INTRODUCTION The Almighty gave us legs to walk on gave us mobility; to carry us from place to place and gave us hands to be creative, to perform the daily chores of life and to carry the burden of mankind. Primitive hunting man used to walk miles to hunt food for himself and his family. He had to have strong legs to do this day in and day out. Since there was never any certainty where he would go and what he would find, his limbs were tuned to work that extra mile or two if the need arose. In those days, limbs or rather the joints served man faithfully for really long number of years and most mortals were mobile till death.

From Home  elevator  car  Office  elevator. But then came the Industrial Evolution and Man had to develop different faculties. The joints were used less and less till life became almost sedentary : From Home  elevator  car  Office  elevator. The only exercise people indulged in is climbing walls and jumping to conclusions! The joints now had to be prescribed exercise by doctors, as a must for maintaining mobility and good health. As a result of disuse – joints stiffened, synovial fluid dried up, joints started degenerating earlier. Every which way you looked at it, the joint refused to cooperate. What more can you call spondylitis in early 30s and sever OA knee in mid 40s?

There are more joints in the child than in an adult. Definition : It is a junction between two o more bones or cartilage. It is a device to permit movements. There are more joints in the child than in an adult.

Classification of Joints Functional 1) Synapthrosis - Immovable It. 2) Amphiarthosis - Slights movable 3) Diarthrosis - Freely movable Structural Classification Fibrous Joint 2,Cartilaginous Joints * Synchonorosis or Hyaline Cartilage Joints. It B/w Epiphysis and diphysis of a growing long bone. Example : Spheno – Occipital Bone. Costochondral and Coststernal Joint. * Symphysis or fibro cartilaginous Joints. Example: Symphysis pubis Manabrio sternal joint

3. Synovial Joints or Diarthrodial Joints Also k/s Freely movable joints The ends of tow bones are held together by joint capsule, with ligaments and tendons inserted at the outer surface of capsule. A synovial joint has a fluid filled cavity. The fluid is known as synovial fluid (produced) Synovial fluid acts as lubricant. Most of the disease of Joints affected Diarthrodial or Synovial Joints.

Types of Synovial Joints & their movements 1 .Plane or Gliding movement Example- Intercarnel Joints Inter tarsal joints Joints b/w bertebras Movements – Gliding movements.

Hinge Joints Uniaxial Joints Movements are limited in one plane. Example - elbow joint Ankle joint Interphalangeal joints movements - Flexion & extension

Pivoto Joints Condoyle Joints Uniaxial Joints Example - superior and inferior radio ulnar. Median Atlanto axial joints Movement - Rotation only Condoyle Joints Joints permit movements mainly in one plane around transverse axial but partly in another plane around vertical axis. Movement possible – Flexion & extension & limited rotation. Example - Knee joint right & left Saw joints 260

Ellipsoid Joints Saddle Joint (Seller) Biaxial Joints Free movement are permitted around both the axis. Movements Possible –Flexion, Extension abduction, adduction and circumduction. Example - wrist Joints Metacarpophalengeal joints. Saddle Joint (Seller) Multiaxial Joints Move possible-- Flexion, Extension, adduction, abduction and conduct rotation. Example  Sternoclavicular joint Calcaneocuboid joint

Ball and socket Joint (Spherodial) Multiaxial joint Movements occurs around and indefinite number of axes which have common centre. Movements-Flexion, extension, abduction, adduction, medial rotation, Lateral rotation and circumduction. Example - Shoulder joint Hip joint Talocalcaneonavicular joint

Factor maintaining stability of joint Muscles Ligaments Bones

Aging & Joints With aging, a decrease in synovial fluid, thinning articular cartilage and decrease flexibility ligament occur. Most individual experience some degeneration is the knees, elbows, hips and shoulder due to aging presses.

ARTHRITIS It is a form of Rheumatism in which joints have become inflamed and painful Characterized by Inflammation, Pain and stiffness and moving usability Arthritis affects about 10 % people of world Population. Most common in older Aged people due thinking of particular cartilage and decrease in synovial fluid

Also due to injury, Truma, Allergy and infections disease spread such as Tuberculosis. Gonococcal Syphilitic etc.

Important cause of Arthritis Diffused connection tissue disease such as RA Degenerative joint disease such as OA. 3.Metabolic and endocrine Disease such as Gouty Arthritis.

