Severe low backache and stiffness

Mr Tan is an ardent badminton player who plays once a week for 1 to 2 hours in the St John's Institution hall (enclosed and no air-conditioning). He came in with severe backache yesterday (a day after playing with younger opponents) and wanted quick pain relief. His back was so stiff (stiffness was worse than the pain) that he had difficulty bending forwards and backwards. I was surprised when he informed me that he does not drink before the match or during the match and he only drinks a small bottle of 500ml after the session! He also never believed in warm-up or cool-down. No wonder he had severe muscle spasm in his both paraspinals and quadratus lumborum.

I gave him 5 days of NSAIDS* and a muscle relaxant injection but told him to rehydrate adequately for the next 48 hours. If symptoms did not improve, I would review his back condition in 3 days. He should try sports drinks e.g. Horley's Replace or Gatorade before, during play and after play to prevent recurrence. Even if you don't feel thirsty, you need to drink up!, I said.





Find out what the experts recommend:-
ACSM Position Stand on Exercise and Fluid Replacement
*US FDA Advisory on NSAIDS use

Rt Big Toe Gouty Arthritis

Mr Lim came in walking on his heel with a painful and swollen base of the right big toe (see photo) yesterday. He could not remember having any falls or trauma to the toe but had a little too much beer, seafood and peanuts for the past week.

I was keen to find out whether he had any insect bites or previous injury but he had none. I took a blood sample for his uric acid levels and sent him off with an NSAIDS for 5 days. Had to give him some gastric preventive medication i.e. Proton-Pump Inhibitors to prevent any gastric side-effects. Also warned him not to take NSAIDS on his own as it could cause hypertension or heart problems if given indiscriminately.

True enough his serum uric acid levels came back elevated. He was advised to avoid excessive intake of protein and beer. If he had recurrence in his condition, he may have to be on medication to lower the uric acid levels e.g. cholchicine or allupurinol.

Glucosamine for knee osteoarthritis

Athletes with osteoarthritis of the knee joint often suffer from recurrent pain and swelling of the joints after intensive running and jumping. Current research provides good evidence to support the use of glucosamine sulfate in the treatment of mild-to-moderate knee osteoarthritis. Most studies have used crystalline glucosamine sulfate supplied by one European manufacturer (Rotta Research Laboratorium). Results of a recent large clinical trial (GAIT) comparing the effects of glucosamine / chondroitin sulphate for treatment of knee osteoarthritis did not show any additional benefit except in the patients with moderate to severe pain from osteoarthritis. A more recent study (GUIDE) shows in a 6 months random placebo controlled trial that oral glucosamine sulphate (1500mg/day)is more effective that placebo or acetamenophen (3gm/day). ARTHRITIS & RHEUMATISM Vol. 56, No. 2, February 2007, pp 555–567

Most of my athletes with mild to moderate Osteoarthritis have had symptom relief and functional improvement after taking Glucosamine for a tleast 1 to 3 months. Those with recurrent swelling and pain would also benefit from a course of three to five Intra-articular Hyaluronic Acid weekly injections. Athletes who undergo this injection are advised not to continue with vigorous running and jumping during the course of treatment. These athletes would also be given other forms of exercises to improve strength and stability.

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Diet only is as effective for weight loss?

A randomized controlled trial (CALERIE) done by Redman et al to test the effect of a 25% energy deficit by diet alone,CR or diet (12.5% Energy deficit) plus exercise (12.5% increase in exercise energy expenditure),CR+EX for 6 months on body composition and fat distribution. Thirty-five out of 36 healthy overweight (16M/19F) subjects completed the study. Participants lost 10% of body weight (CR:-8.3±0.8, CR+EX:-8.1±0.8kg, p=1.00), 24% of fat mass (CR:-5.8±0.6, CR+EX:-6.4±0.6kg, p=0.99), and 27% of abdominal visceral fat (CR:0.9±0.2, CR+EX:0.8±0.2kg, p=1.00). This study suggests that diet restriction may be equivalent to diet restriction and exercise.
Journal of Clinical Endocrinology & Metabolism, doi:10.1210/jc.2006-2184
Blog Authors comment: This study does not rule out the additional benefits of doing physical exercise which has cardiovascular and metabolic implications. However, it is encouraging as a weight loss of 10% has additional benefits on cardiovascular risk reductions for obese or overweight patients.

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