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Joy Rosentel graduated Summa cum Laude from the University of Texas at Arlington with a
Bachelors Degree in Nursing. She is also board certified in both Case Management and
Ambulatory Care. Her clinical background is in Orthopedics and Trauma at a 400 bed, trauma
level 2 hospital in the DFW metroplex. She also worked in primary care, the starting point for most
back & joint pain and is well versed in the initial conservative treatments that can often solve the
problem without the need for painful and expensive surgeries.
Amanda Powell, Associate of Applied sciences degree from Trinity Valley College, graduating with
honors and then obtained a Bachelor of Science in Nursing from Grand Canyon University in
2015. Amanda’s clinical background includes Orthopedic Trauma and Medical/Surgical nursing.
Also in 2015, I achieved certification in orthopedics after successfully completing a national exam.
Lindita Hasa , is a case manager for HealthSelect members through UHC and has an Associate
Degree in Nursing from George Brown Community College and Bachelor Of Science in Nursing
in 2009 from University of Texas at Arlington. Lindita has been with United Healthcare since April
2012 and loves helping people through telephonic case management.
All 3 are case managers supporting HealthSelect members through UHC.
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Obesity: A diet high in calories and fat can make you gain weight.
Too much weight can stress the back and cause pain. Each pound of weight adds
4lb of stress to your knees and increases pressure on your hips six-fold. Over time
the extra strain causes the cartilage that cushions these joints to break down. The
fat tissue also produces proteins called cytokeins that promote inflammation through
out the body. In joints the cytokeins destroy tissue ay altering the function of
cartilage cells.
Lifestyle: Both at home and work your movements can affect your joints and
muscles. Poor physical fitness results in loss of muscle. Muscles work in stabilizing
your joints. Participation in some sports increases ones chances of an injury. On
the job if you have to lift, push, or pull while twisting your spine, you may get back
pain. If you work at a desk all day and do not sit up straight, you may also get back
pain.
High Blood Sugar: Diabetes causes systemic inflammation which causes cartilage
loss.
Smoking: Your body may not be able to get enough nutrients to the disks in your
back if you smoke. Smoker’s cough may also cause back pain. People who smoke
are slow to heal, so back pain may last longer.
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Sometimes called degenerative joint disease or degenerative arthritis, osteoarthritis
(OA) is the most common chronic condition of the joints, affecting approximately 27
million Americans. OA can affect any joint, but it occurs most often in knees, hips,
lower back and neck, small joints of the fingers and the bases of the thumb and big
toe.
In normal joints, a firm, rubbery material called cartilage covers the end of each
bone. Cartilage provides a smooth, gliding surface for joint motion and acts as a
cushion between the bones. In OA, the cartilage breaks down, causing pain,
swelling and problems moving the joint. As OA worsens over time, bones may break
down and develop growths called spurs. Bits of bone or cartilage may chip off and
float around in the joint. In the body, an inflammatory process occurs and cytokines
(proteins) and enzymes develop that further damage the cartilage. In the final
stages of OA, the cartilage wears away and bone rubs against bone leading to joint
damage and more pain.
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Maintain a healthy weight.
Each pound of weight adds 4lb of stress to your knees and increases pressure on your
hips six-fold.
Over time the extra strain causes the cartilage that cushions these joints to break down.
Fat tissue produces proteins called cytokeins which promote inflammation throughout
the body. In our joints the cytokeins destroy tissue by altering the function of cartilage
cells.
Control your blood sugar.
High glucose levels make cartilage stiffer and more sensitive to mechanic stress.
Keep joints healthy in the first place.
30 min of moderate exercise 5 times a week helps joints stay limber and strengthens
muscles that support and stabilize your hips and knees. It will also strengthen your heart
and lungs, while lowering diabetes risk and help you reach your goal of a healthy weight.
Avoid injury: Cartilage doesn’t heal well. Joints that have suffered trauma/injury are 7
times more likely to develop osteoarthritis.
Dietary supplements such as Glucosamine & Chondroitin strengthens your joints and
helps maintain flexibility. Effects of these supplements are noticeable in about a week.
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Live a healthy lifestyle.
The best defense against any disease, including osteoarthritis, is a healthy
lifestyle. The way you eat, exercise, sleep, manage stress and interact with
others, and whether you smoke or drink can have a tremendous influence not
just on overall health, but also on the health of your joints.