CLINICAL MANIFESTATION Arthralgia - Pains in Joint Chondritis - Inflammation of Cartilage (3 Synovitis - Inflation of a Synovial membrane. in joint.

CLASIFICATION OF ARTHRITIS Arthritis with psoriasis 1. Rheumatoid Arthritis – and its variants such as Arthritis with psoriasis Juvenile rheumatoid arthritis Rheumatic spondylitis Reiter’s syndrome Arthritis due to rheumatic fever. 3. Osteoarthritis.

4.Arthritis associated with known infectious agents – e.g. Gonococcal, Tuberculoses – most common Involve – spine, hip join & Knee joints Tuberculosis of spine is termed as POTTS DISEASE Spondylitis. Syphilitic – Pneumococcal, etc.

Associated with metabolic or bio-chemical or endocrine abnormalities - Gout, hemoglobinopathies, onchronosis, acromegaly, etc. 6.Traumatic arthritis 7.Neuropathic arthritis 8.Allergy and drug reaction.

10. Connective tissue disease – S.L.E. Polyarhteritis nodosa, 9. Arthritis with blood disorders 10. Connective tissue disease – S.L.E. Polyarhteritis nodosa, Dermatomyositis. 11. Miscellaneous Disorders - Amyloidosis Erythema multiform, Ulcerative colitis, Sarcoidosis

OSTEOARTHRITIS (O.A) Also called as Osteorthrosis or Degenerative Joint Disease Result from a combination of aging, irritation of joints, wear and abrasion. Commonly known as wear and tear arthritis and leading cause of disability in older individuals. Most common form of chronic disorder of synovial joints particulars weight bearing joint

In Older Age. The Articular cartilage show Degenerative changes in CENTRE (Fibrillation of cartilage) And Proliferative change around the edges (Osteophytes ) It is characterized by : Degeneration of the cartilage with associated over growth of bone at the margin of joints And Changes in synovial membrane Affect up to 10% of world population

IT COMMONLY INVOLVES :

The proximal Interphalangeal finger joints – to form bony swelling – The distal IP joints of the fingers- to form bony swelling – The Heber den nodes. The proximal Interphalangeal finger joints – to form bony swelling – The Bouchard nodes

The lumbar spine – lumbar spondylitis

The cervical spine – cervical spondylitis.

The large joints – including Hips and Knees.

Pathogenesis PRIIMARY– OESTEOARTHRITIES  Occur more commonly in women than men . Progress begin by end of 4th decade. Pathogenesis Wear and tear with repeated minor trauma, heredity AND obesity.

Secondary Osteoarthritis  -May appear at any age. -Results from any previous injury, fracture inflammation and congenital dislocation of the hip. Clinical manifestaslation : Joint stiffness. Diminished mobility, pair etc. The symptom are prominent on walking up from the Bed in morning. .

The degenerative changes in the interphalenges joints lead to hard bony and pain less modules at the base of terminal. Its phalanx called as HEBERDEN”S NODES.

HEBERDEN”S NODES

Pathos Physiology of secondary osteoarthritis

Thicking of jointCauses swelling. Most marked in weight – bearing region. Initially Loss of cartilaginous matrix Resulting Progressive loss of normal metachron Focal loss of chondrocytes Causes Loosening, flaking and fissuring of Articular cartilage. Resulting Breaking off of pieces of cartilage. Developing of Osteophytes. Thicking of jointCauses swelling.

MACHINICAL SYMPTOMS ARE CHARACTERRIZED BY: Pain: The pain is usually relieved by rest. Night pain may be a feature. Pain on weight- bearing, if the lower limb joints are involved. Stiffness after rest: usually lasting less than 5 minutes – with the patient loosening up quickly by moving the joints. Morning stiffness is not a prominent feature and short lived if present at all. Swelling is usually bony rather than soft tissue in character.

Risk factors: Age Obesity Repetitive stress injury / trauma to joints. Sex – Female are more frequently involved (10:1) Genetics – this is a problem often seen within families. Other diseases causing cartilage damage – resulting in secondary osteoarthritis.

