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  • Sex and Arthritis: Raise the curtains

    Sex and arthritis: let’s say it’s time to raise curtains/ let’s take it to drawing room/centrestage

    When I wrote the word “sex” to begin this article, my well-nourished cultural morality appeared out of nowhere and grappled me, asking, “What are you writing?” That, too, in our group’s main publication, which enjoys widespread acclaim among our common fraternity of doctors and patients. When I regained my senses after a brief period of confusion, my desire to write this article grew even stronger.

    Sex has long been thought to be a topic best discussed behind iron curtains and with extreme secrecy, even if it means public exposure of a relationship’s bad companionship. It’s not hard to believe that, after Amazon, YouTube, Google, Gmail, and Hotmail, sex-related words are among the most sought-after words in the virtual world (google search), but are still rarely discussed in real life. In fact, it has a hidden share of the popularity of other commonly searched words. We love to watch it, read about it, participate in it, and enjoy it in all of its forms—but why, with all of this interest and openness, and even 30 years after the chart-topping song “Let’s Talk About Sex” by the group Salt-N-Pepa, is this still a taboo topic in society that we struggle to openly discuss?

    In my more than a decade of arthritis practice, I met thousands of patients and professional colleagues of all ages, genders, socioeconomic classes, and ethnic groups. We talked about treatment, work, lifestyle, and many other aspects of arthritis, but only a few doctors and patients were able to engage in open communication about sex. The majority either remains silent or speaks indirectly, like in traditional Indian films, where props such as flowers, birds, and trees are used to symbolise it.

    Sexual health is an essential element of our overall wellbeing, and it has a direct and indirect impact on our micro and macro environments. Unlike other chronic disorders, arthritis has long been seen to be a sex-neutral medical condition, although it can have a significant impact on our sexual lives in a variety of ways. It can cause physical discomfort (Pain, stiffness, fatigue, limited movement and decreased muscle strength) that makes different positions or acts unsuitable, as well as emotional issues (depression, reduced self-esteem, decreased sexual expression, low sex drive and side effects of medication) that lead to an aversion to active sex life. It sometimes causes dryness in the sexual organs of the female partner also, which may make sex uncomfortable.  It may also topple the balance of your partnership and your shared tasks in everyday life, where you need each other’s assistance.

    It is important to discuss not only for fun but also for starting a family. Inability to start a family has a lot of psychosocial consequences for engaged partners, as well as a lack of respect in many ethnic groups. By raising age-old iron curtains and putting it front and centre, we can dispel beliefs about it and guide our patients to have an active, happy and graceful sexual life even with arthritis.

    People have many questions, such as whether or not having sex is harmful to their arthritis. Does sex help arthritis? Will my arthritis medication affect my sexual life? Could these medications have an impact on my family planning? Is it possible for joint replacement to interfere with my sexual activities? And What are our options for resolving these issues?

    We’ve already talked about how arthritis affects sexual life in various ways. Contrary to popular belief, sex and orgasm are effective pain relievers. The act entails gentle range-of-motion exercise that reduces pain and inflammation. Another mechanism that explains its positive effect on pain control is the release of the body’s endogenous pain relievers, oxytocin and other endorphins. It strengthens the muscles around the joints, which aids in their support. According to Palo Alto sex therapist Marty Klein, PhD, it is also mood-elevating, which helps alleviate pain.

    According to a study conducted by Beverly Whipple, a renowned sexologist and author and professor emeritus at Rutgers University, “during orgasm, the pain tolerance threshold and pain detection threshold increase significantly by 74.6 per cent and 106.7 per cent, respectively.”

    Generally, arthritis medications do not interfere with sexual functioning; however, a few medications may interfere with libido and some may cause erectile dysfunction if used long term. Some medications, such as sulfasalazine, have the potential to temporarily reduce sperm count.

    If you’re planning a pregnancy, it’s critical to talk to your doctor because some medicines can cause a miscarriage or an undesired abnormality in the baby. In such instances, it may be necessary to use contraception or devise particular drug washout methods. Few medicines can pass breast milk and damage your infant, so it’s critical to have an in-depth and honest conversation with your doctor.

