend to shrink a little and hence you are a little “shorter”.
 
The commonest spinal cause for loss of height would be a vertebral collapse - maybe from a trauma or tumour. A disc prolapse in theory could lead to this too, particularly if it is very bad, but to be honest you would probably have other issues such as nerve symptoms to go with it. For minor changes, the loss is probably not that significant.
 
To limit the impact, I would suggest maintaining your back health - good hydration, rehabilitation and exercise.
 
I hope this helps.
 
Bw
Dr Dinesh
17 Sep 2018
Thanks for your question. This is certainly something that concerns a lot of people when considering their options.
 
While I am not a surgeon, I do know that the costs of an operation will vary according to the following:
  1. If you are within the public hospital system it will go up if you move from being a subsidised, to private patient and depending on the ward type you select.
  2. Private hospitals are usually considerably more expensive than public institutions
  3. What you require during the operation - more complex procedures and more expensive equipment usage will usually incur greater costs
Ultimately where you have an operation depends on
  1. Where you are comfortable being seen
  2. You finances
  3. Whether you have heath insurance
  4. What you need to have done (some centres may provide more specialised services than others)
I hope this helps.
 
Bw
Dr Dinesh
17 Sep 2018
Thanks for your question. This is certainly an important one to ask when considering undergoing an operation.
 
The type of surgery that she requires will depend on the following what she needs to have done and what the surgeon is able to offer you. Most surgeons will use the least invasive route possible to limit the amount of potential damage to the surrounding tissue.
 
If a minimally invasive option is available, this should be offered provided:
  1. You are able to afford it financially
  2. Your hospital can provide it for you (some centres may provide more specialised services than others)
Ultimately if surgery is required then it is - nevertheless this should only be considered if all non-surgical options have been considered and faithfully tried.
 
This includes physiotherapy, guided spinal injections, acupuncture, analgesia etc. If all have failed to alleviate symptoms and no other option is available, then it should not be delayed.
 
How this helps.
 
Bw
Dr Dinesh 
17 Sep 2018
This is certainly a concern for patients with a widely degenerative spine where multiple discs have herniated and there maybe other wear and tear changes.
 
The simple answer is - we don’t know! Your surgeon will operate with the best intentions and provide you with the best service possible. But there are many other factors than the surgeon or surgery itself that can impact on your recovery.
 
This includes:
  1. Your weight - obesity is a significant risk for back pain and can impact recurrence
  2. Other medical conditions - such as diabetes, vascular disease etc - these can impact on your overall healing and recovery from any kind of procedure
  3. The extent of your degenerative changes - the more diffuse the changes, the harder it will be to resolve all of your symptoms and indeed limit the recurrence
Things you can do to help yourself include
  1. Attend physiotherapy/rehab sessions to strengthen you back
  2. Exercise - many people use back pain as an excuse not to exercise but this is essential and can help reduce your pain levels
  3. Reduce weight - again, as with point 2, many people say back pain limits their activities but in fact people with back pain MUST exercise
  4. Control you other medical conditions
Sometimes when people have had a fusion operation, they can develop more pain above or below the operation due to their increased compensatory movement at these levels and hence it increases the development of degenerative changes as well. This can lead to their pain not resolving.
 
I hope this helps.
 
Bw
 
Dr Dinesh 
17 Sep 2018
Thank you for this question and yes, it is certainly very subjective.
 
While we don’t have a list of the hottest surgeons around, there are a few things you could consider:
  1. Whether they discuss alternative treatments prior to discussing surgery - surgeons should recognise the limitations of operations and hence advocate that people try conservative measures where possible before going under the knife. This might include physiotherapy, spinal injections, analgesia or alternative treatments.
  2. Whether you feel comfortable with them - this is an essential as you maybe seeing them for some time.
  3. Costs - private vs public hospitals can incur considerable differences in cost
  4. Complications rates and outcomes - you might be able to ask your surgeon for their complications rates etc. It please remember, spine surgery is hugely complex and most people who undergo it are quite unwell or have significant problems, hence some of these risks cannot be avoided.
I hope this helps.
 
