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  1. 1. Dr. Shamanthakamani Narendran OSTEOARTHRITIS M.D. (Pead), Ph.D. (Yoga Science)
  2. 2. <ul><li>Arthritis characterized by erosion of articular cartilage, either primary or secondary to trauma or other conditions, which becomes soft, frayed, and thinned with eburnation of subchondral bone and outgrowths of marginal osteophytes; pain and loss of function result; mainly affects weight-bearing joints, is more common in older persons. </li></ul><ul><li>Syn: degenerative arthritis, degenerative joint disease, hypertrophic arthritis, osteoarthrosis. </li></ul>DEFINITION
  3. 3. <ul><li>Osteoarthritis, sometimes called degenerative joint disease or osteoarthrosis, is the most common form of arthritis. </li></ul><ul><li>Osteoarthritis is characterized by the breakdown of joint cartilage and may affect any joint in the body, including those in fingers, hips, knees, lower back and feet. </li></ul><ul><li>Initially osteoarthritis may strike only one joint. </li></ul><ul><li>But if fingers are affected, multiple hand joints may become arthritic. </li></ul>INTRODUCTION
  4. 4. <ul><li>The word &quot;arthritis&quot; is a blend of the Greek words &quot;arthron,&quot; for joint, and &quot;itis,&quot; for inflammation. </li></ul><ul><li>In other words, arthritis literally means &quot;joint inflammation.&quot; </li></ul><ul><li>Although arthritis is often referred to as one disease, it's not. </li></ul><ul><li>Arthritis has more than 100 forms and is a common cause of disability. </li></ul>
  5. 5. <ul><li>There's no cure for osteoarthritis, but available treatments can relieve pain and helps to remain active. </li></ul><ul><li>In addition, how well live with osteoarthritis often depends on behaviors and attitude. </li></ul><ul><li>If osteoarthritis actively managed, pain can be controlled. </li></ul>
  6. 6. <ul><li>Osteoarthritis often develops slowly, and some people may not experience any signs or symptoms. </li></ul><ul><li>Osteoarthritis can cause the following signs and symptoms: </li></ul><ul><ul><li>Pain in a joint during or after use, or after a period of inactivity </li></ul></ul><ul><ul><li>Discomfort in a joint before or during a change in the weather </li></ul></ul><ul><ul><li>Swelling and stiffness in a joint, particularly after using it </li></ul></ul><ul><ul><li>Bony lumps on the middle or end joints of the fingers or the base of the thumb </li></ul></ul><ul><ul><li>Loss of joint flexibility </li></ul></ul>SIGNS AND SYMPTOMS
  7. 7. <ul><li>The acute pain of early osteoarthritis often tends to fade within a year of its appearance, but it may return if overuse the affected joint – this is especially true of fingers affected by osteoarthritis. </li></ul><ul><li>Areas osteoarthritis typically affects include: Fingers, Spine, Weight-bearing joints. </li></ul><ul><li>Unless it has been injured or placed unusual stress on a joint, it is uncommon for osteoarthritis to affect the jaw, shoulder, elbows, wrists or ankles. </li></ul>
  8. 8. <ul><li>With osteoarthritis the problem lies in the cartilage that cushions the ends of bones in the joints. </li></ul><ul><li>Over time, the cartilage deteriorates, and its smooth surface roughens. </li></ul><ul><li>Eventually, if the cartilage wears down completely, patient may be left with bone rubbing on bone – causing the ends of the bones to become damaged and the joints to become painful. </li></ul>CAUSES