    To overcome the previously mentioned challenges, remember that the brain is the centre of all our emotions and thoughts, as well as the transmitter of impulses that initiate a chain of events leading to genital arousal, making the brain the largest sexual organ. As a result, you should prepare your mental frame by discussing concerns and solutions with your partner, counsellor, doctor, or other health care expert. Staying sexual in your body language will help you build an environment with your spouse. Before making love, consider making alterations in place (cushioning, height, and adequate supports, for example), taking a hot shower, a brief bout of exercise, and possibly analgesic drugs. For a cohesive atmosphere in your safe, happy, active, and graceful sex experience with arthritis, be informed, adaptable, and experimental with your preferences. Emotional and physical intimacy must be the goal instead of focusing on intercourse.

    If nothing else seems to be working, you may want to consider joint replacement options to address the arthritis problem in the affected joints. Although, due to a lack of suitable understanding and training, sexual activities during the initial recovery period may be detrimental. Sexual life improves dramatically after surgery, and you can contemplate resuming sex life after 8-12 weeks. When Jose A. Rodriguez, M.D., head of Lenox Hill Hospital’s Centre for Joint Preservation and Reconstruction, evaluated 147 persons with severe arthritis, he discovered that the majority of them had sexual impairment and unhappiness. However, 81 per cent of them reported greater sexual frequency and enjoyment after joint replacement.

    A word of caution for people who have had hip replacements: certain movements are prohibited due to the risk of dislocation, which may necessitate position changes. Kneeling may be difficult for 6-8 weeks after a knee replacement, so necessary adjustments and training would be beneficial. So, rather than enduring a repeat intervention and subsequently repenting owing to a misadventure, there should always be an open dialogue between patient and caregivers about the movements patients should avoid in a particular joint replacement depending on the surgical technique utilised. If you’re unsure about anything, ask – they’ve probably been asked the same question many times before.

    Finally, I can state that having a decent sexual life is not an unreasonable expectation of arthritis patients, nor is it a misrepresentation if we doctors prescribe sex as part of arthritis care with other modalities.

    7 commandments for sports injury prevention

    Sports injury prevention

    As an athlete, body fitness is of paramount importance and maintaining it consistently throughout the season is rather bigger challenge. But nowadays when sports are getting faster and more competitive, it’s really unpredictable when someone would get injured. In fact, injuries can occur in the blink of an eye. Although it only takes one second but its agony and impact on the body, mind and soul lasts long and this fear haunts for lifetime.

    Injuries are a real nightmare for every sports and gym enthusiast. Even in their wildest dream nobody wants an injury. If you ever enquire any athlete, anywhere in the world at any point of time in their career, regarding their biggest fear, there would be only handful who would not name injuries. Injuries show up like termites along with their aspiring career and come to eat away talents and all hard work invested by them.

    With a rush to activities after lockdown, not only sportsperson but also everybody wants to resume their life as it was in Pre-Covid time because of rebound fitness craving and an eagerness to go out. Unfortunately, they are not aware of their true capacities. They consider themselves fit but indeed their fitness level has been dropped over this period of inactivity and restrictions, which they don’t appreciate and succumb to injuries.

    Injuries causes a great setback in one’s life whether it may be a commoner, fitness freak or sportsperson. It takes toll on their mental framework when they have to just see their teammates, friends and colleagues in action from the side-lines with an anxiety of losing career and impact on future. Whether you play sports for competition or fitness or you are a commoner who just want to stay active, nobody wants to be side-lined with an injury. Everyone dislikes being isolated or forced inactivity resulting due to injuries.

    While it seems impossible to stop occurrence of every injury, the American Academy of Orthopaedic Surgeon’s research comes as a ray of hope which says that injury rates could be reduced by 25% if athletes take appropriate preventative action. Hereon we can infer that although injuries are part and parcel of sports career and inevitable but at least 25% of them are preventable which is really an inspiring fact. So, it’s very important to know about prevention of these injuries.

