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Panorama: Osteoarthritis and the Role of Physiotherapy

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By Fatima Suleiman Halilu and Maryam Bashir Galadanci

Osteoarthritis (O.A), popularly known as a degenerative joint disease (DJD) is commonly defined as the gradual ‘’wear’’ and ‘’tear of the protective tissues at the end of bones that occurs over time with aging. Recent research and clinical evidence have shown that O.A is beyond ‘’ wear’’ and ‘’tear’’ and is an interplay of Physical, biological, and mechanical factors that affects the repair of joint cartilage (protective soft tissue for shock absorption) and surrounding structures leading to changes in joint structures. It is the most common type of arthritis and a major cause of pain in the elderly.

Osteoarthritis affects over 520 million people globally. According to research, there has been a 48% increase in osteoarthritis cases from the year 1990 to the year 2019 and the figures are expected to rise in the coming years. It is a major cause of disability in developing and developed countries and is expected to increase as the population ages. In age groups below 50yrs, men are more often affected, while in the older population the disease is more common in women with a ratio of 2:1 (due to a decrease in sex hormones with menopause). Research on the prevalence of O.A in Africa remains scarce, but a study carried out in South Africa revealed 55.1% of those affected in the urban population and about 87.2% in the rural population are adults aged 65 and above. A certain study on reported cases in healthcare facilities in Nigeria estimated that about 3.3 -7.1% of the population of the country have O.A. This figure is however believed not to be the true value of the cases in the community as there is still little awareness of the condition and more research needs to be carried out.

Osteoarthritis can affect any joint, but the most commonly affected of them are the weight-bearing joints (knee, hip, and spine). With aging over time and repetitive weight bearing on these joints, they start to deteriorate in function. Knee O.A accounts for about 60% of diagnosed O.A cases.

There are two types of O.A: Primary O.A and secondary O.A. The causes of primary O.A are still unclear but genetics is believed to play a role in it. Secondary O.A is caused by s specific triggers that exacerbate cartilage breakdown. Examples of such triggers are joint, injuries, metabolic and inflammatory diseases, Inactivity, and Abnormal mechanical forces.

Signs and symptoms include Pain, stiffness, limitations in movement, a snap/crackle and pop Sound (crepitus) while moving the joints, Muscle weakness, Mild Swelling, tenderness and decreased quality of life. Some joint-specific symptoms might also set in.

Risk factors include Age above 45, Female gender, Overweight or Obesity, Genetics, Trauma or injury to the joints, repetitive stress, sports injuries, joint malalignment, Bone deformities, Occupations that involve certain repetitive movements like bending and prolonged standing, and living a sedentary lifestyle.

Complications that might arise due to O.A include Loss of muscle bulk(atrophy), joint instability, joint deformity, balance impairments and fall risks, neurological symptoms, disability, and depression.

Osteoarthritis is diagnosed through detailed patient history taking, physical examinations, and some special tests. An X-ray may sometimes be done to determine the extent of changes in the affected joint or to eliminate other similar conditions like gout arthritis. CT and MRIs are rarely done. Lab tests might also be carried out if there is a need to rule out conditions like septic arthritis and rheumatoid arthritis.

Osteoarthritis is a chronic, progressive lifelong condition that cannot be cured. Symptoms can, however, be managed conservatively and the disease progression slowed down through the use of medications, supplements, intra-articular injections, diet, lifestyle adjustments, weight loss, and Physiotherapy. In severe cases, joint replacement surgery might be required.

The World Health Organisation recommends Physiotherapy as the first line of management for osteoarthritis. Physiotherapists are specialized health care professionals concerned with improving human function, and movement and maximizing physical potential. On September 8th each year, World Physiotherapy (formerly the World Confederation of Physical Therapy, WCPT) marks World Physiotherapy day as a day to celebrate the profession worldwide and create awareness of health issues concerned with the profession. The 2022 World Physiotherapy theme is ‘’Osteoarthritis and the role of Physiotherapy’’.

Physiotherapists play a vital role in the management of O.A. Their roles span from preventive, to conservative management to pre-and post-joint replacement surgery management. In the preventive stage, Physiotherapists educate patients, clients, and the general public on, the causes, effects, and risk factors of osteoarthritis. Modifiable risk factors like being overweight/ obese and sports injuries can be addressed and managed by a Physiotherapist. Preventive measures are also given.