  9. 9. <ul><li>The exact cause of osteoarthritis isn't known. </li></ul><ul><li>Researchers suspect that it's a combination of factors, including being overweight, the aging process, joint injury or stress, heredity, and muscle weakness. </li></ul><ul><li>Some scientists believe the cartilage damage may be due to a mechanical stress that results in an imbalance of enzymes released from the cartilage cells or from the lining of the joint. </li></ul><ul><li>When balanced, these enzymes allow for the natural breakdown and regeneration of cartilage. </li></ul>
  10. 10. <ul><li>But too much of the enzymes can cause the joint cartilage to break down faster than it's rebuilt. </li></ul><ul><li>The exact cause of this enzyme imbalance is unclear. </li></ul><ul><li>The body goes to work repairing the damage, but the repairs may be inadequate, resulting instead in growth of new bone along the sides of the existing bone, which produces prominent lumps, most noticeable on hands and feet. </li></ul>
  11. 11. <ul><li>Each of the steps in this repair process produces pain. </li></ul><ul><li>The pain and tenderness over the bony lumps may be most marked early in the course of the disease and less evident later on. </li></ul><ul><li>Osteoarthritis commonly occurs in the fingers, neck or lower back. </li></ul><ul><li>Hips and knees also are frequently affected because they bear most of the weight. </li></ul><ul><li>Chronic pain or varying amounts of discomfort when standing and walking. </li></ul><ul><li>Swelling also may occur, especially in the knees. </li></ul>
  12. 12. Osteoarthritis most often occurs in the hands (at the ends of the fingers and thumbs), spine (neck and lower back), knees, and hips. What Areas Does Osteoarthritis Affect?
  13. 13. In osteoarthritis, disks narrow and spurs form. Where bone surfaces rub together (facets), cartilage becomes worn and may be painful. Osteoarthritis of the spine
  14. 14. The hip joint on the left is normal, but the hip joint on the right shows deterioration of cartilage due to osteoarthritis. Osteoarthritis of the hip
  15. 15. <ul><li>The exact causes of osteoarthritis are unclear, but these factors increase the risk: </li></ul><ul><ul><li>Being 45 years old or older </li></ul></ul><ul><ul><li>Being female </li></ul></ul><ul><ul><li>Having certain hereditary conditions, including defective cartilage and malformed joints </li></ul></ul><ul><ul><li>Having joint injuries caused by physical activity or sports </li></ul></ul><ul><ul><li>Being obese </li></ul></ul>RISK FACTORS
  16. 16. <ul><ul><li>Having diseases that change the normal structure and function of cartilage, such as rheumatoid arthritis, hemochromatosis, gout or pseudogout </li></ul></ul><ul><ul><li>Having weak thigh (quadriceps) muscles, which may lead to develop osteoarthritis in the knees </li></ul></ul>
  17. 17. <ul><li>If presence of swelling or stiffness in the joints that lasts for more than two weeks, seek medical advice. </li></ul><ul><li>If the doctor determines osteoarthritis, he or she can work to develop a pain management and treatment plan. </li></ul><ul><li>Also seek medical advice if experiences side effects from arthritis medications, such as nausea, abdominal discomfort, black or tarry stools, constipation, and drowsiness. </li></ul>WHEN TO SEEK MEDICAL ADVICE
  18. 18. <ul><li>Doctor may use a variety of methods to diagnose osteoarthritis, including a physical examination, blood tests and certain imaging techniques. </li></ul><ul><li>Doctors use blood tests to diagnose or rule out specific types of arthritis. </li></ul><ul><li>Fluid may be withdrawn from a joint for analysis (joint aspiration). </li></ul>SCREENING AND DIAGNOSIS