X RAY OF NORMAL KNEE JOINT

X RAY OF OSTEORITHRITIC KNEE

OSTEOARTHRITIS OF KNEE Most commonly affected joints found in clinical practice. Joint space narrowing with Osteophytes (new bone formation) and loose bodies are seen. The patellofemoral articulation is the most commonly affected with medical tibiofemoral compartment being second. In early disease, spiking of the tibial tubercles and marginal Osteophytes are seen.

OSTEORTHITIS OF THE HIP JOINT This is the second most affected joint in the body. Secondary osteoarthritis following: Congenital dysplasia. PERTH’S DISEASE congenital dislocation, slipped epiphysis, Aseptic necrosis etc is more common than primary osteoarthritis. Joint space reduction and marginal osieophyisis are seen. The femoral head migrates either superiorly or medially. A-P views of the hip usually provide adequate information. In certain cases, a CT scan show areas of subaiticular crescents as in aseptic necrosis or geode formation in advanced cases.

NORMAL X RAY OF THE HIP JOINT

OSTEORTHITIS OF THE HIP JOINT

OSTEOARTHRITIS OF THE HANDS In osteoarthritis, the distal interphalageal joints are most commonly affected with joint space narrowing and large peripheral osteophytes resulting in the clinically evident “Heber dens nodes “

X RAY OF ARTHITIS OF THE TOE JOINT

RHEUMATOID ARTHRITIS Definition – A systemic connective tissue disorder which affects predominantly the synovial joints, hence the term rheumatoid disease. Its systemic manifestation include hematological, pulmonary, neurological & CVS abnormalities

Etiology : Age – any age, majority Between 20-40. Sex – more in females than males = 5:1 Climate – in temperature climate. Familial tendency. Genetic factors. Sex hormones – more in female than in males. 7.Psychological factor – Physical 8.Exposure to cold & wet. 9.Trauma: Arthritis may start in a joint which has been the seat of trauma and other joints subsequent get involved. 10.Environmental triggers.

EITIOPATHOGENISIS OF REHEVMATOID ARTHERITIS IMMUNOLOGIC FACTORS (II) GENETIC FACTOR

Genetic susceptibility ( MHC – Class – II ) Antigenic stimulation ( By infections agent ) CD4 + T –Cells Cytokines ( TNF – α, INF – γ, IL -1) Activate Activate Activate B – Cells Endothelial Cell Macrophages Anti IgG – antibody Release of adhesion Cytokines (Rheumatoid factor) molecule Protease Formation of immune complex, Inflammatory Cells, Inflammatory damage to synovium, small vessel collagen Destruction of cartilage bone fibrosis, ankylosi joint Deformities

Types of Presentation:- 1.Classical – Pain, stiffness and swelling of small joints of head, wrists. 2.Palindromic – Pain, swelling and redness usually of a single joint, followed by rapid return to normal after several days. 3. Systemic - Weight loss, Pleurisy and pericarditis but minimal joint involvement. 4. Polycyclic - Plain and stiffness in shoulders and hips with subsequent synoptic. 5. Monoarthritic - Single joint involvement usually the knee. 6. Acute Onset - Sudden overnight onset with stiffness and pain. 7. With generalized lymphadenopthy.

Clinical Features :- In early stage – Joints are warm, swollen and tender. Weakening of joints, capsule and tendon along with ligament damage. Instability, subluxation, dislocation. Severe joint damage may lead to fibrous or body ankylosis

secondary degenerative changes. 1.Hands - Tenosynovitis (inability to appose the palms) Rupture of flexor/ extensor tendons with weakness of grip. 2.Legs - Knees – synovial effusion Ankles – Valgus deformity 3.Cervical Spin -

1.Skin - Palmer erythematic Rashes Psoriasis. 2.Myositis - Muscle wasting around inflamed joints 3.Bone - Generalized osteoporosis 4.Eye - Keratoconjunctivitis scleritis 5.Heart - Pericarditis Myocarditis Rheumatoid Vulvulitis. 6.Blood - Anemia (mild normocytic norm chromic anemia) G.I. bleeding by Aspirin and other Analgesics. 7.Respiratory- Pleurisy and ale Ural effusion Rheumatoid nodules Pulmonary hypertension

8.Nervous System - Neuropathy Nerve root compression Pain Numbness or Paraesthesiae 9.Kidney - Proteinuria Microscopic heaematuria 10.Investigation - E.S.R. (elevated) R.A. Factor S.L.E. 11.Radiology - Reduced of joint space X-ray bone Deformity

X-RAY & bone Deformity

GOUTY ARTHRITIS In Gouty Arthritis, sodium create crystals are deposited in the soft tissue of the joints. The crystal irritate and erode the cartilage causing The person who suffers from govt. either produce excessive uric acid or is unable to excrete as much as normal. Result in building up uric acids in the blood. Uric acid + sodium ↓ Crystal of Sod. Ureate Deposited in the soft tissue of the joints.

