Musculoskeletal Disorders

Joint Pain

Musculoskeletal Disorders

Musculoskeletal conditions affect the joints, bones and muscles. They can also include rarer autoimmune diseases and back pain. There are more than 200 musculoskeletal conditions which affect one in four of the adult population in the UK. Common musculoskeletal conditions include: back pain, sciatica, osteoarthritis, tendonitis and fibromyalgia. The symptoms of these musculoskeletal conditions are listed below:

Symptoms:

Symptoms and signs of back pain can include:

  • Muscle aches
  • Stabbing or shooting pain
  • Pain anywhere from the top of the neck down to the hips that can develop either suddenly or gradually
  • Pain that radiates down your leg
  • Pain that becomes worse with lifting, bending, standing or walking
  • Pain that tends to get better or worse depending on your position (for example, it may feel better when sitting or lying down)
  • Pain that is typically more severe when moving (it is not a good idea to avoid moving your back completely, as this can make the pain and stiffness worse)

Symptoms and signs of Sciatica can include:

  • Signs of irritation in the sciatic nerve (which runs from your hips to your feet)
  • Pain in your bottom, backs of your legs, feet or toes
  • Pain in the above areas that can be described as: a stabbing, shooting or burning sensation
  • Numbness and in the above areas
  • Tingling (like pins and needles) in the above areas
  • Noticeable weakness in the above areas
  • Symptoms that get worse when moving, coughing or sneezing
  • Potentially accompanied by back pain, but of a lesser intensity than pain in the bottom, legs or feet

Symptoms and signs of Osteoarthritis can include:

  • Joint pain, stiffness and tenderness
  • Restricted movement of a certain joint or joints
  • Inflammation around the joint or in the joint
  • Warm to the touch, and reddened skin over the affected joint
  • Weakness and muscle wasting

Symptoms and signs of Tendonitis can include:

  • Pain in the tendon (for example, the elbow, shoulder or knee) that gets worse when you move
  • Difficulty moving the tendon
  • Swelling and possibly heated and reddened skin
  • A lump along the tendon
  • A feeling of grating or a ‘cracking sensation’ when you move the tendon

Symptoms and signs of Fibromyalgia can include:

  • Widespread pain all over the body
  • Continuous pain (although this may be severe and less severe at different times)
  • Increased sensitivity to pain
  • Hyperalgesia (extreme sensitivity to pain)
  • Allodynia (feeling pain from something that should cause no pain, such as lightly touching something)
  • Extreme tiredness (fatigue)
  • Stiff muscles (even muscle spasms – where the muscles contract tightly and painfully)
  • Problems sleeping
  • Difficulty concentrating, problems with memory and other mental processes (known as ‘fibro-fog’)
  • Headaches
  • Irritable Bowel Syndrome (IBS) a digestive condition that causes bloating, irritation and stomach pain
  • Pain that comes and goes in relation to: stress levels, changes in the weather or how physically active you are
  • Pain that feels like: an ache, a burning sensation or a sharp, stabbing sensation
  • Sensitivity to: smoke, bright lights, certain foods
  • Feeling especially bad and experiencing more pain after you have been exposed to something you are sensitive to
  • Dizziness and clumsiness
  • Feeling either too cold or too hot (due to not being able to regulate your body temperature)
  • An overwhelming urge to move your legs (restless legs syndrome)
  • Tingling, numbness, burning or prickling sensations in your hands and feet (pins and needles)
  • Unusually painful periods in women
  • People with fibromyalgia can also sometimes experience anxiety and depression

When to see an expert at Ahmeys

If you are experiencing the symptoms above, your symptoms are getting worse, have not gone away within a few weeks or months, have not gone away with home treatment and self-care or have begun to affect your mobility and day to day life, we recommend that you call Ahmeys to book an appointment. One of our experts can check your symptoms and conduct tests to confirm a diagnosis and rule out any other problems.