  19. 19. <ul><li>Imaging techniques may include X-rays, bone scans, computerized tomography (CT) scans, magnetic resonance imaging (MRI) scans and arthrography — an image taken after dye has been injected into joint. </li></ul><ul><li>Imaging techniques can reveal bone spurs, worn-down cartilage and loss of joint space, indicating the presence of osteoarthritis. </li></ul>
  20. 20. <ul><li>The major complication of osteoarthritis is pain. The degree of pain can vary greatly, from being a mild inconvenience to being debilitating. </li></ul><ul><li>Although arthritis doesn't go away, for many people the acute pain of early osteoarthritis often diminishes within a year. </li></ul><ul><li>It can return if overuses the affected joints. </li></ul><ul><li>Doctor can help to determine how to adjust the activities to reduce stress on those joints. </li></ul><ul><li>People with very painful osteoarthritic joints may require joint replacement surgery for pain relief. </li></ul>COMPLICATIONS
  21. 21. <ul><li>There's no known cure for osteoarthritis, but treatments can help to reduce pain and maintain joint movement. </li></ul><ul><li>Doctor may recommend a combination of treatments that may include medication, self-care, physical therapy and occupational therapy. </li></ul><ul><li>In some cases, surgical procedures may be necessary. </li></ul>TREATMENT
  22. 22. Knee replacement surgery can repair damage from osteoarthritis and other inflammatory conditions. The artificial joint has metal alloy caps for the thighbone and shinbone and high-density plastic to replace eroded cartilage within the joint and on the kneecap. Knee replacement
  23. 23. <ul><li>Medications are used to treat the pain and mild inflammation of osteoarthritis and to improve the joints' functioning. </li></ul><ul><li>They include both topical medications and oral medications. </li></ul><ul><li>Over-the-counter (OTC) medications may be sufficient to treat milder osteoarthritis, but stronger prescription medications also are available. </li></ul>MEDICATIONS
  24. 24. <ul><li>Topical pain relievers. </li></ul><ul><li>Acetaminophen </li></ul><ul><li>NSAIDs </li></ul><ul><li>COX-2 inhibitors </li></ul><ul><li>Tramadol </li></ul><ul><li>Antidepressants </li></ul><ul><li>Injections of pain relievers </li></ul>
  25. 25. <ul><li>Helps to relieve disability and pain. </li></ul><ul><li>Joint replacement. </li></ul><ul><li>Arthroscopic lavage and debridement. </li></ul><ul><li>Repositioning bones. </li></ul><ul><li>Fusing bones. </li></ul>SURGICAL OR OTHER PROCEDURES
  26. 26. Gradual deterioration of cartilage that occurs in osteoarthritis is the most common reason for hip replacement surgery. Implanting an artificial joint eliminates pain and restores near-normal movement Hip replacement
  27. 27. <ul><li>Fortunately, patient can relieve much of the discomfort associated with osteoarthritis through healthy-living strategies and self-care techniques, such as the following: </li></ul><ul><li>Exercise regularly. </li></ul><ul><li>Control the weight. </li></ul><ul><li>Eat a healthy diet. </li></ul><ul><li>Apply heat. </li></ul><ul><li>Choose appropriate footwear. </li></ul><ul><li>Apply cold for occasional flare-ups. </li></ul><ul><li>Practice relaxation techniques. </li></ul><ul><li>Take the medications as recommended. </li></ul>SELF-CARE
  28. 28. <ul><li>Osteoarthritis can affect everyday activities and overall quality of life. </li></ul><ul><li>As a result, it's important to adopt coping strategies for dealing with the disease. </li></ul>COPING SKILLS
  29. 29. <ul><li>Might consider the following: </li></ul><ul><li>Keep a positive attitude. </li></ul><ul><li>Use assistive devices. </li></ul><ul><li>Know the limits. </li></ul><ul><li>Avoid grasping actions that strain the finger joints. </li></ul><ul><li>Spread the weight of an object over several joints. </li></ul><ul><li>Take a break. Periodically relax and stretch. </li></ul><ul><li>Maintain good posture. </li></ul><ul><li>Use the strongest muscles and favor large joints. </li></ul>