    Here are few general guidelines by which you can prevent injuries, no matter you are involved in some gym or sports activities

    1. Adopt a sensible timetable, set realistic goals, plan and prepare with graduated exercise programmes

    To condition the body for sports, one should work out in the early morning or evening, when temperature is lower and should stick with their time table. You should adopt a regular, consistent and graduated exercise programs customised as per your activity needs. Your fitness plan should include good blend of cardiovascular exercise, strength training, and flexibility.  This will help to decrease your chances of injury.

    It’s always better to meet with your primary care provider first and discuss your options before starting a new programme or exercising regularly. Also, devote some time to learn the proper techniques required for your machine, sport or program. Starting new activities with a personal trainer can be a good idea to stay safe during recovery.

    1. The Three Musketeers: Nutrition, hydration and sleep

    The first is effective nutrition. you should eat a balanced and nutritious diet that includes good mix of key food groups such as protein, essential minerals like calcium, potassium and vitamins like vitamin D & B. Meal shots (Small and frequent meals between an hour and 30 minutes) are really important before your exercise to give yourself an energy kick.

    Staying hydrated is of paramount importance. We all are aware about benefits of hydration during activities but it’s also vital to maintain hydration even if you are not working out, especially when recovering. Adequate hydration is crucial to maintain health and minimize cramps and also to prevent dehydration, heat exhaustion, and heatstroke.

    Sound sleep is an essential constituent of injury prevention programme. It relieves fatigue accumulation, gives rest to the body, mind and increases attention span on field, in this way it decreases the possibility of injury occurrence on field. It’s important to stick with routine so that you can have quality sleep.

    A lot of people spoiled these three important basic lifestyle aspects after getting distressed from lockdown. Now when you are re-planning your activities and training, be careful about them. 

    1. Appropriate sports gear

    Wearing protective gears such as helmets, gloves, protective pads, shin pads etc is vital to reduce chances of injury. Wear relaxed fit and breathable fabric to help prevent overheating and good running shoes supported by Gait Analysis to counter ground reaction force on joints. It also helps to correct certain foot problems that can lead to injury.

    1. The holy trinity: Warm-up, stretching & cool down (Pre- and Post-Exercise)

    You should always start with gentle warm up by stretching the relevant muscle groups before the activities. To accomplish this, Warm-up with jumping jacks, stationary cycling or running or walking in place for three to five minutes or jogging before you start your exercise and then again afterwards to help your muscles cool down slowly.

    Flexibility could also be improved by stretching and it is best to do so once the body is already warm, before and after a workout. This improves the muscle’s performance and reduce the risk of injury. Start slowly and then build it gradually up to point of muscle tension. Try to hold this position for few seconds and gradually increase this duration. Stretching should be painless, one should look into technique they are using for stretching.

    It increases blood flow to the muscles and makes them more flexible. In this way it prepares body for the stresses and strains ahead and promote recovery once you have finished your exercise for the day. Injuries are more common when muscles are cold. Cold muscles are more prone to injuries. Cool down usually takes double the time of warm up. These extra few minutes before and after exercises can do lot of value addition in your programme and potentially reduce the risk of injuries.

    1. Training with an assessment of your technique, Strength and Flexibility

    Many injuries happen because of poor technique and form. Invest some time to learn your machine, sports and correct technique. It is safe to restart exercises with a personal trainer, professional coach and always consult your sports medicine specialist for your strength assessment before returning to sports activities.

    You should reduce you’re your distance and speed for cardiovascular exercises and weight for strength training after long pause. Take your time to regain your previous stamina and endurance. One can follow 10 percent rule to increase your intensity, frequency and duration to avoid injuries.

    1. Listen Your Body and take your time

    Tendency of pushing yourself beyond limits is not good for players. Give enough time to body while regaining strength so that body can get adjusted with increasing stresses. Take appropriate rest when you feel like, identify your limits and respond by adjusting your activities accordingly. explore other possible ways to address it. Fatigue consumes protective ability of muscles and make them prone for injuries.