The conservative role of physiotherapy in osteoarthritis is aimed at slowing down the disease progression, preventing occurrences in other joints, fall prevention, and management of symptoms like pain, swelling, joint stiffness, joint instability, tenderness, impaired mobility, or balance. Physiotherapy also helps improve muscle strength, joint motion, and flexibility, and encourages participation in daily activities with ease. Additionally, Physiotherapists encourage weight loss and design exercises to cater to that. All this ultimately improves the patient’s quality of life. Methods and techniques applied to achieve this include Range of motion exercises, muscle strengthening exercises, stretching exercises, balance exercises, aerobic exercises, functional activity exercises, manual therapy, joint mobilizations, hot and cold therapy, electrotherapy, hydrotherapy (exercises on water) Muscle energy techniques, use of orthotic devices like a knee brace, splint, neck collar, use of a cane and other mobility aids. The type, frequency, and intensity of the exercises, treatment plan, and materials used are dependent not only on the joint structures and muscles affected or the extent of their affectation but also on other factors like the Patient’s goals, age, gender, occupation, body mass index and the presence of other medical conditions. lifestyle. activity level, exercise tolerance, and sometimes beliefs influence management plans. A well-detailed history taking, physical assessment, investigations, and special tests will help your Physiotherapist design a personalized treatment plan that best suits you. These treatment plans are progressive and will usually get improved or adjusted over time with patient improvement or lack of it. Your Physiotherapist will also advise you on a diet, lifestyle adjustments, coping strategies, proper posture, ergonomic/workplace adjustments, and practices.

In cases where conservative management like Physiotherapy fails or certain symptoms and complications set in, Surgery is required. Physiotherapy plays an important pre-and post-operative role in joint replacement surgeries. In the pre-operative phase, patients are assessed holistically and educated on what to expect after surgery including precautions to take and absolute restrictions. They are informed of symptoms to expect like pain, possible swelling, restricted movement, and muscular weakness and how their Physiotherapists can help address them. Their goals are being put into consideration and they are being taught bed exercises and safe transfer methods.

Physiotherapy may commence a few hours after surgery taking into consideration the general health status of the patient and the type of surgical procedure done. A Physiotherapist would perform a detailed assessment and design an appropriate treatment plan according to patient needs, goals, and capabilities. This aims to promote patient independence, address post-surgical symptoms, prevent complications, improve the general health status of the patient and reduce hospital stay. Strengthening exercises, aerobic exercises for improved cardiovascular function, mobility and transfer training, balance and coordination exercises, and walking re-education are among the strategies employed by Physiotherapists post-joint replacement surgeries. Your physiotherapist will be responsible for training you to make use of assistive aids like a wheelchair, walking frames, and canes, graduating you in stages and eventually weaning you off to encourage functional independence. In-patient discharge rules and outpatient appointment sessions for follow-ups, monitoring, and progression are usually given to patients. This has proven to improve the outcome of surgery.

For consultations, and more information about Physiotherapy and Osteoarthritis, contact the nearest Physiotherapist to you. Also, check www.world.physio/wptday and https://nsphysio.org/.

MYTHS VS FACTS:

MYTH FACT
O.A is a disease of old age While most cases of O.A are diagnosed from ages 45 and above, younger people do get O.A
Exercises and activities worsen O. A While certain movements, exercises, and activities might worsen O.A symptoms, a carefully planned exercise regimen by a qualified Physiotherapist can help manage the symptoms of O.A and improve quality of life.
O.A is caused or triggered by cold weather There is no evidence that cold weather causes O.A. However, people are more likely to be inactive during cold seasons. This triggers O.A symptoms in an already affected joint

Fatima Suleiman Halilu PT, and Maryam Bashir Galadanci PT,  are members of Kano State Chapter of Nigeria Society of Physiotherapy (NSP)

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Opinion

Osun: The Power of the People is Under Attack

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By James O. Bamgbose

At the mention of democracy, what easily comes to mind is the fact that it is a system that places the power to decide leadership on the people. But the experience of the people of Osun state has been the entire opposite of this enticing feature that endears people to democracy. Politicians who fail to get the mandate of the people seem to have found a way to use the court to impose themselves power.

The most recent instance of such a repressive approach is the Justice T.A. Kume led Election Petition Tribunal decision that waved aside the will of the people for a different choice. In the majority judgment read by Justice Kume, the panel made a sweeping attack on the power of the people to choose their leaders as envisaged by the democracy.

The judgment was a clear indication that the law court is now an abode for politicians rejected at the ballot to sneak into power. Before now, violence and manipulations are the tools for politicians to force their way to power, but judges, who are obviously compromised, are the willing tools for politicians to boycott the people to power.