  30. 30. <ul><li>Because many complementary medicine methods haven't been studied extensively by researchers using mainstream scientific methods, it's difficult for the scientific community to evaluate their effectiveness and safety. </li></ul><ul><li>And with much of today's research funding coming from the pharmaceutical industry, some &quot;low-tech,&quot; nontraditional approaches to manage diseases such as arthritis may not get as much attention from the research community as they deserve. </li></ul>COMPLEMENTARY AND ALTERNATIVE MEDICINE
  31. 31. <ul><li>For these reasons, many Western physicians just don't know enough about these methods to endorse them. </li></ul><ul><li>Nonetheless a growing body of evidence indicates that complementary medicine practices could have a role in treating and managing some diseases. </li></ul><ul><li>Common forms of complementary and alternative medicine for treatment of osteoarthritis include: Acupuncture, Copper jewelry, Homeopathy, Magnets </li></ul>
  32. 32. INTEGRATED YOGA MODULE FOR ARTHRITIS <ul><li>Loosening Exercises </li></ul><ul><li>Passive rotation of toes </li></ul><ul><li>Toe bending </li></ul><ul><li>Ankle rotation </li></ul><ul><li>Knee rotation </li></ul><ul><li>Knee cap tightening </li></ul><ul><li>Full butterfly </li></ul><ul><li>Waist rotation </li></ul><ul><li>Wrist rotation </li></ul><ul><li>Shoulder rotation </li></ul><ul><li>Neck bending </li></ul><ul><li>Neck rotation </li></ul><ul><li>Quick relaxation technique (QRT) </li></ul>
  33. 33. <ul><li>Sakti Vikasaka Suksma Vyayama </li></ul><ul><li>For wrist – Mani bandha sakti vikasaka </li></ul><ul><li>For palms – Kara tala sakti vikasaka </li></ul><ul><li>For fingers – Anguli sakti vikasaka </li></ul><ul><li>For elbows – Khaponi sakti vikasaka </li></ul><ul><li>For arms – Bhuja bandha sakti vikasaka </li></ul><ul><li>For back – Kati sakti vikasaka </li></ul><ul><li>For thighs – Jangha sakti vikasaka </li></ul><ul><li>For calf muscles – Pindali sakti vikasaka </li></ul><ul><li>Instant relaxation technique (IRT) </li></ul><ul><li>Quick relaxation technique (QRT) </li></ul>
  34. 34. <ul><li>Yogasana </li></ul><ul><li>Standing postures </li></ul><ul><li>Ardhakati cakrasana </li></ul><ul><li>Ardha cakrasana </li></ul><ul><li>Padahastasana </li></ul><ul><li>Prone postures </li></ul><ul><li>Bhujangasana </li></ul><ul><li>Salabhasana </li></ul><ul><li>Supine postures </li></ul><ul><li>Sarvangasana </li></ul><ul><li>Matsyasana </li></ul><ul><li>Sitting postures </li></ul><ul><li>Vakrasana </li></ul><ul><li>Ustrasana </li></ul><ul><li>Deep relaxation technique (DRT) </li></ul>
  35. 35. <ul><li>Pranayama </li></ul><ul><li>Preparatory practices for pranayama </li></ul><ul><li>Cleansing breath (kapalibathi kriya) </li></ul><ul><li>Vibhagiya svasana (sectional breathing) </li></ul><ul><li>Pranayama </li></ul><ul><li>Surya Anuloma Viloma pranayama </li></ul><ul><li>Sitali/ Sitkari/ Sadanta pranayama </li></ul><ul><li>Meditation </li></ul><ul><li>Nadanusandhana </li></ul><ul><li>OM-Dhyana (meditation) </li></ul><ul><li>Devotional song </li></ul><ul><li>Silence </li></ul>
  36. 36. <ul><li>Other practices </li></ul><ul><li>Kriyas – </li></ul><ul><li>Jalaneti, </li></ul><ul><li>Sutraneti </li></ul><ul><li>Vamanadhouti </li></ul><ul><li>MSRT (30 min) or PET (30 min) daily (Audio cassettes of SVYASA) </li></ul>
