Treat a cramp gently. Don’t jump up and down on the affected leg or slap the area that’s cramping. Stretching the muscle will help to relieve the pain Gentle massage is also useful, as is walking about the room. Fortunately, the cramp will disappear on its own within a minute or two. If you are troubled by persistent, recurring leg cramps, see your doctor. Cramps that occur after exercise may have a serious underlying cause; most night cramps in older people, however, are not serious an can be relieved with simple medications.

Back pain can come suddenly or course of time; it can be the immediate result of an attempt to lift a large object or the cumulative effect of endless hours camped in front of a television set. In most cases, the actual cause is weak muscle tone in the lower back and abdominal areas, muscles that are critical in the support of the arching spinal column. When they are not doing their job – or are straining to do it under pressure – back problems are all but inevitable. In fact, most people experience back pain at some time int their lives, and millions of dollars are spent every year in search of relief.

CAUSES BACK PAIN
Back pain can have several causes, and more than one may be involved simultaneously. The pain is usually located in the lower lumbar region, where the spine curves inwards just before it reaches the buttocks. A sudden wrenching movement or prolonged stress on this are can cause muscle spasms, in which the tensed muscles cannot relax, or tiny tears in the muscles or ligaments – any of which can cause pain.

In some cases, a sudden injury or the prolonged failure of the surrounding muscles to support the lower spine may cause the vertebrae to squeeze one of the discs that separate them. As the disc flattens, its jelly-like core may protrude to the side. Called a prolapsed or slipped disc, this protrusion can press on one of the nerves branching out from the spinal cord and produce sharp pain that often extends down the leg.

To relieve the pressure of a slipped disc, the muscles surrounding the spinal cord may go into spasm. But this protective response can also cause a problem the muscle on one side of the spine may contract so strongly on the other are drawn up several centimeters higher than  normal. Such a spasm can result in pain as acute as that cased by a pinched nerve itself.

Another common cause of lower back pain, especially in middle-aged and older people, is osteoarthritis of the the spine. The pain in the facet joints that link pairs of vertebrae can also mimic that caused by a slipped disc.

HOW TO AVOID BACK PAIN AND KEEP IT FROM RECURRING
Your first defense against back injury is to get in shape and learn how to use your body properly. There are many recommended exercises that will benefit our back by improving the body tone generally, but pay special attention to strengthening your abdominal and leg muscles, which together do most of the work of supporting the back. Ask your doctor or physiotherapist to give you an exercise schedule. Aerobic classes may sometimes aggravate your condition.

Sit-ups (with legs bent) are excellent for the abdomen, as are swimming, cycling and rowing. Regular walking is great but beware of sports like tennis, in which bursts of exertion alternate with sudden stops, lurches and periods of inactivity. If you are overweight, slim down: extra fat means extra strain on your back.

Learn how to walk, sit, sleep and lift properly. Good posture also helps: when standing or walking, contract your abdominal muscles and tuck your buttocks under slightly. Keep your shoulders back (but not in an exaggerated arch) and your torso loose. If it is necessary to stand for a long time, raise one foot to take some of the weight off your lower back. Avoid high heels or any other uncomfortable shoes.

Straight-backed chairs that keep you from slumping are better for the back than rounded ones. When sitting, keep your knees higher than your hips. and when rising from your chair, bend your knees and push off with your hands.

Make sure your mattress is firm, and never sleep on your stomach, since this forces the spine into an exaggerated curve that can cause aggravation. If you can’t sleep lying on your back, try lying on one side, with knees tucked up in the foetal position.

Let your legs, not your back, do the real work whenever you lift anything. Get close to the object you want to lift, slowly bend your knees, and then come up with your back straight. Be especially careful not to bend at the waist.

The most common type is osteoarthritis, which occurs mainly in people over 40. The next most common, and potentially the most serious, form is rheumatoid arthritis, which affects women more often than men and may strike at any age.

Osteoarthritis, or degenerative joint disease, is very common – almost everyone over 60 has it to some degree. In mild cases, the disease is almost indistinguishable from normal wear and tear on the joints. In others, degenerative process speeds up, suggesting the presence of a still unidentified trigger. Previous injury seems to be a contributing cause, as osteoarthritis often occurs at the site of earlier joint damage. Many people, however, get osteoarthritis in joint that have never been injured.