For anyone who followed the Tribunal proceeding up to the point of judgment, they will hardly be surprised by the verdict reached by Justice Kume and his colleagues. This is because Justice Kume never hides his bias against the respondents to the point that you wonder whether he is an arbiter or the petitioner counsel.

It got worse in his judgment, where he maliciously attacked the 2nd respondent (Governor Ademola Adeleke) by making a veil dismissal of his (Adeleke) as a dancer. “The 2nd Respondent cannot “go lo lo lo” and “Buga won” as the duly elected Governor of Osun State in the election conducted on the 16th day of July 2022. See Kizz Daniel’s song,” Justice Kume noted in his judgment.

This is not only a new low for a judicial officer but a clear statement of bias. It is evident that this bias weigh heavily on his decision, which by every indication, was perverse. Or, how can one reconcile the conclusion made by Justice Kume in the judgment that the Exhibit submitted by the respondents after the Exhibit BVR “amount to tampering with official documents” without any clear evidence adduced in that regard?

A judge is not a superman, and this is why most times, they rely on the presentation of an expert to have a clear understanding on the matter before them. One would have expected an unbias arbiter to seek the advice of an expert on the BVAS technology so as to make a sound decision that will ensure true justice.

This was not the case in the Osun Tribunal case, as Justice Kume, relied more on his opinion, rather than evidence that is before it to arrive at the judgment. Or, what could have informed the decision to ignore the BVAS machine physical examination ordered by the court, and go for a server report that has been disputed as incomplete by the maker, the Independent National Electoral Commission (INEC).

It is known to the whole world that the BVAS machines were the device used in the polling units and hold more credible data than a server in far away Abuja. What Justice Kume did with the judgment is beyond injustice, but a serious attack on our democracy. With a decision as the one done by Justice Kume, voters will no longer be encouraged to participate in an election because their votes may not actually matter but the whim and caprices of a judge who was not anywhere near the place of the election.

This unfolding reality will be devastating. In other words, politicians will no longer be interested in what the voters think, but be sure to manipulate the judiciary and find their way to power irrespective of what the people decide at the poll. This is a great setback on our democracy and to imagine that the judiciary, which should ensure the sanctity of the ballot, is the same fouling it, is to say the least a demoralising.

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Opinion

The Oracle: Ethics and Discipline in Law: Akin to Waiting for Godot (Pt. 3)

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By Mike Ozekhome

INTRODUCTION

A nation is said to be developed when the standard of her discipline and ethics are measured in comparison with others in the developing society. Where this is lacking in Nigeria for instance, is what has led her to fail to measure up with other developed nations of the world. Today, we shall continue our discourse on this.

ETHICS AND MORALITY (continues)

To analyse law, refers must be made to a classic tale, originating in India, of a group of blind men and elephant even though there are numerous variations of the story, but I enjoy the Jain’s version in particular:

“Once upon a time, there lived six blind men in a village. One day the villagers told them, “Hey, there is an elephant in the village today.”

They had no idea what an elephant is. They decided, “Even though we would not be able to see it, let us go and feel it anyway.” All of them went where the elephant was. Every one of them touched the elephant.

“Hey, the elephant is a pillar,” said the first man who touched his leg.

“Oh, no! It is like a rope,” said the second man who touched the tail.

“Oh, no! It is like a thick branch of a tree,” said the third man who touched the trunk of the elephant.

“It is like a big hand fan,” said the fourth man who touched the ear of the elephant.

“It is like a huge wall,” said the fifth man who touched the belly of the elephant.

“It is like a solid pipe,” said the sixth man who touched the tusk of the elephant.

They began to argue about the elephant and every one of them insisted that he was right. It looked like they were getting agitated. A wise man was passing by, and he saw this. He stopped and asked them, “What is the matter?” They said, “We cannot agree to what the elephant is like.” Each one of them told what he thought the elephant was like. The wise man calmly explained to them, “All of you are right. The reason every one of you is telling it differently because each one of you touched a different part of the elephant. So, the elephant has all the features of what you all said.” 

Because of the multi-dimensional and interdisciplinary nature of law several theories and schools of law have been propounded to wit: the Naturalist School, the Socialist Theory, the Positivist Theory, the Realists Theory, the Utilitarian Theory and so on, but we are not going to wear ourselves out with the various theories. For the sake of this write-up, we shall adopt the definition proposed in the Black’s Law Dictionary above, that is:

“As that which is laid down, ordained, or established. A rule or method according to which phenomenon or actions co-exist or follow each other. Law, in its generic sense, is a body of rules of action or conduct prescribed by controlling authority and having binding legal force. That which must be obeyed and followed by citizens subject to sanctions or legal consequences. Law is a solemn expression of the will of the supreme power of the State”.