DIAGNOSIS OF ARTHRITIS 1. PHYSICAL EXAMINATION Whenever a patient presents with a problem joint, the primary care physician has to picture All the structures that makes up a joint. Any one or more of the following may be involved: Trauma Degenerative changes Infection: both acute and chronic and Neoplastic

If a Patient is looking with pain in joint the pain can be of three things. Bone Muscle Nerve Examination of – Swelling /Edema Tender Redness Any eruption Tortuousness of veins Hot/cold ( temperature ) Movement Sound (cracking )

To complete the list, metabolic (gout) & Neoplastic causes also have to be kept in mind. On the other hand the joint may be affected as part of a widespread systemic disease – Rheumatoid arthritis and other seronegative spondyloarthropathies. When a patient presents with any joint pain, it is the duty of the physician to assess the entire locomotors system:

ESTABLISH THE EXTENT OF ABILITY OR DISABILITY To carry out routine, day-to-day chores. Eg in rheumatoid arthritis can he open / shut a zip or unbutton her blouse; what are the activities which are not possible now and should be our first target at improvement. Ask the patient: Can you climb stairs? Can you dress normally? Are you free from any muscle stiffness any where in the body? If the answer is No. go into details an if the answer is yes, it is unlikely that the patient has any significant involvement in affection of a joint / muscle group.

OBSERVATION Ask the patient to disrobe as much as is comfortable for both the physician and the patient. Ideally patient should be in undergarments. Stand away from the patient and observe closely as the patient carries out your instructions. Observe the patient from behind to Assess the buttocks, shoulder, Para spinal muscles. Are they symmetrical? Is there any deformity or swelling? Is the spine straight or tilted/ curved to one side? Observe from side Are cervical and lumber curvatures normal? Ask the patient to touch the toes. Is the flexion of hip and spine normal? (ie whether he can touch the toes)

From the front TOUCH head both ways – checks lateral flexion of the neck. Open and close the mouth – Temporo-mandibular joint. Ask to put hands behind the head – tests gleno-humeral and sterno clavicular movements. Ask to hold arms straight – tests elbow extension. Ask to supinate and pronate the hands. 6.Ask to spread the fingers and show you the hands-look for any wasting, deformity or swelling (s). 7.Ask to put thumb and index finger together – checks pincergrip

Closely observe the lags – quadriceps bulk, any deformity or swelling. Knee joint- any effusions by patellar tap? Observe feel – any deformity? Any callosities? Ask to walk around- is the gait normal? Are the amis swinging while walking? Is the strike of heal on the ground as well as lift of toes from the ground normal? Can he turn quickly and normally?

LAB . INVESTIGATION OF ARTHRITIS BLOOD INUESTIGATION RA- FACTOR ESR RA- FACTOR ASOTITER SLE

X-RAY REPORTS OF ARTHRITIES

C. T. SCAN MRI SYNONICAL BIOPSY URIN TEST

OTHER MODE OF TAEATMENT ALLOPATHY Anti inflammatory Pain killer Relexacent Sedatives Local application Hot fomentation AYUERVEDIC UNANI NATUROPATHY YOGA

Homeopathic Mode of Treatment Examination : Physical and LAB Investigation Case taking Constitution History : weather patient had any trauma or accident in the past Miasm : psora , syphilis or sycosis Diathesis : Rheumatic or Gouty Mental Location : Hand , Wrist , Knee, Cervical spine or Hip joint Ailments (Cautions)