GOUT
Gout is an arthritic condition brought on by excess uric acid, which lodges in crystal form in the joints, and causes severe pain. The usual site of a first attack is the base of the big toe. There is visible swelling, the skin covering the affected are takes on a dry, red brightness, and the pain may be so acute that not even the touch of a sock can be tolerated. Later attacks may involve the knees, wrists and ankles, and may occur at increasingly frequent intervals. Chronic gout can lead to the formation of kidney stones or of large uric acid deposits, called tophi, under the skin.

There exists a secondary form of gout that isn’t inherited; this may be triggered by other diseases or by certain drugs. Blood pressure medications, for example, may hinder the body’s ability to dispose the uric acid.

WARNING SIGNS
Sometimes the onset of rheumatoid arthritis is preceded by a period of listlessness, muscle pain and appetite loss, after which specific symptoms of joint inflammation - swelling, redness, tenderness, stiffness, pain - appear. This gradual onset may make the disease hard to recognize at first. In other cases, inflammatory symptoms come on suddenly and without warning. The most common initial sites are the hands, feet and knees, with both sides often affected. The disease may also affect the neck, shoulders, elbows, wrists and hips.

SYMPTOMS
Osteoarthritis starts with slow but irreversible erosion of the cartilage layers which line opposing bone ends in a joint and ease joint movement. In the early stages of the disease, the cartilage begins to soften, crack and break loose; this restricts the motion of the joint, causes pain and inflammation, and may induce the bone to compensate by growing new bone. In time, the unprotected, raised ends of the bones may grind together. Mobility may then be further limited by the build-up of cartilage fragments and other debris in the joint. In the later stages of the disease, bone spurs may form at the damaged ends of the bone and, if they press on nearby nerves, the result will be further, severe pain.

Sensation of pain, visible swelling and stiffness in the joint, especially after you use it, are the usual early signs. They may occur sporadically at first, and continue intermittently for years before becoming troublesome enough to warrant medical attention. As the deterioration of the joint continues, however, the symptoms may begin to interfere with daily life. The pain become severe enough to disrupt sleep; osteoarthritis in the hip or knee can make walking difficult; in the spine, it can preclude bending and lifting; in the fingers or hands, it can make simple tasks like brushing teeth or laying the table a misery.

TREATMENT
The treatment of osteoarthritis consists of plenty of rest, to prevent overuse and irritation of the joints; regular moderate therapeutic exercise, to preserve mobility and strengthen the muscles supporting the joints; and aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and swelling. Application of moist heat and massage ar also helpful, while swimming and other aquatic activities (in which most of the body’s weight is supported by water) are both soothing and excellent for maintaining long-term condition and flexibility.

For servere discomfort, your doctor may recommend injecting corticosteroids – synthetic hormones with a strong anti-inflammatory affect – into acutely inflamed jointes. In cases of extreme joint degeneration, surgery to remove damaged tissue or replace a joint (usually hte hip or the knee) may be needed. The important thing is to consult the symptoms and to begin a treatment programme that will enable you to manage your arthritis rather than allow it to control you.

The treatment of rheumatic arthritis requires a team effort, involving not only you, the patient, but also your family, your doctor, a rheumatologist, physio- and occupational therapists and an orthopedic surgeon. The basic treatment programme consists of cautious therapeutic exercises, warm compresses and plenty of rest during flare-ups, and anti-inflammatory medication – usually aspirin and non steroidal anti-inflammatory drugs (NSAIDs). But, if necessary, your doctor may also prescribe additional and more powerful medications that require careful monitoring on his part as well as a high degree of cooperaton on yours. These so-called disease-modifying or remissive, agents include gold salts, penicillamine and azathioprine. They can halt and even reverse the course of severe rheumatoid arthritis. Corticosteroid drugs are usually reserved for resistant cases. Because these drugs can all cause potentially serious side effect or adverse reactions, it’s important for a patient to advise his physician immediately of all effects he may experience as a result of taking such drugs.