“WAITING FOR GODOT” is a term coined from the story – Waiting for Godot – to describe a situation where people are waiting for something to happen, but it probably never will. Simply put, it is to engage in wishful thinking or to build castles in the air. The phrase is coined from the play by Samuel Becket. The play is basically two clowns waiting for someone who never shows up. It’s a metaphor for humanity waiting for some revelation of God’s presence amid horror, destruction and chaos.

They never get it. At the end a messenger boy comes to say Mr. Godot is very sorry but he’s unable to come today, but perhaps tomorrow. That’s life. Waiting for Godot is a tragicomedy in two acts by Irish writer Samuel Beckett, published in 1952 in French as En attendant Godot and first produced in 1953. Waiting for Godot was a true innovation in drama and the Theatre of the Absurd’s first theatrical success.

NATIONAL ETHICS

National ethics simply means a set of conduct and behaviours expected of every citizen, the breach of which attracts punishment. National ethics is defined as a system of morals, rules, and behaviour which every community in a country is bound to abide by and a breach of such rules usually attracts punishment.

National ethics is stated in the Constitution of a nation to guide the behaviour and conduct of citizens in their places of work. It serves to establishment of law and order and attainment of meaningful development in a country. The present Constitution of Nigeria states the national ethics to comprise the following: Discipline, Integrity, Dignity of Labour, Social Justice, Religious Tolerance, Self-Reliance, and Patriotism.

Discipline, Integrity, Dignity of Labour, Social Justice, Religious Tolerance, Self-Reliance, and Patriotism.

By discipline the Constitution meant Nigerians should try not to be corrupt, disobedient to laws or embezzle government’s funds when they found themselves in a position of leadership. Citizens are expected to be disciplined, always observing self-control and associating themselves only with people of good character. The importance of discipline which cannot be overemphasized include but not limited to the following: Discipline builds good habits; Discipline helps one stop procrastinating; Discipline helps one manage one’s time better; Discipline helps one achieve your goals; Discipline boosts one self-esteem; Discipline helps one master things; Discipline makes one more reliable; Discipline improves one’s ability to manage challenging emotions. When you have discipline in your life you can make small sacrifices in the present for a better life in the future. Discipline creates habits, habits make routines, and routines become who you are daily.

Like a muscle, discipline can be trained. The more you work on your discipline the stronger it becomes. You see this in sports all the time, the more disciplined team ends up beating the undisciplined team with greater talent. Disciplined teams can see the big picture and use restraint during adversity. Teams who aren’t as disciplined lose their cool and end up costing themselves a shot.

By integrity the Constitution states that Nigerians should try to be firm and honest in all their activities. They should not allow others to drag them into illegal and dishonest activities.

Integrity is a characteristic that many of us value in ourselves, and it’s one we look for consistently in our leaders.  But what does it really mean to have integrity? It is the quality of being honest and strong about what you believe to be right.

One could say that integrity is always doing the right thing, even when no one is looking, and even when the choice isn’t easy. Or, one might see integrity as staying true to oneself and one’s word, even when one is faced with serious consequences for the choices that you’re making.

When we have integrity, we gain the trust of our leaders, our colleagues and our team. We’re dependable, and, when we hold ourselves accountable for our actions, we become role models  for others to follow.

All of this, in turn, directly impacts our success in life.

Dignity of labour entails that Nigerians should be proud of the work they do irrespective of its nature provided it is legal. It also means labour should be rewarded accordingly. That is, we should have respect for those who work for us. The dignity of labour is the philosophy that all types of jobs are respected equally, and no occupation is considered superior and none of the jobs should be discriminated on any basis. Regardless of whether one’s occupation involves physical work or mental labour, it is held that the job deserves respect. Simply put, any form of work, manual or intellectual, is called labour and respecting any kind of job (manual or intellectual) is called “dignity of labour”. Dignity of labour, in a nutshell, is the experience of self-worth and achievement that a person derives from his or her work. It is experienced when a person is treated as an equal in the workplace and when they feel useful to their company and to society in general.

By social justice the Constitution implies that Nigerians irrespective of where they come from should be treated fairly and rightly. That is, they should be given equal opportunities in terms of access to justice, employment, education, etc. This could help to bridge the gap between the rich and the poor to the barest minimum.