Bw
Dr Dinesh
17 Sep 2018
Thanks for your question. Unfortunately I cannot help you with this one. It would be best to check with the administrative team at your local hospital, but I believe it depends on how much you have already used, what you have accumulated and so forth.
 
Often surgical costs are quite individual depending on whether you are Singaporean or PR and also on what exactly you need to have done.
 
I hope this helps.
 
Bw
 
Dr Dinesh
17 Sep 2018

Thank you for your question. It’s certainly pertinent with the prevalence of smart device and computer use. It can also occur from tightness/weakness of various muscle groups such as your pectoral and shoulder retractors. Forward positioning of the neck can also be due to alterations in neck curvatures.

I would suggest seeing a Sports/MSK physician or a physiotherapist who can assess you and advice what might be going on. You might benefit from a neck X-ray and depending on other symptoms - other investigations. 

Differentiating between the two depends on your clinical symptoms and presentation.

I hope this helps.

Bw

Dr Dinesh 

28 Oct 2018

Rounding of the shoulders and protrusion of the neck is certainly pertinent with the prevalence of smart device and computer use. It can also occur from tightness/weakness of various muscle groups such as your pectoral and shoulder retractors. Forward positioning of the neck can also be due to alterations in neck curvatures.

I would suggest seeing a Sports/MSK physician or a physiotherapist who can assess you and advice what might be going on. You might benefit from a neck X-ray and depending on other symptoms - other investigations.  Treatment can be as simple as stretching off some muscles groups or strengthening others.

You might need to have your workplace assessed and other habits/practices discussed.

Differentiating between the two depends on your clinical symptoms and presentation and so too does your treatment.

I hope this helps.

Bw

Dr Dinesh 

28 Oct 2018

Thank you for your question.  I would like to direct you to the article on frozen shoulders here that I wrote a few months back as it might be helpful.

There are various treatments/procedures available for frozen shoulders including 

1. Physiotherapy

2. Ultrasound guided injections

3. Hydrodilatations

4. Surgical treatments

Depending on what you have/haven’t tried (and depending on what your physician or hospital is able to provide) you could try any combination of these.

Hope this helps.

Bw

Dr Dinesh 

29 Oct 2018

Thank you for your question and please also see the article I wrote on frozen shoulders here.

Wrt the surgical treatment, MUA is basically where you are anaesthetised and the surgeon manually moves your arm to break the adhesions.  There is a the risk of other trauma to the shoulder but it is an option. 

The arthroscopic approach requires more finess and surgical training/experience.  This is where the surgeon uses a minimally invasive approach to then cut away at the adhesions from within.

Usually in our centre we try the hydrodilatations and physiotherapy before moving onto a surgical approach and in general our surgical need has leases end due to this minimally invasive injection technique.

So what is better? It depends on what your surgeon and centre are able to provide!  Both have its merits and risks and it needs you to decide with your surgeon what you want to pursue.

Bw

Dr Dinesh 

29 Oct 2018

Thank you for the question and I feel your frustration.  Calluses and corns are usually the result of increased pressure on a particular area of your foot and can be the result of an injury, change in footwear, altered sensation (due to conditions such as diabetes) or your chosen activities.

The treatments you mention are there to help with the symptoms i.e. the calluses and corns themselves.  What it doesn’t do is assess you and seek why you are developing these.

I would suggest seeking help from Sports/MSK physician or a podiatrist.  They can assess you more thoroughly and advise you on what treatment is the best for you.

Bw

Dr Dinesh

29 Oct 2018

Thank you for the question.  It sounds like you are already seeing someone about your knee symptoms and they have given you some reasonable options.  In some respects it depends on your symptoms.  