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Although there is no diet cure for arthritis, certain foods have been shown to fight
inflammation, strengthen bones and boost the immune system. Adding these foods
to your balanced diet may help ease the symptoms of your arthritis.
• Because certain types of fish are packed with inflammation-fighting omega-3 fatty
acids, experts recommend at least 3 to 4 ounces of fish, twice a week. Omega-3rich fish include salmon, tuna, mackerel and herring.
• Not a lover of fish? Try heart-healthy soybeans (tofu or edamame). Soybeans are
also low in fat, high in protein and fiber and an all-around good-for-you food.
• Extra virgin olive oil is loaded with heart-healthy fats, as well as oleocanthal,
which has properties similar to non-steroidal, anti-inflammatory drugs. But it’s not
the only oil with health benefits. Avocado and safflower oils have shown
cholesterol-lowering properties, while walnut oil has 10 times the omega-3s that
olive oil has.
Many berries are loaded with antioxidants, such ascorbic acid (a form of vitamin C)
and anthocyanins and carotenoids, which give soft berries their deep colors. These
compounds help rid the body of free radicals that promote inflammation and they
help prevent heart disease and certain cancers.
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Strawberries. Strawberries are naturally low in sugar and have more vitamin C per
serving than an orange. Vitamin C can lower risk for gout, high blood pressure and
cholesterol problems. Research has also shown that women who ate 16 or more
strawberries a week had lower C-reactive protein (CRP), a measure of body-wide
inflammation linked to arthritis flares and heart disease.
As with cherries, scientists suspect anthocyanin, along with other phytochemicals
gives strawberries their anti-inflammatory and antioxidant health benefits. These
berries are also a good source of folic acid, which the arthritis medication
methotrexate can deplete. People taking methotrexate often need folic acid
supplements to help prevent side effects. You may still need a capsule supplement,
but strawberries help increase your intake while providing other benefits.
Red Raspberries. Like strawberries, these berries are among the highest in vitamin
C and anthocyanin. Animal studies have shown extracts from the fruit reduce
inflammation and osteoarthritis symptoms. Other research shows the fruit’s bioactive
compounds lower system-wide inflammation and, when a regular part of the diet, help
prevent a number of chronic conditions, such as heart disease, stroke and type-2
diabetes.
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Tart Cherries:
Tart cherries get their rich red color and many of their powerful anti-inflammatory
and antioxidant benefits from the flavonoid anthocyanin. These properties make tart
cherries a popular research subject, and some investigators compare the effects
to nonsteroidal anti-inflammatory drugs (NSAIDs).
Studies, which often use the concentrated juice of Montmorency cherries, have
found tart cherries may relieve joint pain in people with osteoarthritis and lower the
risk of flares in those with gout. In addition, Dulan notes, recent studies suggest tart
cherries may improve the quality and duration of sleep.
Avocado. The rich, creamy texture of this fruit comes in part from its high content of
anti-inflammatory monounsaturated fat. Avocados are also rich in the carotenoid
lutein. Unlike most fruits, avocados are a good source of vitamin E, a micronutrient
with anti-inflammatory effects. Diets high in these compounds are linked to
decreased risk of the joint damage seen in early osteoarthritis.
Studies also show eating avocados daily increases “good” HDL cholesterol and
lowers its “bad” LDL counterpart. Despite the fruit’s relatively high calorie content,
research has found that regular avocado eaters tend to weigh less and have smaller
waists. Their high fiber and fat content may help people control cravings, Dulan
says.
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Watermelon. Watermelon is another fruit with anti-inflammatory action; studies show
it reduces C-Reactive Protein. It’s high in the carotenoid beta-cryptoxanthin, which
can reduce the risk of rheumatoid arthritis, according to studies that followed people’s
dietary habits over time. It leads the fruit pack in lycopene, an antioxidant that may
help protect against certain cancers and lower heart attack risk, says Dulan.
Once cup has about 40% more lycopene than raw tomatoes, the next richest raw
food source. Watermelon is also ninety-two percent water, which makes it great for
hydration and weight management. One cup of watermelon has about 40 calories –
plus about a third of your recommended daily allowance of vitamins A and C.
Grapes. “Grapes, both white and darker-colored varieties, are a great source of
beneficial antioxidants and other polyphenols,” says Dulan. “Fresh red and black
grapes also contain resveratrol, the heart-healthy compound found in red wine that
contributes to cardiovascular health by improving the function of blood vessels.”