HOMEOPHATHIC REMADY FOR ARTHRITIS, RHEUMATISM & GOUT

For excessive pain before the swelling comens            ABROTANUM Especially for ANKLE JOINT & WRIST JOINT For OSTEOARTHRITIS Rheumatism:     For excessive pain before the swelling comens   From suddenly –checked Diarrhea or other Secretion, Alternate with Hemorrhoids, with dysentery Aggravation; - at night and from cold Amelioration; - by motion

ACTAEA SPICATA Special Affinity for Smaller joints   Wrist, & Fingers Ankles & toes Rheumatism: ·  Swelling & aching in joints after a slight exercise. ·  Affected joints are swollen and in affected limbs great weakness. ·  Right arm and right wrist are specially affected. Pain: Are violent tearing and drawing character Aggravation: - At night motion and change of weather. Wrist, & Fingers, Ankles & toes. Ankles & toes

· Patient cannot bear pain · Great fear of being touched or struck. 3)ARNICA MONTANA Especially for Traumatic Rheumatism or Arthritis. Rheumatism: ·        Ascending type of rheumatism. ·        Patient cannot bear pain ·        Great fear of being touched or struck. Pain;  in the back and limbs as if bruised or beaten.  cannot walk erect on account of pain in pelvic organ. Aggravation: At rest; when lying down: from wine Amelioration: From contact ; Motion

BENGOIC ACID Urine dark brown And The urinous odor highly intensified Especially for GOUTY ARTHRITIS In a person who have History of Suppressed Gonorrhea, Syphilis. Gouty concretion arthritis Affects all the joints, especially knee joint Cracking on motion; Nodositis Urine dark brown And The urinous odor highly intensified Pain – tearing, stitching , in large joints, Pain aggravates in night

 For Articular Rheumatism  Allumina is chronic of bryonia  BRYONIA ALBA  For Articular Rheumatism  Allumina is chronic of bryonia  Great dryness of all mucus membrane.  Great thirst for large quantity of cold water at long interval Pain: Stitching, tearing, worse at night. Aggravation: from slight motion, exertion, touch, Suppressed discharges of any kind, at 9 pm Amelioration: Complete rest, lying on painful side pressure, cold.

CALCAREA CARB CAULLOPHYLLUM For Gouty Nodos ties about fingers Arthritis nodosa deformans. Aggravation: cold air wet weather, cold water in morning. Amelioration: Lying on painful side.   CAULLOPHYLLUM For Arthritis Deformam in women’s. Affinity for smaller joints. Pain: Severe drawing, tearing pain. Pain is of flying nature; migrate from one place to another. Pain in fingers and wrist. Fingers are very stiff. Aggravation: in open air and coffee Amelioration: By emission of flatus.

CAUSTICUM For Rheumatoid Arthritis For Chronic Articular Rheumatism   CAUSTICUM For Rheumatoid Arthritis For Chronic Articular Rheumatism Rheumatism: Of joints with stiffness and contraction of flexor tendons, Shortening of muscles. Aggravation: in clear weather Amelioration: In damp weather and by warm air.

CMICIFUGA (Actaea recemosa) Articular rheumatism of lower limb. Joints commonly affected are lumbo-sacral region and Big Joints. Rheumatism: ·        Good remedies for muscular rheumatism. ·        Especially affects the bellies of muscles of neck and back. ·        Joints commonly affected are those of LUMBO-SACRAL REGION and big joints. ·        Uneasiness, restlessness, aching in the limb with pain in lumbar and sacral region. ·        Rheumatism alternates with mental symptoms. Aggravation: ·        from using arm in sewing , type writing, piano-playing. ·        From cold damp weather and during menses. More severe the flow, greater the sufferings. Amelioration: from warmth

COLCHICUM AUTUMNALE Valvular Disease or pericrditis following rheumatism. Acute Rheumatic fever. Action more marked on Small Joints Rheumatic pain Of the clavicle, neck, shoulder, arms and back. ·        In the elbow joint, forearm, waist, and ligaments of the finger Joints, and of great toes. ·        With lameness in the arm which make it impossible for the patient to hold lightest thing. ·        Flying pain in the Hips, ·        Tearing pain in thighs and knee joints with swelling. ·        Tingling pain in Toes. ·        Pain has tendency to move from one joint to another ; from one side to other , from below to upwards or from above to downwards. Aggravation : From cold damp weather, by motion, during Autumn Amelioration: from warmth, by rest, and lying down.