If you are having recurrent instability and dislocations, then, depending on the frequency and it’s impacting your daily activities, then a surgical treatment maybe appropriate.  They might do a lateral release or, if you have a shallow femoral trochlea, your surgeon might try a patella tendon transfer.

Either way, surgical treatment is invasive, you’ll have to deal with the post operative phase and need lots of rehab afterwards - trust me, I’m speaking from personal experience. 

If on the other hand your symptoms are not so troublesome and rather than dislocations you experience subluxation, then rehab might be best.  Often this will involve loosening off the ITB and strengthening your quads.  You could see a sports/msk physician or a physiotherapist to look into this.

I would encourage you to discuss further with your current doctor as well.

Bw

Dr Dinesh 

29 Oct 2018

Thanks for your question.  If you have developed recurrent dislocations, pain around the front of the knee, swelling and crunching, it is possible that you might develop wearing of the cartilage behind the knee cap.  

This could potentially lead to wear and tear (degenerative) changes in the future.  In this scenario, it would be good to limit these changes by doing early rehab and strengthening around the knee.  

You might benefit from seeing a sports/msk physician or a physiotherapist in the first instance as they can look into non operative, conservative measures to help with your symptoms.  You might need an X-ray or other investigation after your assessment.

Hope this helps.

Bw

Dr Dinesh 

29 Oct 2018

Plantar fasciitis (PF) is certainly a very common problem that I see in clinic on an almost daily basis.

PF can be triggered by many different causes such as:

  • Prolonged standing
  • Sudden impact
  • Increased weight or
  • A sudden change in activity.

 It sounds like your symptoms are triggered by long walks. 

In general, simple treatments for PF include:

  1. stretching your calves
  2. wearing cushioned footwear and
  3. rolling the PF with a ball or ice bottle.  

If you would like to look into further, I would suggest seeing a Sports/MSK physician or a podiatrist - they can assess you clinically and perhaps scan your foot with an ultrasound scanner.  

You might then require other treatments such as:

  1. orthotics
  2. shockwave therapy or
  3. injection treatments

I hope this helps.

Bw

Dr Dinesh 

1 Nov 2018

You do sound like you are experiencing a mix of unusual symptoms and perhaps it might be worth seeing a neurologist with a special interest in myopathies and neuro-muscular disease.

Hope this helps.

BW

Dr Dinesh 

2 Nov 2018

Thanks for your question - really relevant to many people in Singapore.  For mildly elevated cholesterol, I would suggest first trying dietary changes together with exercise, provided you don’t have any other significant cardiac risk factors such as high BP, diabetes or a family history.

You might benefit seeing a dietician, a sports physician or an exercise physiologist to help you.  They can advise on diet and set up an exercise program for you based on broad principles.

After about 3-6 months of this, it would be worthwhile rechecking to see if things have improved.  If not, then you might want to discuss other possibilities.

Bw

Dr Dinesh 

3 Nov 2018

Thanks for your question.  You might be interested in looking into a phenomenon called over training syndrome.  

In this condition when you train harder, it leads to worsening performance and it’s becomes a negative cycle.  Often alongside this loss of performance, you can experience illnesses such as coughs, colds or other viral illnesses.  

While 5 days of training will probably not cause this, if you over-train over a prolonged time it can lead to these issues.  It might be worth seeing a sports physician who can look at your training load and adjust accordingly.

I hope this helps.

Bw

Dr Dinesh 

29 Nov 2018

Neck pain is very common, particularly with computer and smart device use.  Often its a postural issue and hence simple measures such as changing your computer position or holding your phone or tablet in a different position might be all that is needed.

If this is not helping, then looking into physiotherapy exercises, topical or oral analgesia, heat patches or acupuncture might be further steps.

If none of these help, then it might be worth seeing a Sports/MSK physician who can examine you, assess your neck and organise investigations and further treatments as required.  In our centre, we provide ultrasound guided injections for pain - this can then allow you to do the rehabilitation exercises without discomfort.

