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Dr Rodrigo Megale is a Brazilian physician specialising in geriatrics , graduated from Medical School (UFMG) in 2002, with advanced training in Internal Medicine (2002-2004) followed by Geriatrics (2004-2006) through accredited residency programs (MEC). He has Masters Degree in Public Health (Epidemiology) from Fiocruz and is, currently, undertaking his PhD in The University of Sydney - Medical School.

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It is usual among older adults to think that musculoskeletal pain is a benign symptom related to the “wear and tear” of ageing. If you are in your 70s or 80s, you probably have already heard from health professionals that chronic pain is something that you should get used to, and that it is a very common age-related condition. I, myself, have said that to many of my patients. It turns out that having chronic or persistent musculoskeletal pain is not as benign as it was thought to be.
Several studies have shown an association between chronic pain and frailty, a pre-disability condition, clinically characterised by weight loss, exhaustion, weakness, slowness and low physical activity. Those who have been experiencing bothersome joint or low back pain might be worried at this moment; however, there is no reason for that. If your pain is not interfering in your daily living activities, and your doctor has already assessed it in order to rule out any serious condition, there are some tips that can help you cope with your symptoms.

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The first important thing that you need to know about chronic pain is that, in many cases, the source of pain is not only joint inflammation, cartilage damage or disc degeneration/ protrusion. Actually, it seems that our brains play a very important role in this condition. Chronic pain usually involves a problem in the so called “descending inhibitory pathway”, which is part of your body’s pain management system, and it is controlled by your brain. That is probably why some patients report less pain when they are surrounded by loved ones or when they are on a pleasant trip. Our brain is capable of modulating the pain we feel. If you focus on your pain and drive all your attention towards your suffering, your behaviour could probably “enhance” your pain. On the other hand, if you drive your attention away from your suffering and try to focus on positive aspects of your life, there is a reasonable chance of achieving pain improvement.

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Today, we have a guest post from the Osteoporosis Re-Fracture Prevention Project Officer at Royal North Shore Hospital, Christine Collins giving us some tips on preventing falls. Christine comes from a physiotherapy background and works in the Osteoporosis Clinic at Royal North Shore Hospital.
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Falls are no laughing matter – just ask Humpty Dumpty. Whilst medicine has come a long way and we no longer rely on “all the kings horses and all the kings men” to remedy fall related injuries, prevention remains key…particularly if you are an egg.

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Falls are one of the main reasons that older people are admitted to hospital. Each year, one in every three people over the age of 65 will fall. Falls can be associated with serious injuries including hip fracture and head injury. But we’re not only talking about people up ladders (or up on walls for that matter) – the most common type of fall resulting in a hospital stay is a fall on the same level, meaning a simple trip, slip or stumble.

So how do you know if you are at risk of falls? If you answer yes to any of these, you may be at increased risk of falling:
1. Have you had any previous falls (including trips, slips and stumbles)?
2. Do you suffer from any changes in your memory?
3. Do you wear glasses or have poor vision?
4. Do you take more than 4 prescription medications?
5. Are you afraid that you may fall?
6. Do you suffer from incontinence?

If you answered NO to all of these questions, then your falls risk is relatively low. But don’t stop reading. Anything you can do now to protect you from falls in the future is a bonus.

If you answered YES to any of these questions, read on to find out how you could address these problems.

Stay Active

Adult should engage in regular physical activity of moderate intensity, on most days of the week, ideally reaching a total of 300 minutes per week. This includes activities such as brisk walking, swimming, cycling, dancing or organised sport. Balance should also be incorporated into a regular exercise program. Examples include dance, Tai Chi, Yoga, or a home exercise program designed specifically to challenge your balance. Advice can be sought from a Physiotherapist, Exercise Physiologist or accredited Personal Trainer.

Here are my top tips for Staying Active:
• Physical Activity doesn’t have to be the same all the time – if it’s a nice day make the most of it and get outside for a walk, do some gardening, or go for a swim. On other days you might find it more pleasant to take part in an indoor activity such as a gym class or do some exercise on your own at home
• Doing any physical activity is better than doing none. If you currently do no physical activity, start by doing a small amount, and gradually build up to the recommended amount.
• Involve others – you may find it more encouraging and enjoyable to exercise with others.
• Everyone is different – although there are guidelines for exercise, everyone will have their own challenges. Yours may be painful arthritic knees or back. This doesn’t mean you can’t exercise – it just means you may have to choose wisely and modify your program on days when your pain is worse. Speak to a health professional to get advice. But remember, something is better than nothing!

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Information on community exercise programs in NSW can be found at www.activeandhealthy.nsw.gov.au

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Good old calcium; it keeps our teeth and bones strong, keeps our hearts healthy and helps us have healthy muscle function. Sadly we cannot produce calcium in our bodies and have to consume it (and enough of it) to stay healthy. When calcium levels are low, our body turns to our calcium bank (also known as our bones) and withdraws calcium for the rest of the body to use. However, this becomes a problem when the amount of calcium extracted exceeds the amount deposited making our bones more brittle and prone to fractures. In women, this is seen predominantly during and post menopause when there is a rapid decline in estrogen (which leads to more rapid calcium loss from bones).