FERRUM MET ELLICUM For Neuralgic and Rheumatic Pain. Rheumatism of LEFT SHOULDER ·      Tearing and stinging nature of pain. ·       Rhematic Pain in Deltoid muscle. ·        Violent pain in muscles and along the nerves. Aggravation: From cold and rest Amelioration: slowly moving

KALI BICHROME Pain Rheumatism · For Syphilitic Arthritis ·     Tearing sensation in the tibia, with swelling and stiffness of joints. ·     Rheumatism alternates with gastric symptoms. Pain ·      In small spots, which can be covered with TIP of finger. ·      WONDERING PAIN, Aggravation: from cold and motion.

KALMIA LATIFOLIA For Acute Rheumatic fever. Rheumatism:- ·   Caused by chill, exposure to cold ·   Right-sided affection. ·   Sensation of numbness, coldness, weakness, in the limbs. Pain: WANDERING PAIN, changes place suddenly, goes from one joint to other. Pains are sticking darting, pressing, shooting in the a downward direction. Joints are hot, red, painful and swollen. Þ   Heart complaint alternate with Rheumatism. Aggravation: from least movement , becoming cold. Amelioration: continued motion

LACHESIS Sciatica, right side, better on lying down. Pain For Rheumatic Carditis. Sciatica, right side, better on lying down. Pain In lower Extremities, in Tibia, in Neck worse cervical region Shortening of tendons. Neuralgia of coccyx, worse rising from sitting posture. Sensation of threads stretched from back to arms, legs, eyes, etc. Aggravation: from warm bath, pressure or constriction, hot drinks Amelioration: appearances of discharges warm application

LYCOPODIUM CLAVATUM Chronic Articular Arthritis Right-sided remedy Rheumatic Pain In ankle, and finger Joints, Painful Callosilitis (CORNS ) on soles All disease is worse in the afternoon from 4 to 8 pm. Tearing in shoulder and elbow joints. One feet hot and other is cold. Chronic gout, with chalky deposit in joints. Aggravation: Right side, from right to left, from above downward. 4am to 8 pm. from heat Amelioration: by motion. After mid night

NATRUM MUR Symptoms are worse from sunrise to sunset, Chronic articular Arthritis. Based on History of Dyscrasia. Symptoms are worse from sunrise to sunset, especially from 10 to 11 pm. Painful contraction of the Hamstring. Pain in back with desire to support. Palms hot and perspiring. Ankles weak and turn easily. Cracking in joints on motion. Aggravation: from noise, music, lying down, heat, and talking. Amelioration: open air, pressure against back. Lying on right side.

RHODODENDRON Fibrous deposit is great Toe-joint. Right-sided remedy. Chronic Osteoarthritis Gout with fibrous deposit in great toe joint. Rheumatism:- Chromic Rheumatism affecting the smaller joint Acute inflammatory swelling of the joints. Pain. ·       Drawing ,tearing pain in the limbs. ·       Sometimes wandering from one joint to other. ·       Pain in dorsal region, extending to arm, in bone and periosteum ·       Pain in the shoulder that arm cannot be moved. Aggravation ; During rest, before and during storm Amelioration; By warmth, wrapping up moving.

Traumatic and Articular Arthritis. Rheumatism:- RHUS- TOXICODENDRON Right-sided remedy For Osteoarthritis Traumatic and Articular Arthritis. Rheumatism:- ·     Caused by lying on damp ground, summer bathing, working in damp place. ·     Great restlessness, anxiety and apprehension. ·     Always want to be moved, cannot remain in one place. Pain.: ·       As if Sprained, As if muscle or tendon were torn from its attachment. ·       As if bone were scrapped with knife. Aggravation; - After midnight, in rainy weather, " On first moving, and getting up in morning." Amelioration; - By walking, and continued motion.

SULPHUR THUJA OCCIDENTALIS Facilitates absorption of serous or inflammatory exudates in pleura & joints Acute and Chronic Rheumatism After the attack of acute Dyscrasia Aggravation; By standing, rest, heat, bathing, changeable weather. Amelioration; By dry warm weather, lying on right side THUJA OCCIDENTALIS Gonorrheal Arthritis Sycotic Poison, Arthritis deformens Aggravation; At night, at 3pm and 3 am, form cold damp air . Etc… Amelioration; In open air, by movements, pressure, rubbing

MANAGEMENT The concept of joint protection is vital for the patients with OA. Especially where large joints are involved. Protection from overuse is important. Assistant devices to reduce weight bearing joint pain – ie canes. Reduce impact exercise like jogging. Increase non weight bearing exercise – ie swimming / cycling. .