    Learn to distinguish the difference between hard work and hurting because of an injury. While a mild and short-lived muscle ache is generally considered good pain while pain in the joints is a warning sign that you should not push hard. Do not play through the pain and slow down or stop until you recover. Somebody truly said that you can always come out to play again next weekend, if you don’t get injured today.

    1. Pre-hab is always better than Re-hab

    Injuries can derail the best-laid fitness plans. The bed rest further ruins our resolve to stick to a fitness routine. With recovery there is rebound pampering by the family which may further complicate diet management and end up in adding extra pounds. The best alternative way to manage these injuries is prevention of their occurrence by above simple tips. But, if you sustain sports injury, then take necessary medical help and complete rehabilitation process before resuming previous activities.

     

    Don’t underestimate psychological component of injury

    Tips to neutralize the psychological impact of an injury

    Can you tell me about any person who doesn’t like a fairy-tale kind of miraculous recovery from an injury, with the movement of a magic wand? I bet you can’t give a single name but that’s not the reality. Indeed, injuries can happen just in a blink of an eye to almost everyone may it be a sportsperson, a fitness freak or a commoner while recoveries may take days to a month or even longer time. It may end up in few days if you are fortunate enough to have minor injuries, but in severe injuries like fractures, ligament tears or concussions it goes to an undefined period or maybe unrecovered with lifelong morbidity and sometimes almost no return to sports.

    Recognise and don’t underestimate the psychological component of injury

    Injuries not only affect the body, but also have a daunting impact on mind and soul hence recovery must never be labelled as complete by merely looking on its physical aspect as there is an associated psychological component too. Majority sports specialist underestimate this component and don’t devote due care. This unaddressed psychological unrest might precipitate over time and contribute to further injuries. it’s all about to recognise injuries, learning how to face injuries and accepting them. Nobody can predict injuries, but they can recognise their occurrence and condition their psychological reflexes towards injury.

    The need for a social support network

    A lot of people feel sidelined, isolated and frustrated due to injuries. This is high time when they need a tough mindset and social support network to help them in combating with the array of psychological aspects integrated with the injury. Social support network comprises a team of experts like psychologist, coach, friends and family members with whom they can get emotional, educational and tangible support. A team spends maximum time together during the competition, practice, travelling and share special bond hence they can be crucial in overcoming this isolation.  

    Be optimistic in thoughts

    An injury is kind of a trap to negativity and pessimism, where one can tend to think despondently and try to seek answers of why me. In this situation, they think that they are the unfortunate ones, and that’s why it happened or they have haunting flashes of injury. This defocuses them and derails their process of recovery. Staying positive through it all is the best solution to come out of it because once it happened, you simply don’t know if it was going to be short-term, long-term, midterm.

    Read stories of different sports stars and their comeback. Believe me, everyone has faced these hurdles in their career at different points of time. These real-life stories will give you all the strength and motivation you need and they have been a constant source of inspiration, determination and hard work to the future generation. Be optimistic, after recovery you might be one of them with a good comeback story.

    Use the age-old trick of future positive self-images

    Always visualise a positive Image of yourself working out in the gym or playing your sports in future. Somewhere I read about a person who was working out to reduce his weight. He hung a small size of his dress in front of him as a goal, which acted as a catalyst to achieve his goal. Although, these small mental tricks seems funny but proven miraculous in past.

    Look for other adaptive mechanism

    Missing out on competition and team environment can compromise all aspects of your well-being including emotional and social. But, Every adversity is an opportunity on the other side. In this covid lockdown, a lot many people took it positively and considered it an opportunity to learn something new, explored their hidden talents and spent good time with family. Likewise, in the recovery phase, you might write a book on your experiences with it, dabble with the cooking, or explore your time with new hobbies. Getting engaged is another way of averting negative thoughts from your mind. An injury may last awhile, in this situation, one must look for different adaptive mechanisms to keep them going, engage their mind and maintain their love for their respective sport.

    Keep a check on your diet

    During recovery, there are high chances to get pampered by the family regarding getting extra supply in the diet or there may be a possibility of digestion upsets due to physical and mental stress. Both the scenarios are not in the larger interest of a person recovering from injury as it might fiddle with their body mass index which is vital for recovery. So, one should be very careful about the intake of extra calories or altered bowel mechanism.