Now, we all know to drink our glass of milk everyday but is it really enough? The answer is no. A cup of milk (250ml) only provides 30% of an adult’s daily recommended intake. Adults over the age of 19 are recommended to have 1000mg per day, women over 50 and men over 70 are recommended 1300mg by Osteoporosis Australia. That is equivalent to about 4 cups of milk which we may not want to drink every single day!

Myth busting: While it is commonly thought that full cream milk is better for calcium absorption due to the fat content compared to skim milk, it is not true! Fat does not actually affect calcium uptake by our bodies! So drink away whichever you prefer.

Here are some tips on how to increase your daily calcium intake:

1) Try to consume 3 – 5 servings of calcium rich food. Foods like milk (a cup), yoghurt (a tub) and cheese (a slice) have high calcium levels
2) Your can incorporate milk powder into soups and casseroles
3) Yoghurt also makes a very tasty salad dressing
4) Almonds, figs, apricots, and rhubarb are high in calcium and can be a great snack
5) Canned fishes like salmon and sardines are rich in calcium
6) Include more green leafy vegetables as part of your daily diet

**My favourite is having Babybel light! It provides you with 20% of your recommended calcium intake in a yummy little package.

As amazing as calcium is, it has a sidekick that it needs to be effectively absorbed: Vitamin D. Vitamin D can be sourced from supplements or more naturally from the Sun! Depending on where in Australia you live, the season and your skin type (fair or dark), the amount of time you need to spend in the sun varies differently. Thankfully Osteoporosis Australia has a map to show you how much sunlight your skin needs and when you need it for all over the country. !

If you are spending longer times out in the sun, don’t forget your sunscreen!

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Many fitness enthusiasts would say that fitness is their drug. They are actually not that far off from the truth. Exercise has been found to provide benefits to many different medical conditions such as heart disease and high blood pressure. In osteoarthritis, exercise provides moderate benefits to pain levels. While this may not seem like much, it is actually about the same relief you can get from simple pain relief medications like Paracetamol (Panadol) and oral anti-inflammatories (NSAIDS) like Ibuprofen which are the first line drug treatments for many sufferers of OA.

With this knowledge it’s clear that exercise will be good for you but what kind is best when your joints are already vulnerable? There are many types of exercises that are prescribed including cardiovascular exercising (like cycling or walking), balance training and muscle strengthening. These exercises work by strengthening the muscles that control and stabilise your knee, reducing joint load by weight loss and by improving your general health!

There are many recommended exercises but here are a few tips to get started:

• Try low impact activities to reduce the force going through your joints. This includes things like walking, swimming (the heated pool will feel great!) or Tai Chi.
• Aim to exercise for about 30 minutes a day. This could even be in blocks of 10 minutes.
• Plan your exercise for when you experience the least pain or stiffness in the day or even when your medications are most effective.

Muscle strengthening is also really important for lower limb OA and here are a few simple exercises you can try:

1)Standing Calf Raises

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Starting position
Stand on two feet near a wall or table. Hold on gently to maintain balance.

Activity
Keeping the knee straight, rise up on the toes and hold for 3 to 5 seconds then lower slowly.
Try to do 2 to 3 sets of 10 repetitions

Hint: The exercise can be made more difficult by doing it on one leg

2)Partial wall squats

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Starting position
Stand with feet approximately one foot (30cm) away from the wall and feet apart. Slightly turn your feet outwards (if you get pain in the front of your knees with this exercise related to kneecap arthritis we would not encourage this exercise).

Lean your trunk and buttocks against a wall and keep your back straight.

Activity
Slowly slide down the wall (as if to sit) keeping your body in contact with the wall as you do.
Keep your knees moving over your toes.
Stop when your knees are bent to about 60 degrees (or less if it is painful).
Hold the position for 5 seconds.
Slowly slide back up keeping your body in contact with the wall as you do.

Try doing 2 to 3 sets of 10 repetitions

A physiotherapist can help recommend more exercise suited to your needs and ability.

For more information on physical activity and OA check out the physical activity fact sheet on MyJointPain.org.au.

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The holiday season can be incredibly busy for many of us. It becomes harder when managing pain with all the different tasks that need to be done! Here are a few tips to help you through this season.

Planning
Plan out your day! There are times of the day where you feel better. So plan your days so that strenuous activities are done when you feel your best.

Catering
Consider catering meals for gatherings you host. This way you won’t have to spend ages standing around cooking a large meal.

Decorating
Start decorating early or do it with other people. It is still fun to decorate but it means that you could do a little bit at a time without tiring yourself out. If you get to do it with other people, you could let them reach high up to place decorations.

Online Shopping
Consider online shopping to get gifts. Many places have a cut-off date to order gifts, but some places will allow you to order things online and pick them up in store. This stops you from having to walk about a really crowded shopping centre. (Extra tip!! Most shopping centres have a gift wrapping station for you to get that out of the way too!)

Happy Holidays Everyone!
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