Hope this helps. 

BW

Dr Dinesh

2 Jan 2019

In addition to what Dr Sean has already mentioned, you could consider a guided injection for ongoing nerve root pain - this can help settle the pain symptoms and therefore allow you to do the rehabilitation pain-free.

BW

Dr Dinesh

2 Jan 2019

Sorry to hear about your pain symptoms - I imagine it’s quite troubling.

Non-surgical management of neck and back pain can include pain relief, physiotherapy, strength and conditioning and also guided treatments such as nerve root or facet joint injections.

It would be good for you to be assessed and see what treatments are approate for you.  I would suggest seeing a Sports or MSK Physician for this initial consultation.

Hope this helps.

Bw

Dr Dinesh 

29 Nov 2018

Thank you for your question - I imagine that your symptoms are troubling and causing concern.

Shoulder blade pain can be from a variety of causes, including changes in rotator cuff strength, positioning of the shoulder or a scapulothoracic bursa.  If you are experiencing pain and a popping feeling around the shoulder then this might be the underlying problem.

I would suggest an initial assessment with a Sports/MSK physician - they might provide you with a Bessie ultrasound assessment too before recommending further treatment/

Hope this helps.

Bw

Dr Dinesh 

29 Nov 2018

Thank you for your question. I can fully empathise with you having fallen off bikes and scooters in the past.

There can be many causes for shoulder pain following trauma including an injury to the rotator cuff, a frozen shoulder, AC joint disruption and more. From your symptoms alone, the active movements might suggest an injury to the former (rotator cuff). Significant symptoms are limitation in movement, night pain and impact on your function.

In the first instance, I would suggest seeing an MSK/Sports Physician who is able to provide a clinical assessment and ultrasound examination - often this is enough before initial management as the ultrasound can provide a good assessment of the tendons. 

The clinician can then decide if a conservative or surgical approach is required and arrange further investigations or treatments as needed. Often, things can heal with simple interventions.  An MRI provides more information about the joint, including the cartilage and labrum. 

I hope this helps.

BW

Dr Dinesh

7 Dec 2018

Thank you for your question. There can be many causes for shoulder pain following trauma including an injury to the rotator cuff, a frozen shoulder, AC joint disruption and more. 

From your symptoms alone, the active movements might suggest an injury to the former (rotator cuff).  Significant symptoms are limitation in movement, night pain and impact on your function.

In the first instance, I would suggest seeing an MSK/Sports Physician who is able to provide a clinical assessment and ultrasound examination. 

They can decide if a conservative or surgical approach is required and arrange further investigations or treatments as needed.  Often, things can heal with simple interventions.

I hope this helps.

BW

Dr Dinesh 

7 Dec 2018

Wow - a tough one!  Three questions spring to mind

1. What does your cardiologist say?

2. What level of exercise do you currently do?

3. Have you been for an exercise test?

So for number one, your cardiologist will know how your heart is functioning - whether the echos are looking normal and so on. If there is any concern that you might be decompensating, then best to check with them.

Number 2 - what exercise do you currently do?  Triathlons take considerable training and it’s sensible to build upto this over a phased period.  Remember, you’ll need to be able to swim, cycle and then run - all of which will stress your body in different ways.  It’s good to start training early and if you develop symptoms then seek an urgent assessment.

Number 3 - there are different ways to undergo an exercise test, including on a treadmill or cycle.  The best available currently is a cardiopulmonary exercise test.  You might need to find a centre in Singapore that offers this - essentiallly if goes down to your basic physiology to see if your body can cope with the stress.

Ultimately, no body can truly say whether you will be 100% safe to take part, but we can try and make an educated guess based on a review of information from these different sources.

Hope this helps.

Bw

Dr Dinesh 

11 Dec 2018

It’s a common problem amongst runners.  

ITB related pain can be due to tightness, a busitis, snapping or flicking of the band.  Often symptoms develop after you have been running for a certain distance.