    Alternative ways to stay fit

    During the recovery process, I consider the biggest challenge is staying fit and maintaining your stamina. The biggest mistake which a player, athlete or person commit during the recovery process is following plain meaning of doctor’s advice of rest and goes into the comfort zone. You should make a habit to focus on what is written in between lines and reconnoiter different alternatives for keeping yourself fit and sports ready after recovery.

    Adopt a sensible comparison practice

    I always advise my patients not to compare their recovery performance in shorter intervals like on daily basis to avoid self-guilt and disappointment. You should compare your performance against established parameters with a time interval to attain quantifiable changes like on fortnightly basis.

    Don’t rush back to sports

    Everyone can understand your eagerness to resume sports back but starting sports or gym activities again without completing rehabilitation or consulting sports injury specialist might prove counterproductive. Incomplete healing of muscle or ligament might turn into havoc leading to a permanent disability or a more serious problem.

    Hence, before joining activities back, get yourself evaluated with qualified sports practitioner to assess your strength, flexibility, stamina and opinion on the future course of graduated training programme customised as per your needs.

    Patience and confidence are the key

    This whole process wanders around who blinks first between hope and frustration. Patience is always rewarding in these instances because when they would retrospect this event after getting recovered, they would label it as just a small rough patch in their life.

    Sometimes they might even lose confidence in their abilities. Because when players are recovering, one can see them questioning their movements after coming back from the injury. Here comes the role of sports specialist to reassure them regarding their recovery and the importance of confidence and patience.

    Remember, you are neither the first nor last who had an injury, almost every athlete face some or other kind of injury. Having conditioned your mental reflexes towards such events might reduce physical, mental, financial suffering up to a certain extent and can make the recovery process less stressing. Consider yourself at field, gym or in your arena and play this game of recovery with same mental strength, zeal and enthusiasm to win the recovery process.

    Basics, common sports injuries

    Sports injuries: basics, common injuries and their treatment

    Sports injuries have been classically defined as a new or recurring musculoskeletal complaint, or concussion incurred during competition or training, receiving medical attention, regardless of time loss from competition or training.

    It has been classified in different ways like Direct/Indirect, Contact/Non- contact sports, Minor/Major. Usually, common sports injuries are mild or moderate. It generally occurs for two different reasons: trauma and overuse.

    Traumatic sports injuries are usually obvious and may be due to improper or poor training practices, wearing improper sporting gear, being in poor health condition, improper warm-up or stretching practises before a sporting event or exercise. Overuse injuries are more common nowadays.

    Overuse injuries often occur when the body is pushed past its current physical limits or level of conditioning but poor technique and training errors, such as running excessive distances or performing inadequate warm-ups, frequently contribute.

    The most common sports injuries are strains and sprains. Sprains are injuries to ligaments, the tough bands connecting bones in a joint. Suddenly stretching ligaments past their limits deforms or tears them. Strains are injuries to muscle fibres or tendons, which anchor muscles to bones. Strains are called “pulled muscles” because over-stretching or overusing a muscle causes tears in the muscle fibres or tendons.

    Though biological tissues in the human body are stretchable, they break when stretched beyond a certain limit. Think of ligaments and muscle-tendon units like springs, the tissue lengthens with stress and returns to its normal length — unless it is pulled too far out of its normal range.

    Sometimes, avoiding common sports injuries is beyond our control, but many times sports injuries are preventable. People bring a lot of injuries because they are not conditioned for the activity.

    Most common injuries & Overuse syndromes

    • Sprains and strains
    • Joint injuries (Knee injuries (ACL tear), Ankle injuries, shoulder (labral & cuff tears), Back injuries and Neck injuries
    • Dislocations & Fractures
    • Achilles tendon injuries
    • Groin pain
    • Knee Patellofemoral Syndrome (an injury resulting from repetitive movement of knee-cap, Sinding-Larsen-Johansson disease, Sever’s disease, Osteochondritis dissecans, Jumper’s knee (patellar tendonitis)
    • Muscle injuries, Pulled muscles
    • Tennis elbow, Little Leaguers’ elbow or shoulder
    • Spondylolysis, Spondylolisthesis
    • Hamstring strain
    • Shin splints: Pain along the shin bone

    You should know that some common sports injuries may take months to heal, even with good treatment. If a sprain or strain is severe, however, the entire muscle, tendon, or ligament is torn away, and surgery may be needed.