Physiotherapy will maintain joint protection through Good quality footwear, when walking recreationally. If any leg length discrepancy, ensure it is corrected. Weight reduction is crucial especially in obese patients with large joint problems on weight bearing. Physiotherapy will maintain joint protection through optimizing the strength of adjacent supportive muscles. Heat and ultrasound may relieve muscle spasm.a

General Measures Diet Rest - Both mental and physical One has to avoid the following items. Tea, Coffee, Fried things, Salt, Chilly, Spices and condiments milk and milk products. Heavy digestive Dal , Rice , Pickles Alcohol an d Non- veg diet . 2. Yogic therapy include Yogasanas, Pranayama, rest and other arthritic exercise Rest - Both mental and physical Exercise- morning walk, running etc. 5. Correction of Anemia 6. Avoidance of cold, dampness and draughts. 7. Removal of focal infection

Exercises for arthritis

CORRECT YOUR POSTURES 1.Correct postures of sitting, standing and walking make a difference in patients of cervical spondylitis. Wrong postures, even temporary, can result in strains on the joints and bring diseases. There should not be any hump in the back when the child learns to sit, stand and walk

3.When we sit, stand, walk or drive a vehicle, do not bend spine Car drivers not keeping their backs straight also get neck pains. The seat of the car should be adjusted nearer to the steering wheel and if there is space between seat back and upper hips area. A small pillow should be placed in between.

Sleep, bed and pillow: Both neck and back pain have a definite bearing with the type of bed 7. Sleeping posture. Those who suffer from cervical spondylosis should try to sleep on the left or right side instead of continuous sleeping on the back. While sleeping on the sides of the body, one should lie with the legs slightly flexed or bent at the knees towards the abdomen. This offers great relaxation to the muscles

Standing postures during parties: In most of the parities, the fashion is to stand for a long lime at one place.

13. Working on computers need more care for neck pain 13. Working on computers need more care for neck pain. The table should match your height. Roughly your elbows and table top should be at same level. Your eye level should be in alignment with screen of computer continuously for hours

Case:- Patient’s Name:- Mr. Bhagwan Lal Patel Address:- Arnodh (Dist.:-Indore) Age:- 68yrs. Occupation:- Farmar Date:- 14/11/08 Mobile:- 99009245062

PRESENT COMPLANTS Pain & Swelling in both Knee & Ankle Joints (Since:- 4 Months) Allergic Rashes on Neck & Face taking antiallergic. Difficulty in Breathing. Pain worse when goes to upstairs & down stairs.

Personal history Thermal Relation:- chilly Pt. Thirst:- 10 to 12 glass per day. Appetite:- decreased. Aggravation:- when goes upstairs, down stairs & cold wet weather. Amelioration:- warm application. Stool:- Clear Urine:- Scanty

MENTAL GENERAL Restlessness. Fearful Irritable+

General Examination Built:- N Skin:- Rashes on Neck & Face Toung:- Red & Cracked B.P. 130/80 mm/hg

1ST Prescreption Rx Rhus. Tox. 200] 1 drm T.D.S. for 7days

Second prescription C/o Slightly relief in pain & swelling Rashes disappears Rx Plc 200]1/2 dm B.D. for 7 days

C/o Pain & swelling as it is. Sneezing & coryza. Rx Rhus. Tox. 200]1/2 dm B.D. for 5 days

C/o Pain & Swelling worse. relieved in coryza & sneezing. Stiffness in neck. Pain in both shoulder Rx Rhododendron 200 ]1/2 drm T.D.S. for 3 days Plc 200 ] B.D for 5 days

Advise Avoid sour things, fatty food & high rich protein diet. Do some mild exercise

C/o Much relief in all complaints mentally feel well Rx Plc 200 ] 1 drm B.D for 8 days

C/o No further relief Complaints are as it is Rx Medorrhinum 1M ] 1dose Rhus tox 200 ] 1drm B.D. for 7 days