Resveratrol is also a potent anti-inflammatory. Studies show this bioactive compound
acts on the same cellular targets as NSAIDs. Researchers are studying its potential
for improving symptoms of osteoarthritis, as well as for other chronic diseases linked
to aging.
Citrus fruits – like oranges, grapefruits and limes – are rich in vitamin C. Research
shows that getting the right amount of vitamin aids in preventing inflammatory arthritis
and maintaining healthy joints with osteoarthritis (OA).
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Low-fat dairy products, like milk, yogurt and cheese are packed with calcium and
vitamin D, both found to increase bone strength. Vitamin D is essential for calcium
absorption, and it has been shown to boost the immune system. If dairy doesn't
agree with you, aim for other calcium and vitamin D-rich foods like leafy green
vegetables.
Green tea is packed with polyphenols, antioxidants believed to reduce inflammation
and slow cartilage destruction. Studies also show that another antioxidant in green
tea called epigallocatechin-3-gallate (EGCG) blocks the production of molecules
that cause joint damage in people with rheumatoid arthritis (RA).
Break Out the Beans
Beans are packed with fiber, a nutrient that helps lower C reactive Protein. Beans
are also an excellent – and inexpensive – source of protein, which is important for
muscle health. Some beans are rich in folic acid, magnesium, iron, zinc and
potassium, all known for their heart and immune system benefits. Look for red
beans, kidney beans and pinto beans.
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Grab the Garlic
Studies have shown that people who regularly ate foods from the allium family – such
as garlic, onions and leeks – showed fewer signs of early osteoarthritis (OA).
Researchers believe the compound diallyl disulphine found in garlic may limit
cartilage-damaging enzymes in human cells.
Nuts are rich in protein, calcium, magnesium, zinc, vitamin E and immune-boosting
alpha linolenic acid (ALA), as well as filling protein and fiber. They are heart-healthy
and beneficial for weight loss. Try walnuts, pine nuts, pistachios and almonds.
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ANATOMY OF THE HIP
The hip is one of the largest weight-bearing joints in the body. It's commonly
referred to as a “ball-and-socket” joint and is made up of two main bones: the ball
(head of the femur) found at the top of the thighbone (femur). This fits into the
socket (acetabulum) in the pelvis.
The surfaces of the ball and the socket are covered with cartilage. This provides
cushioning to the ends of each bone. This allows them to move easily. A band of
fibrous cartilage (the labrum) surrounds the socket and helps stabilize the hip.
The remaining surfaces of the hip are covered with synovial membrane. This
produces a small amount of a clear, thick, stringy substance called synovial fluid. It
lubricates and eliminates most friction in the joint.
ANATOMY OF THE KNEE
The knee is made up of three main bones, the lower end of the thighbone (femur),
the upper end of the shinbone (tibia), and the kneecap (patella).
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The surface of the ends of the bones is covered with cartilage which provides
cushioning to the ends of each bone and allows them to move easily.
Bands of tissue called ligaments connect the thighbone and the shinbone. Ligaments
control motion and stabilize the knee joint
Bands of tissue called tendons connect the bones to the muscles that move the knee.
The joint capsule contains synovial fluid.
The meniscus is a wedge-shaped piece of cartilage located on both sides of the joint
and helps to cushion the joint by acting as a shock absorber. It also helps in keeping
the knee stable.
Several bursae are located around the knee joint. These are flat sac-like structures
that serve as cushions between the bones and other structures that move over them,
such as skin and tendons.
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PAIN
There are many different causes of pain. Pain can be categorized as acute or
chronic.
Acute pain - This is often caused by injury due to trauma or excessive activity. Injury
may occur during sports or exercise, auto accidents, or falls. Minor injuries usually
get better within six weeks with conservative treatment.
Chronic pain - This is often caused by general wear and tear over time. This may be
related to problems such as osteoarthritis. (Osteoarthritis is a disease that causes a
slow, progressive breakdown of the joint cartilage and bone.) It lasts longer than
six weeks and usually becomes worse over time. Acute problems that are caused
by trauma can also become chronic.
CONSERVATIVE TREATMENT
Conservative treatments should be tried for a long period of time (depending on the
cause) before considering surgery.