As Dr a Paul suggests, it would be worth being assessed, together with an ultrasound scan to look for a bursa or a gait analysis to check whether your running pattern might be contributing.  In some patients, modifying this is all that is required, whereas for others, they might require a guided treatment.

I hope this helps.

Bw

Dr Dinesh  

11 Dec 2018

I’m sorry to hear about your symptoms/diagnosis. I imagine it can be quite frustrating. Firstly, it’s great to hear that you are on a disease modifying medication and hopefully this will control your symptoms/condition.  

From an overall health perspective I would fully advocate exercise as it can help your arthritis as well as your overall well-being. Exercise will help limit weight gain. In doing so, it should limit the pressure on your joint and hopefully the arthritis symptoms that you are experiencing. Although it light not eliminate it altogether, you will all most certainly reap the benefits. Also, if you are able to exercise, it should limit the development of other medical conditions.

It would be great if you could begin with non-impact activities such as cycling, swimming and cross trainer. Start slow and build up as your fitness progresses. Equally, it would be good to add in a light strengthening and stretching program - this will hopefully help with stability around the joints, increase your exercise capacity and also limit stiffness developing in the joints.

Ideally, this should be done under the supervision of an exercise specialist or a trainer who is familiar with inflammatory arthritis.

I hope this helps.

Bw

Dr Dinesh

22 Dec 2018

Neuromuscular conditions are complex and varied in nature and can present as a primary condition or in association with other problems. 

Their symptoms can also be quite varied and difficult to elicit, but as they progress it can start with weaknesses in in big muscle groups initially before smaller ones such as your respiratory (breathing) muscles.

Neuromuscular conditions are usually diagnosed through a mixture of clinical history/examination and investigations such as nerve conduction tests, muscle biopsies and imaging.  

If you are concerned about a NMD, it maybe worth seeking help from a neurologist who specialises in this area of medicine.

Hope this helps.

BW

Dr Dinesh

5 Jan 2019

Welcome to the over 30's club!  I say this with personal experience of knee pain and a story similar to yours. 

Cartilage injury around the front of the knee can be quite painful and limit activity, particularly if you enjoy running and jumping sports.  

Seeing a physiotherapist is important in such situations as they can help identify specific muscle weaknesses.  In addition a Sports Physician can help by providing various treatments such as visco-supplementation, where a synthetic form of hyaluronic acid is injected into the knee for pain symptoms, and also a sports podiatrist can help assess your gait, particularly if you are a keen runner.

Having spoken to a sports knee surgeon, options for cartilage injuries such as this include a lateral release, if you have tilting of the patella, trimming away of the injured cartilage or trying to promote healing through other interventions.  The main issue with surgical intervention is the post-op period (trust me) it takes ages to get back to normality!

This give you a number of options to start with - I hope it helps.

BW

Dr Dinesh 

13 Jan 2019

Thanks for your question and I am sorry to hear about your anxieties.  In general exercise is a good preventative measure for many of the risk factors for cardiac disease such as hypertension, hypercholesterolaemia and diabetes.  It can help with the onset and limit the impact of these conditions.

If you are concerned about your risk, might I suggest a pre-participation screening (PPS).  This involves a thorough medical history, clinical examination and appropriate investigations.  You can also discuss your exercise goals with the Sports Physician that you are consulting and they can help to put together an exercise program for you.  While a PPS cannot 100% eliminate all risk, it can help identify if there are any existing problems and reasons for not exercising.

Why don't you look into PPS further and perhaps, if you are keen, try this out.  It might alleviate some of your anxieties and then allow you to get back to one of the lowest risk treatments for many different health conditions - EXERCISE!!!!!

BW

Dr Dinesh

1 Feb 2019

Thanks for your question - you have already been given an excellent answer by Dr Daniel so I will try to add to this.  

Your symptoms do sound suspiciously like piriformis syndrome, where the sciatic nerve is irritated by its close proximity to the piriformis muscle. 

