By Harshima Sharma

A renowned Orthopaedic – Dr. Nilesh Mishra has umpteen knowledge and expertise in his field.  His area of interest includes Arthroscopic Surgery, Arthroplasty, Spinal Deformity Correction and Bone Trauma. Based in Ranchi, Dr. Nilesh had studied and got trained at prestigious medical institutions like Kasturba Medical College (KMC), Manipal, the Indian Spinal Injuries Centre, New Delhi, and Ortho-One Orthopaedic Speciality Centre, Coimbatore. He is presently associated with Medanta Hospital, Ranchi and is also available for private consultation at his Orthopaedic Clinic situated at Heritage Building, Baritau Road.

With a regular stream of young patients visiting his clinic with bone and joint ailments that commonly afflict older patients, Dr. Nilesh is of the opinion that this spurt is a part of a lifestyle disorder syndrome, addiction to smartphones and lap tops, faulty sitting postures, sedentary lifestyle and poor dietary intake. Here he answers about some common bone and muscle ailments that we should know.

Dr. Nilesh Mishra

  1. Every Orthopaedic specializes at one particular domain, can you throw light on your expertise?

Orthopaedics now is divided into multiple specialities, there are patients undergoing specific treatments for joint replacements, spine surgery, knee surgery and such others. I specialize mainly in spine and joint surgeries.

  1. What are the most common bone and muscle disorders reported to you by patients?

Back pain, knee pain

has become the backbone of our OPD practice these days. Off late we have started seeing more of neck pain and shoulder pain, because of excessive use of smartphones.

Many complaints often come from older adults, who suffer from arthritis or other joint ailments, experiencing a decline in their ability to perform basic functional tasks in their daily lives.

The common kind of bone disease affects children and adults and occurs due to genetic abnormalities, nutritional deficiencies, hormonal disorders, infections and other causes.

Back Pain is one of the most common reasons people go to the doctor or miss work and a leading cause of disability worldwide. Most people suffer from back pain at least once. Signs and symptoms of back pain are:

  • Muscle ache
  • Shooting and Stabbing Pain
  • Pain that radiates down your leg
  • Limited flexibility or range of motion of the back

Contact a doctor if your back pain:

  • Is severe and doesn’t improve with rest
  • Spreads down one or both legs, especially if the pain extends below the knee
  • Causes weakness, numbness or tingling in one or both legs
  • Is accompanied by unexplained weight loss

Back pain can come on suddenly and last less than six weeks (acute), which may be caused by a fall or heavy lifting. Other conditions that can cause back pain are muscle or ligament strain, bulging or ruptured disks, arthritis, skeletal irregularities and osteoporosis.

Prevention includes, exercise regularly, Regular low-impact aerobic activities — those that don’t strain or jolt your back — can increase strength and endurance in your back and allow your muscles to function better. Being overweight strains back muscles. If you’re overweight, trimming down can prevent back pain.

Team of women having step aerobics.

  • Maintain a neutral pelvic position. Good posture can reduce the stress on back muscles.

  • Choose a seat with good lower back support, armrests and a swivel base. Consider placing a pillow or rolled towel in the small of your back to maintain its normal curve.

  • Avoid heavy lifting, if possible, but if you must lift something heavy, let your legs do the work. Keep your back straight — no twisting — and bend only at the knees.

Cervical Spondylosis

The bones and protective cartilage in your neck are prone to wear and tear that can lead to cervical spondylosis. Cervical spondylosis is a common, age-related condition that affects the joints and discs in your cervical spine, which is in your neck. It’s also known as cervical osteoarthritis or neck arthritis. It develops from wear and tear of cartilage and bones. While it’s largely due to age, it can be caused by other factors as well.

Some occupations or hobbies involve repetitive movements or heavy lifting, such as construction work. This can put extra pressure on the spine, resulting in early wear and tear.

Factors other than aging can increase your risk of cervical spondylosis. These include:

  • Neck injuries
  • Work-related activities that put extra strain on your neck from heavy lifting
  • holding your neck in an uncomfortable position for prolonged periods of time or repeating the same neck movements throughout the day (repetitive stress)
  • genetic factors (family history of cervical spondylosis)
  • smoking
  • being overweight and inactive

Treatments for cervical spondylosis focus on providing pain relief, lowering the risk of permanent damage, and helping you lead a normal life. Nonsurgical methods are usually very effective.

Your doctor might send you to a physical therapist for treatment. Physical therapy helps you stretch your neck and shoulder muscles.

Osteoporosis

Our bones normally reach their maximum mass at the age of 25 – 30 and after this, they gradually lose density. Osteoporosis is characterized by abnormal loss of bone mass and deterioration of normal bone structure. This leads to bone fragility and an increased risk of fractures. This bone disorder rarely causes symptoms and is often diagnosed only after a fracture has occurred. It’s important to exercise regularly and maintain a balanced diet; vitamin D intake should be increased too. Medications called bisphosphonates help preserve bone mass in people with osteoporosis. 