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Conservative treatment for an injury causing acute pain depends on the type of
injury and how severe it is. It usually begins with:
• Activity modification (changing activities that make the pain worse).
• Applying cold to the area.
• First-line pain medicines.
If these treatments don’t work, your doctor may recommend adding exercise or
physical therapy or narcotic or antidepressant medicine.
For pain caused by arthritis, self-management education is also recommended.
If conservative treatment over time does not improve the pain other options to
discuss with your physician are
• TENS (transcutaneous electrical nerve stimulation)
• Acupuncture
• Surgery, if severe symptoms greatly interfere with your daily life. We will talk about
this more later
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REST - Allow your injury to heal before you do slow movements.
ICE - Place an ice pack or a bag of frozen peas wrapped in a towel over the painful
part. Never put ice right on the skin and no more than 10 to 15 minutes at a time.
Heat may be used later but not right away as it can make swelling worse. If your
doctor tells you to use heat, put a heating pad on the painful part for no more than
20 minutes at a time. Never go to sleep with a heating pad on as this can cause
burns.
COMPRESSION - Padding, brace, or compression wraps or shorts may help lessen
swelling. Other assistive devices such as crutches or a cane may be recommended
by your physician
ELEVATION - Prop your hip or knee on pillows to help with swelling.
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Anatomy
The backbone (spine) extends from the base of the skull to the tailbone. It's made
up of 33 small bones called vertebrae. These are stacked on top of one another.
The lower back includes five lumbar vertebrae (L1 through L5) and five fused sacral
vertebrae (S1 through S5).
The vertebrae are separated by discs. These are made up of a jelly-like center
(nucleus pulposus) with a tough, fibrous outer ring (annulus fibrosa). The discs act
as shock absorbers for the spine and allow it to be more flexible.
They're sandwiched between the vertebral bodies (the flat round front sections of
the vertebrae).
The vertebrae are held together by muscles and tough bands of tissue which are
called ligaments and tendons.
The vertebrae are joined together on the back side of the spine by the facet joints
which keep the spine in alignment and allow it to bend and rotate.
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The sacral spine is joined to the pelvis by strong ligaments and the sacroiliac joints.
The backbone supports and protects the spinal cord. This is a large bundle of nerves
that begins at the base of the brain and runs through the center of the vertebrae in an
opening called the spinal canal.
The spinal cord ends just above the lower back. This is where a large bundle of nerve
roots for the lower back and legs (cauda equina) continues down the spinal canal.
These nerve roots exit through spaces between the vertebrae and in the sacrum
known as foramen (plural: foramina).
The discs help maintain these spaces.
The sciatic nerve is a large cable-like collection of spinal nerve roots from L4 through
S3. It begins in the lower back and runs through the buttocks, thigh and lower leg.
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Anyone can have back pain, but some things that increase your risk are:
Back pain is more common the older you get.
Back pain is more common in people who are not physically fit.
Being overweight, too much weight can stress the back and cause pain.
• Smoking. Your body may not be able to get enough nutrients to the disks in your
back if you smoke. Smoker’s cough may also cause back pain. People who
smoke are slow to heal, so back pain may last longer.
• Your job. If you have to lift, push, or pull while twisting your spine, you may get
back pain. If you work at a desk all day and do not sit up straight, you may also
get back pain.
• Sports: Being tackled in football or not stretching your muscles before vigorous
activity may result in back pain
• An unexpected fall or impact to the back will leave you with a sore back
• Lifting heavy objects without proper technique puts stress on the back.
• Mechanical problems with the back such as disk break down, muscle spasms,
tense muscles or ruptured disks and injuries from accidents cause back pain.
Underlying medical conditions: Some types of arthritis and cancer can cause
back pain. Back pain also is common with kidney stones, pregnancy, and scoliosis.
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Low back pain is very common and the majority get better with time and exercise.
Low back pain can sometimes happen with sciatica. Sciatica occurs when the nerve
roots in the lumbosacral area of the back are compressed , irritated, or injured. Pain
radiates most often through the buttocks and the side or the back of the thigh and
into the lower leg. It may also include numbness, tingling or weakness in the leg or
foot.
Pain that starts quickly and lasts less than 6 weeks is classified as acute pain. Much
less common is chronic pain which lasts more than 3 months.
Often back pain resolves without any treatment or simple measures you can take
such as rest, taking acetaminophen or ibuprofen to ease the pain, or applying a cold
pack to the area. Avoid absolute bed rest as activity promotes healing.