In some situations, it can be due to muscle enlargement or entrapment.  However, there are other potential diagnoses that must be considered, including 

1. This pain might be originating from your spine - such as a disc bulge - in which case an MRI spine might be required.

2. It be a bursitis of the sitting bone (the ischium) and hence when you are sitting/standing you get pain.

3. It could be due to hamstring tightness.

My suggestion would be to be assessed by an MSK/Sports Physician or a physiotherapist who is experienced with these conditions.  You can be examined, investigated and treated appropriately.

I hope this helps.

BW
Dr Dinesh

1 Feb 2019

Thanks for your question and well done for giving up smoking!  Together with excessive alcohol intake, hypertension and poor fitness, smoking is one of the biggest risk factors for health.

The only thing I would add to the excellent answers you have already received, it perhaps consider a CARDIO-PULMONARY EXERCISE TEST (CPET).  This is either in the form of a cycle or running test and will essentially allow the physician who is looking after you to assess your physiology.  Sometime after you have been a smoker for a while, it might be a respiratory, cardiac or muscle limitation to your capabilities and a CPET can certainly help establish where the limitations lie.

I hope this adds to what you have already found out.

BW
Dr Dinesh

1 Feb 2019

Thanks for your question - I won't repeat what Dr Henry has already mentioned in his excellent answer, but perhaps I can add to it. 

While I appreciate your concerns about a possible SLAP lesion, there are other potential issues that can happen around a shoulder that might cause ongoing pain. 

This includes a AC joint issue, tendinopathy, impingement, a tendon tear, a frozen shoulder, a nerve injury and so on.  In the first instance, the humble X-ray is still a good test to see if there is anything significant going on with the joint and also, if done while carrying a weight, we can see if there is an AC joint issue.

The ultrasound is excellent for imaging of the tendons, the AC joint and also for a functional assessment of the shoulder.  If you decide to go for an MRI, please consider an arthrogram, where contrast is injected into the shoulder to highlight the injuries.

Many issues around the shoulder can be treated with physiotherapy, injections or adjuvant treatments such as acupuncture.  Before you embark on a treatment, perhaps I can suggest a more thorough assessment by an MSK/Sports physician/physiotherapist.  They can help you with the initial part of you journey.

I hope this helps.

BW

Dr Dinesh

1 Feb 2019

Hi 


Thank you for your question and its certainly something that Sports physicians get asked about quite often - what exercises are advised for someone who is overweight or obese?

Running is an excellent form of exercise, which uses most of the major muscle groups in the body and which can help with improved cardiovascular fitness and weight loss.  Indeed, any exercise is better than nothing and while running is a cheap and easy thing to do, it might not be recommended in the first instance if you are unaccustomed to exercise.  To begin, simply walking on a regular basis is a good start - while it might not be perceived as "good exercise" as running, it is recommended by the World Health Organisation as the minimum level of physical activity for health.  If walking does not appeal, it might be worth starting with non-weight bearing or low impact exercise such as cycling, swimming or gym exercises such as the elliptical trainer.  These open the opportunity to exercise without causing excessive strain on the lower limb.

You see, often, patients who start exercising, can experience knee or lower limb pain, particularly if they are unaccustomed to it.  There is also the possibility of other conditions such as heart disease. 

As a consequence, if you have not exercised for a while or are new to it, it might be worth considering a pre-participation screening (https://www.doctorxdentist.com/questions/can-pre-exercise-screening-help-prevent-heart-attacks-while-exercising).  During this, you will be assessed for your general health, any MSK conditions and you can discuss your fitness/health goals.  You can also decide what program suits you and how to monitor your progress.  This is definitely something to consider if you have heart disease or risk factors such as hypertension, high cholesterol or diabetes.

If you are keen to start, please check with a Sports Physician or GP before doing so! 

Hope this helps 
BW
Dr Dinesh

20 Feb 2019

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