Osteomyelitis

Is the infection of bone tissue, the condition is most commonly caused by the infectious organism Staphylococcus aureus, which reaches the bone via the bloodstream or by extension from a local injury; inflammation follows with destruction of the cancellous (porous) bone and marrow, loss of blood supply, and bone death. Symptoms include fever, chills, and bone pain; later, swelling and redness may develop around the area of infection. Diagnosis is confirmed by radionuclide bone scans. The precise cause of the infection is determined by cultures of the blood and bone. Treatment of osteomyelitis requires the long-term administration of intravenous antibiotics; some patients also require surgery to remove dead bone tissue.

Osteosarcoma

Osteosarcoma also called osteogenic sarcoma, most common bone cancer, primarily affecting the long bones, particularly those in the knee, hip, or shoulder regions. The cause of osteosarcoma is unknown, but genetic factors and radiation therapy may be involved in its development. Osteosarcoma occurs more often in males than in females; most affected individuals are under age 30. Major symptoms include pain (intermittent at first, later severe and constant), swelling, limitation of joint motion, a high frequency of fractures, and eventually fever and general debilitation.

  1. Kindly mention the signs and symptoms of common bone diseases?

Pain is the most common feature, apart from that there’s swelling and redness. People with spine problems experience tingling and numbness like sensations. Those who suffer from arthritis have a very typical feature of morning stiffness and lethargy and they start feeling better as the day progresses.

  1. What preventive measures do you suggest a common man to stay away from bone disorders?

Orthopaedics is basically a branch that deals mostly with lifestyle disorders, most of our complaints can be sorted with lifestyle modifications and proper nutrition. In lifestyle modification what we suggest is regular regime of exercises, may be not long even it’s for 15 to 20 minutes that can do wonders. Apart from that your posture for sitting, sleeping, for using mobile phones, computers and lap tops, the way you sit at office, all these helps a great deal. When it comes to food intake, for most of the people who do not have any medical issues, Milk is the best source of Calcium and Vitamin D that they can get. For people who do take non-vegetarian diet, for them Fish and Egg White is a very good source of calcium, protein and vitamin D. People on vegetarian diet, they tend to have depleted Vitamin D and B12 levels, so for them they need to take supplements on and off.

  1. Back and neck injuries have become very common these days and have created stress amongst people, why is it so? Are surgeries required to cure them?

It is mostly a lifestyle disease, because of lack of exercise and our faulty sitting posture that back and neck related problems are increasing. Surgeries for these problems are limited to a very small percent of patients and patients in which neurological issues starts coming up like weakness and numbness. Surgery is not just suggested for pain, because if your lifestyle is not modified, then you will again tend to have pain. Hence, surgeries are last resort, only for neurological deficits.

  1. How helpful is physiotherapy in treating muscle sprain and other bone disease?

Physiotherapy definitely is a mainstay of your treatment because it retunes and strengthens your muscles so that it can take the load and stress of your body better. Physiotherapy can combat many long-term problems – it can cure bad knees, it can relieve chronic pain, cure back pain, and helps in relaxing your muscle. There are several techniques and exercises that helps in releasing the blockage of muscles and provide strength at the same time.

  1. Cervical Spondylosis is very common amongst youth these days. What are the causes for the same?

Cervical Spondylosis has become very common because of use of computers and smartphones.  We need to take care of the fact that the use of smartphones should be limited and confined to a manner that its safe enough. Use at a fair distance and not close to your eyes. The symptoms include neck pain, light-headedness, nausea and numbness or tingling sensation in hands.

Walking to work, cycling to school or college, taking stairs rather than elevators – all these activities that were a regular part of the last generation have ceased to exist in our lives of today. There’s lack of physical activity in our day-to-day lifestyle, this results in weak muscles and bones, leading to joint and bone ailments, cervical spondylosis being the most common. 

  1. How safe is spine-surgery? Are there any post-operation risk involved?

There’s a risk involved in any surgery, not just spine surgery for that matter. Definitely with the advancement of techniques, better facilities and world-class hospital set up, the risk has definitely decreased. But spine surgery is as risky as any other surgery and we cannot say that this is less risky or more than any other operations. But yes, the indication for the surgery is very limited, when done for right reasons by right surgeons, it is pretty safe.

  1. Does orthopaedic surgery be it traditional or keyhole helps in reliving debilitating pain? If so how?

The advancement in surgeries are such that, be it arthroscopic or joint replacement surgeries – it is definitely going a long way in removing pain and improving the quality of life. We have seen many people who were on the verge of taking VRS from services like police, CISF, CRPF and such others, and they have re-joined their work continuing with their jobs. So, these surgeries are definitely life-changing for them. But again, the surgeries are meant for specific populations, done for right indications and done by right surgeons- it does wonders. 

  1. How common are bunions? What causes them and is bunion surgery common?

Bunions are very common and mostly happens because of faulty footwears and apart from that it starts when we start using narrow footwears during school time. It is the exact time when it starts developing, there are many other reasons but this is the most commonly seen. Hereditary reasons are also there, flat foots again contribute to bunions.

Surgeries are not very common in India, because we tend to tolerate a lot of pain and deformity, but bunions surgeries are most commonly carried out at orthopaedic set-up in UK. If there are 10 cases related to bunions in US, there will be at least two surgeries performed.  In India what we do is give a toe-spreader through this stress is relieved, shoes are modified accordingly, and if still the pain persists we tend to give them local shots of injections on bunions and in spite of all that if the pain persist we go for bunions surgeries.

  1. Since how long are you associated with your profession and what advancement in technology do you see?