If you have severe pain that does not improve with the initial conservative treatment
you should see your doctor or chiropractor for treatment options. This may include
a home exercise program or a program supervised by a Physical Therapist, or
spinal manipulation. Spinal manipulations at the early onset of pain or injury are
more effective that waiting.
Some exercises your doctor or physical therapist may recommend are back
exercises, stretching, walking, swimming or aquatic exercise, yoga.
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Diagnostic imaging tests are overused and having tests you don’t need doesn’t
improve your pain and may not show the cause of your back pain. About 40% of
advanced imaging tests will reveal a bulging disk that is not clinically connected to the
pain.
By learning to lift, push, and pull with less stress on your back you can change how
you exercise, relax, and sleep to help lessen back pain.
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Conservative treatment is the first line treatment for arthritis, hip and knee pain, and
back pain.
Conservative treatments should be tried for an extended period of time before
considering surgery. Conservative treatment usually begins with:
• Rest. Allow your injury to heal before you do slow movements.
• Modify activity.
• Applying a cold compress to the area.
Place an ice pack or a bag of frozen peas wrapped in a towel over the painful
part. Never put ice right on the skin. Do not leave the ice on more than 10 to
15 minutes at a time.
Heat may be used later but not right away as it can make swelling worse. If
your doctor tells you to use heat, put a heating pad on the painful part for no
more than 20 minutes at a time. Never go to sleep with a heating pad on as
this can cause burns.
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• Exercise or physical therapy.
• Weight management.
• Oral or topical pain medicines.
• Prop your hip on pillows to help with swelling.
• Assistive devices
Crutches, a cane, or walker may help take pressure off your injured hip when
walking.
Padding, brace, or compression.
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When pain becomes chronic or when other treatments do not relieve it some
people find relief through alternative treatments. The most common are
Manipulation. Professionals use their hands to adjust or massage the
spine or nearby tissues.
Transcutaneous electrical nerve stimulation (TENS). A small box over the
painful area sends
mild electrical pulses to nerves. Studies have shown that TENS treatments
are not always
effective for reducing pain.
Acupuncture. This Chinese practice uses thin needles to relieve pain and
restore health.
Acupuncture may be effective when used as a part of a comprehensive
treatment plan for low
back pain.
Most people with chronic pain do not need surgery. Surgery may be recommended
if you continue to have severe symptoms that interfere greatly with your daily life.
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Important information you need to know before deciding to have surgery:
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Tests or procedures should only be done if the results will help your doctor
decide how you should be treated. Having tests that you don’t need may expose
you to risks and more cost. And it may not provide you any benefit.
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Joint replacements wear out over time. Another replacement surgery may be
needed. Delaying surgery by using conservative treatments instead can reduce
this risk. This is especially true for younger people.
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Smoking interferes with the healing process so if you smoke you need to stop
before surgery.
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Surgery has risks. And the results may be uncertain. If you're thinking about
surgery, carefully weigh the benefits of the surgery against its risks. Surgery may
or may not work in relieving the pain. It's possible that your pain may not get better
with surgery. Or it may even get worse. Over time, the improvement you gain from
surgery may decline and further surgery may be needed. Repeat surgeries are
often less effective.
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Before having surgery learn all you can about what to expect during the
procedure, immediately post-op and recovering at home.
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See your Primary Care Physician for conservative treatment options and specialist
referral when indicated. Your physician may order physical therapy before
recommending you see a specialist.
Chiropractor: a referral from your primary care provider is not required in order to
receive the in-network level of benefits.
Physical Therapist: assess the area of pain and develops a treatment plan that
includes good body mechanics, proper exercise, range of motion, and demonstrates
progression toward goals
Rheumatologist: Specialist that diagnosis and treat arthritis
Neuro Surgeon: Specialty surgeon for spine conditions
Orthopedic surgeon: Surgeon for knees and hip surgeries
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Questions to ask your physician:
• What’s causing my pain?
• Do I need tests? Why?
• What treatments are available? What are the benefits and risks?
• What can I take to relieve the pain?
• What can I do to avoid surgery?
• When will I start to feel better?
• What symptoms would indicate that I need to see you?
• If I don’t get better, when should I see you again?
• What will happen if I don’t treat my low back/hip/knee pain?
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