    Being tough is good but you also need to be smart. If you suspect a serious injury or if you have any of these signs, see a doctor:

    • Deformities in the joint or bone — it looks “crooked,” or moves abnormally
    • You cannot bear weight or can’t use the limb without it “giving way”
    • Excessive swelling
    • Changes in skin colour beyond mild bruising
    • It’s not getting any better after a few days of PRICE therapy

    Treating the most common sports injuries

    You can limit swelling and start healing faster at home after most sports injuries by using the RICE principle.

    R-Restrict activity: This will prevent worsening of the injury.
    I-apply Ice: Use ice for 20 minutes every 1-2 hours for the first 48 hours after the injury. Do not use heat during this time as it encourages swelling and inflammation.
    C-apply Compression: Compression with an elastic bandage will help reduce swelling.

    E-Elevate the injured area: Elevating the injured area above the heart will also reduce swelling.

    Here are some specific tips for treating each of the most common sports injuries:

    1. Ankle sprain
    2. Groin pull
    3. Hamstring strain

    Three muscles in the back of the thigh from the hamstring. The hamstring can be over-stretched by movements such as hurdling — kicking the leg out sharply when running. Falling forward while waterskiing is another common cause of hamstring strain.

    1. Shin splints

    Pains down the front of the lower legs are commonly called “shin splints.” They are most often brought on by running — especially when starting a more strenuous training program like long runs on paved roads. If you’re active, you could get them if you make sudden changes like more intense, more frequent, or longer workouts. They often heal on their own. Few call its medial tibial stress syndrome. The cause is stress on your shinbone and the connective tissues that attach muscles to your bones. They get inflamed and painful.

    This common problem can result from:

    • Flat feet — when the impact of a step makes your foot’s arch collapse (your doctor will call this overpronation)
    • Shoes that don’t fit well or provide good support
    • Working out without warmup or cooldown stretches
    • Weak ankles, hips, or core muscles

    You’ll know they’re fully healed when:

    • Your injured leg is as flexible as your other leg.
    • Your injured leg feels as strong as your other leg.
    • You can push hard on spots that used to be painful.
    • You can jog, sprint, and jump without pain.

    The most important thing is that you don’t rush back into your sport. If you start to work out before your shin heals, you may hurt yourself permanently. Take up a new no-impact activity that won’t aggravate your shin splints while they heal. If you’re a runner, try swimming or an aggressive interval bike program.

    1. Knee injury: ACL tear

    The anterior cruciate ligament (ACL) holds the leg bone to the knee. Sudden “cuts” or stops or getting hit from the side can strain or tear the ACL. A complete tear can make the dreaded “pop” sound.

    If you suspect an ACL injury, then you need to consult an orthopaedic surgeon immediately. ACL tears are potentially the most severe of the common sports injuries. A completely torn ACL will usually require surgery in individuals who wish to remain physically active.

    6: Knee injury: Patellofemoral syndrome

    It can result from the repetitive movement of your kneecap (patella) against your thigh bone (femur), which can damage the tissue under the kneecap. Running, volleyball and basketball commonly set it off. One knee or both can be affected.

    Patience is key. Patellofemoral pain can take up to six weeks to clear up. It’s important to continue low-impact exercise during this time. Working out the quadriceps can also relieve pain.

    1. Tennis elbow (epicondylitis)

    Repetitive use of the elbow — for example, during golf or tennis swings — can irritate or make tiny tears in the elbow’s tendons. Epicondylitis is most common in 30- to 60-year-olds and usually involves the outside of the elbow.

    It can usually be cleared up by staying off the tennis court or golf course until the pain improves.