Call to make an urgent appointment with Ahmeys if:

  • Pain is severe and doesn’t improve with rest and does not improve within a few weeks
  • Your pain spreads down one or both legs, especially if the pain extends below the knees
  • You are experiencing weakness, numbness or tingling in one or both legs
  • Pain is accompanied by unexplained weight loss
  • You are experiencing stiffness and pain that has come on gradually (you may be experiencing the onset of osteoarthritis, rheumatoid arthritis, or another related arthritic condition)
  • You notice pain and stiffness in your legs, arms or back after sitting for short periods or after sleeping at night (you may be experiencing the onset of osteoarthritis, rheumatoid arthritis, or another related arthritic condition)
  • The pain has come on quickly and you also have a fever (you may have infectious arthritis)
  • Your child has developed a rash or pain in the knees, wrists and ankles, has a fever, poor appetite or is experiencing fatigue (your child may have a type of JIA)
  • Your joint or affected area is still painful after a full week of resting it at home
  • You have a rash or fever in addition to pain in joint or affected area
  • You have pain that came on suddenly and you also have sickle cell anaemia
  • You cannot move or put weight on the affected joint
  • Your joint locks, clicks painfully or gives way
  • If you think you may have ruptured or torn a tendon
  • If your pain is stopping you from doing your normal activities

When to seek emergency care

In some circumstances, musculoskeletal pain can indicate a more severe medical problem. Seek immediate care if:

  • Your musculoskeletal pain is causing new bladder or bowel problems
  • Your musculoskeletal pain is accompanied by fever
  • Your musculoskeletal pain follows a serious fall, injury, or blow to your back
  • Your limb or affected area is badly bruised, misshapen or bleeding
  • You are not able to move your joint or bear any weight on it
  • You have sciatica on both sides
  • You have a weakness or numbness in both legs that is severe or getting worse
  • If you have numbness under or around your genitals or anus
  • If your joint is visibly out of place and you think it may be dislocated
  • If you have had a severe head injury (failure to seek immediate attention after a brain injury can result in serious brain damage, paralysis and even death)

Causes:

Causes of back pain:

  • Poor posture
  • Lifting something awkwardly
  • A minor injury (sprain due to either a pulled ligament or pulled muscle)
  • Remaining in one position for too long (for example oversleeping and lying in an awkward position for hours)
  • Overexerting your muscles during strenuous physical activity
  • Feeling stressed or run down
  • Medical conditions including: a slipped (prolapsed) disc, ankylosing spondylitis, sciatica, spondylolisthesis, arthritis and osteoporosis. For further information on these conditions see back pain and arthritis

Causes of Sciatica:

  • Sciatica is caused by irritation of the root or roots of the lower lumbar and lumbosacral spine
  • A slipped disc (the most common cause), when a soft cushion of tissue between the bones in your spine (vertebrae) pushes out
  • Lumbar spinal stenosis (narrowing of the spinal canal in the lower back)
  • Degenerative disc disease (breakdown of discs, which act as cushions between the vertebrae in the back)
  • Spondylolisthesis (a condition that causes one vertebra to slip in front of another one)
  • Muscle spasm in the buttocks or back
  • Pregnancy

Causes of Osteoarthritis:

  • Osteoarthritis usually develops in adults who are in their mid-40s or older and is more common in women and people with a family history of the condition
  • Previous injury
  • In association with other joint-related conditions, such as rheumatoid arthritis or gout
  • ‘Wear and tear’ that initially affects the smooth cartilage lining of the joint, makes movement more difficult than usual and leads to pain and stiffness

Causes of Tendonitis:

  • Most often caused by sudden, sharp movements or repetitive exercise (such as running, throwing or jumping)

 

Causes of Fibromyalgia:

  • The exact cause of this condition is unknown, but it is thought to be related to abnormal levels of certain chemicals in the brain and changes in the way the central nervous system (spinal cord, brain and nerves) processes pain. For further information, see Fibromyalgia

Diagnosis

If you are concerned that you may have a musculoskeletal condition, call Ahmeys to book an appointment with one of our experts to discuss your symptoms and potential treatments. There are many different conditions with a variety of symptoms, so a doctor will ask you about your medical history, pain levels, and assess what they think might be the cause of your pain. An expert at Ahmeys will review your symptoms and potentially perform the following diagnosistic tests:

  • A physical exam to check for fluid around the joints, red or warm joints and to test the range of motion of the affected joints
  • Blood tests to check for specific types of antibodies and for inflammatory markers
  • Blood tests to check for anti-CCP (anti-cyclic citrullinated peptide), RF (rheumatoid factor) and ANA (antinuclear antibody)
  • Physical examination of your back and assessment of your ability to stand, sit, walk and lift your legs
  • One of our experts may also ask you to rate your pain on a scale of zero to ten and talk to you about how well you are functioning with your pain
  • Assessments to determine where the pain comes from, how much you can move, your range of motion before the pain stops you and whether you have muscle spasms
  • Internal and external rotation of the joint to detect pain-aggravating positions and palpating (touching) over inflamed areas to detect tenderness
  • Straight leg raising can be used to detect sciatica
  • If our Ahmeys expert thinks you may have fibromyalgia, it is likely that they will conduct further tests in order to rule out other conditions that could be causing your symptoms, such as: ME (chronic fatigue syndrome), rheumatoid arthritis and MS (multiple sclerosis). They may also ask if your pain has stayed at a similar level for a minimum of three months and is present in six or more places
  • Conduct or refer you to a hospital for imaging scans such as MRI, X-Ray and CT scans to produce an image of your cartilage and bones. This can also rule out other causes of symptoms and identify bone spurs

Treatment

Once one of our experts has assessed you, they will discuss treatment options with you. Treatment may also depend on the results of any potential diagnostic tests. Treatment may be dependent on your age, weight, other medical history factors and will certainly be dependent on what type of musculoskeletal pain or condition you have been diagnosed with. One of our experts may combine treatment methods to improve pain relief, joint function and to help take pressure off sore joints. Below are some of the potential treatments that one of our experts may use to treat your musculoskeletal pain symptoms:

Treatment for back pain:

  • Over the counter (OTC pain relievers) such as ibuprofen
  • Topical creams to block pain signals
  • Less common medication treatment options include: immunosuppressants, opioids, muscle relaxants and steroid injections
  • Surgery, usually reserved for relieving nerve compression, a herniated disk or narrowing of the spine
  • Physiotherapy
  • Additional alternative therapies include: acupuncture, chiropractic, massage, TENS and yoga
  • For more information see Back pain

Treatment for Sciatica:

  • Over the counter (OTC pain relievers) such as ibuprofen
  • Specific stretching and exercises
  • Physiotherapy
  • Psychological support (counselling)
  • Painkilling injections
  • Surgery, referred to as ‘decompression surgery’, that is sometimes used to help relieve sciatica

Treatment for Osteoarthritis:

  • Over the counter (OTC pain relievers) such as ibuprofen
  • Analgesics, such as hydrocodone or acetaminophen for pain relief
  • Topical creams to block pain signals
  • Less common medication treatment options include: immunosuppressants, opioids, steroid injections, PPR injections and corticosteroids
  • Surgery, including: carpal tunnel release, release of tendons, removal of inflamed tissue, arthroscopy, joint replacement (arthroplasty) and joint fusion
  • Physiotherapy
  • Additional alternative therapies include: acupuncture, chiropractic, TENS and osteopathy
  • Nutritional supplements and dietary changes
  • For more information see Arthritis

Treatment for Tendonitis:

  • Over the counter (OTC pain relievers) such as ibuprofen
  • Steroid injections to provide short-term pain relief
  • Surgery to remove damaged tissue or repair a ruptured tendon
  • Shockwave therapy, which may help speed up recovery time
  • PPR injections

Treatment for Fibromyalgia:

  • Over the counter (OTC pain relievers) such as ibuprofen
  • Less common medication treatment options include: immunosuppressants, opioids, steroid injections, muscle relaxants, anticonvulsants and antipsychotics
  • Physiotherapy
  • Hydrotherapy
  • Cognitive behavioural therapy (CBT)
  • Acupuncture
  • Chiropractic
  • For more information see Fibromyalgia

How to manage your musculoskeletal symptoms

As musculoskeletal pain can be caused by a variety of conditions which are treated in different ways, the tools to manage your condition may be different depending on the diagnosed cause of your pain. Please see the different ways to manage the common musculoskeletal conditions (back pain, sciatica, osteoarthritis, tendonitis and fibromyalgia) below:

How to manage back pain:

  • Apply hot or cold packs to joints to relieve pain
  • Use stretching techniques provided by one of our experts at Ahmeys or a physiotherapist
  • Take painkillers to reduce pain, but make sure that you follow the recommended dose and that the medication does not conflict with any other medication you are currently taking
  • Exercise regularly to keep joints flexible, but avoid overexerting yourself or putting too much pressure on your joints. Swimming is a good non-weight bearing activity
  • Look after your back and try to avoid further damage
  • Relax and try to eliminate stress, as muscle tension and stress can exacerbate your back pain symptoms

How to manage Sciatica:

  • Carry on with normal activities as much as possible
  • Stretch your back regularly
  • Stay active and take regular exercise
  • Use heat packs on painful areas, but do not use hot-water bottles as you could scald yourself if your skin is numb
  • Ask an Ahmeys expert about suitable painkillers as paracetamol is unlikely to relieve the pain on its own
  • Avoid sitting or lying down for long periods of time
  • Use a safe technique when lifting or handling heavy objects
  • Make sure you have good posture
  • Sit correctly when using a computer
  • If you are overweight, weight loss and maintaining a healthy weight can reduce symptoms if you have sciatica

How to manage Osteoarthritis:

  • If you are overweight, weight loss and maintaining a healthy weight can reduce symptoms if you have Osteoarthritis
  • Eat a healthy and balanced diet with fresh fruits, vegetables and herbs
  • Experiment with ‘inflammation reducing’ foods such as fish and nuts and try taking fish oil supplements to help reduce joint pain and stiffness
  • Apply hot or cold packs to joints to relieve pain
  • Use stretching techniques provided by one of our experts at Ahmeys or a physiotherapist
  • Take painkillers to reduce pain, but make sure that you follow the recommended dose and that the medication does not conflict with any other medication you are currently taking
  • Exercise regularly to keep joints flexible, but avoid overexerting yourself or putting too much pressure on your joints. Swimming is a good non-weight bearing activity
  • Look after your joints and try to avoid further damage
  • Practical tips for those incapacitated or severely troubled by mobility problems relating to arthritis are:
    • Keep things within easy reach
    • Install and use a hand rail on the stairs to help you get up and down
    • Use long-handled tools to pick things up or clean
    • As previously mentioned, fit levers to taps to make them easier to turn
    • Use electric kitchen equipment, such as tin openers, when preparing food

How to manage Tendonitis:

  • Warm up before exercising and remember to stretch afterwards
  • Take regular breaks from repetitive exercises to avoid repeated strain
  • Wear suitable footwear for exercise
  • Avoid over-exercising tired muscles
  • Do not attempt a new sport without some training or practice
  • Avoid sticking to the same repetitive exercises

How to manage Fibromyalgia:

  • Follow the advice of your Ahmeys expert with regards to treatment and pain management
  • Join one of the UK’s many support groups across the country that share tips on how to relieve symptoms and live with chronic pain
  • If possible, perform moderate, but non-extremely weight-bearing aerobic activities, such as: cycling, walking or swimming. This will help your endurance, maintain your overall fitness and has been shown to possibly improve quality of life and relieve pain
  • Consider gentle forms of exercise, such as: tai chi, yoga and pilates which can help strengthen and stretch your muscles and potentially aid stiffness and pain
  • Complete strengthening exercises, such as lifting weights, to increase the strength of your muscles and feel less fatigued
  • Balance periods of activity with periods of rest and try not to overexert yourself
  • Try to find time to relax and practice relaxation techniques. This is important as stress can make your symptoms worse and cause a flare up
  • If you have trouble sleeping (insomnia) due to fibromyalgia, it may help to:
    • Have a routine, getting up and going to bed at the same time every morning and night
    • Try to relax before going to bed
    • Create and try to stick to a bedtime routine, such as taking a bath and drinking a warm, milky drink every night
    • Avoid nicotine, caffeine, alcohol and any stimulant before going to bed
    • Avoid eating heavy meals late at night
    • Avoid looking at any blue screened-technology, such as phones or computers, late at night
    • Make sure your bedroom is a comfortable temperature for you and is dark and quiet
    • Avoid checking the time throughout the night, even if you can’t sleep

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