  37. 37. INTEGRATED YOGA MODULE FOR ARTHRITIS <ul><li>Sithilikarana Vyayama </li></ul><ul><li>Passive rotation of toes </li></ul><ul><li>Toe bending </li></ul><ul><li>Ankle bending and Ankle rotation </li></ul><ul><li>Knee bending and Knee rotation </li></ul><ul><li>Half butterfly and Full butterfly </li></ul><ul><li>Waist rotation </li></ul><ul><li>Wrist rotation </li></ul><ul><li>Shoulder rotation </li></ul><ul><li>Neck bending and Neck rotation </li></ul>
  38. 38. <ul><li>Sithilikarana Vyayama (strengthening exercises) </li></ul><ul><li>Manibandha sakti vikasaka (wrist) </li></ul><ul><li>Kara tala sakti vikasaka (palms) </li></ul><ul><li>Anguli sakti vikasaka (fingers) </li></ul><ul><li>Kaphoni sakti vikasaka (elbows) </li></ul><ul><li>Bhujabhandha sakti vikasaka (arms) </li></ul><ul><li>Kati sakti vikasaka (back) </li></ul><ul><li>Jangha sakti vikasaka (thighs) </li></ul><ul><li>Pindali sakti vikasaka (calf) </li></ul>
  39. 39. <ul><li>Pranayama </li></ul><ul><li>Kapalabhati </li></ul><ul><li>Vibhaga pranayama (Sectional breathing) </li></ul><ul><li>Nadi suddhi </li></ul><ul><li>Sitali/ Sitkari/ Sadanta </li></ul><ul><li>Bhramari </li></ul><ul><li>Meditation (Dhyana Dharana) </li></ul><ul><li>Nadanusandhana </li></ul><ul><li>OM meditation </li></ul><ul><li>Kriyas </li></ul><ul><li>Jala Neti </li></ul><ul><li>Sutra Neti </li></ul><ul><li>Vaman Dhouti </li></ul>
  40. 40. SPECIFIC PRACTICES <ul><li>Yoga aims at relaxing and at the same time keeping moderately active so that joints do not become stiff. </li></ul><ul><li>Along with exercises and proper diet arthritics should take a lot of care of their hygiene. </li></ul>
  41. 41. <ul><li>General considerations : Arthritis is non-inflammatory joint disease (typically at the knee or the hip joint). It is more common in middle and old age. </li></ul><ul><li>Contraindications : Straining the joints with body weight. Fortunately jumping is not common in yoga, but Surya Namaskar or some balancing standing asanas may not be suitable. Some people, especially with knee problems, may find it difficult to sit in any yoga meditative asana and an alternative using a chair may be more appropriate for them . </li></ul>
  42. 42. <ul><li>Recommendations : People with non-inflammatory joint diseases usually benefit from practices which gently exercise the joint without pressure. (e.g. Pavanmuktasanasa, part I or cycling from Pavanmuktasanasa, part II). These practices exercise the joints and strengthen the muscles around them, which gives better support to the joint. </li></ul>
  43. 43. <ul><li>Recommended Asanas : </li></ul><ul><li>Surya Namaskar - activates all glands. </li></ul><ul><li>Santulanasan - removes rigidity of joints and normalises blood circulation. </li></ul><ul><li>Trikonasan (Triangular) - Cures pain or any disorder of neck and shoulder joints; activates all major joints (spine, the hip, the hands and the palms)above the waist area and tones the muscles; also provides quality of mental attentiveness. </li></ul><ul><li>Halasan (Plough pose) - makes spine and legs flexible. </li></ul>
  44. 44. <ul><li>Gomukhasan (Cow's face and jaw pose) - exercises finger joints, toes, ankles, knees and hip joints; activates muscles of joints therefore removing waste products from joints; restores joint fluid therby removing spasticity and pain. </li></ul><ul><li>Vrikshasan (Tree pose) -tones up muscles of ankles, toes, knees, hip joints, shoulder, elbows etc. ; brings flexibility in the legs and hands. </li></ul><ul><li>Natrajasan (Dance pose) - activates almost all joints; removes spinal rigidity, pain, backache,and stiffness. Strengthens all major bones and generates vitality. </li></ul>
  45. 45. THANK YOU