Justice is the concept of fairness. Social justice is fairness as it manifests in society. That includes fairness in healthcare, employment, housing, and more. Discrimination and social justice are not compatible. Now, social justice applies to all aspects of society, including race and gender, and it is closely tied to human rights. More specifically, what does social justice mean?

Social justice means that everyone’s human rights are respected and protected. Everyone has equal opportunities. This doesn’t guarantee that society will be perfect, and everyone will always be happy. However, everyone will have a fighting chance at the life they want. They aren’t held back by things out of their control like systemic obstacles or discrimination.

By Religious tolerance the Constitution simply means that Nigerians should learn to stay together without violating each other’s right in their practice of religion. That is, they should learn to believe that the religion of every person is important to him. Therefore, every Nigerian should consider the religion of another Nigerian important to the believer. That is, we should learn to believe that, much as we value our religions other people, too, value their religion no matter the pattern of worship.

This goal is a complex one due the great diversity of religions and spiritual beliefs existing in the world today especially in our society. Religion is also a very emotional topic. It can often be difficult for individuals to put their personal biases aside and consider ideas or situations objectively. (To be continued).

FUNTIMES

“Chatting with a Nigerian girl is like interview, if you don’t ask her question, she has nothing to tell you”.- Anonymous.

THOUGHT FOR THE WEEK

“In just about every area of society, there’s nothing more important than ethics”. (Henry Paulson).

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Opinion

How Atiku Abubakar Will Become the Next President of Nigeria by Dele Momodu

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I have read with bemusement many of the polls about the forthcoming Presidential election on February 25, 2023, and have come to the conclusion that the elitist polls have failed monumentally due to the over-reliance on technology in a largely illiterate population.

I have decided to help situate the forecasts based on the established polical history of Nigeria and empirical data.

A Presidential candidate cannot depend totally on votes from outside his home base to win this election. It is a fact of history that whenever the South produced two strong candidates, the dominant Nothern candidate won, such as in 1979 and 1983, Obafemi Awolowo and Nnamdi Azikiwe versus Shehu Shagari.

Bola Tinubu is far weaker today in the South West and Awolowo was by far more formidable, while Obi is the new Azikiwe (the first Governor General and President of Nigeria) in the South East, and Kwankwaso is the current Aminu Kano.

Atiku Abubakar will dominate the North East, North West, North Central and South South. Tinubu may pick a few states in the North and South West but won’t have enough to win. The bridges required to cross to victory has taken Atiku 30 years to build. Tinubu has not been able to lock down the entire South West not to talk of the whole of Nigeria. Over-reliance on bribing the electorates will fail. Hoping to rig brazenly will also fail spectacularly. I repeat, the entire North and the South South will make Atiku the next President. Atiku will still be competitive in the South East and South West. Wherever Obi is number one in the East, Atiku will be number two. Wherever Tinubu is number one in the South West, Atiku will be number two or vice versa. Atiku will be the first to cross the line of recording 25 percent in 24 states. He will get 25 percent automatically in the 19 states of Northern Regions and will pick six in South South automatically. He will pick more 25 percent in all of the five states in the South East, a traditional base of PDP, and same in the South West. Wherever Obi is number one, Atiku will be number two or vice versa. I do not know of any state PDP will not record 25 percent and eventually win the overall popular votes. Nigeria has become so polarizingly divided (pardon my tautology) that the “peoples” are going to vote majorly along ethnic lines as well as primordial sentiments. The North will not vote a “fake Muslim” in the name of a pretentious and mischievous Muslim/Muslim ticket. The scam is dead on arrival. The North East will never vote for a number two position when they’ve been chasing the number one since 1966. The North West will not abandon an Atiku for a Tinubu who’s well known for his iron grip on Lagos State since 1999. The South West itself knows it has the most controversial and palpably weakest candidate in this race this time and would humbly and readily accept its fate with equanimity. It will also dawn on the South East that Obi’s raving popularity alone cannot carry him across the winning line and many of their traditional voters will willingly settle for ATIKU ABUBAKAR and IFEANYICHUKWU OKOWA, the cerebral man and gentle giant of Igbo ancestry. I predict that former President Atiku Abubakar will be the next President of the Federal Republic of Nigeria. He is the most prepared, experienced candidate in the race who’s ready to hit the ground running from day one…
Nigerians will experience real politicking in the days ahead.

Chief Dele Momodu is the Director of Strategic Communications PDP Presidential Campaign Council

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