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Multidisciplinary Approach and Treatment in Low Back Pain Physiotheraphy Neurology Physiotherapy Algology Spine surgery It is possible with the cooperation of physicians working in their branches. Progressive (algorithmic) treatment principles require anti-inflammatory therapy in primary care and bed rest not exceeding 3 days. In resistant and chronic cases, algologists apply block-pain treatments, physical therapists apply physical therapies. All treatments are supported by muscle strength-posture discipline-ergonomic measures with the support of physiotherapists. Surgical compression of neural structures is the last step of choice in recurrent resistant cases of osteoarthritis due to significant loss of disc height. As open surgery indications: Cauda equina syndrome Progressive neurological deficit Failure of conservative treatment Paresthesias that are not obvious but affect life Pain with attacks and requiring rest more than three times a year countable. The indication for minimally invasive (closed endoscopic) surgeries differs at this stage. Prominent neurological deficit, cauda equina may be a contraindication. Endoscopic surgery has a place in cases requiring bed rest more than three times a year, but without an absolute surgical indication. PAIN, which reduces the quality of life and does not respond to conservative treatment, is NOT THE FATE OF THIS POPULATION. It is a treatment that is purely aimed at improving the quality of life.

Our joints get stronger and stronger as we move. A balanced diet rich in protein and regular exercises are beneficial. Excessive weight gain should be avoided. On the joint, it can be caused by sprains, reverse loading and weakness of muscle strength. Exercises to increase muscle strength should be done. The type of exercise should be appropriate for your level. It is inevitable that you will be injured while running on the treadmill if you have not walked on a straight track. If the items you use around you are in harmony with you (ergonomic), it will reduce your risk of injury. Adapt your surroundings to yourself.

1. Dull elbow 2. Tennis and Golfer’s Elbow (epicondylitis) 3. Cartilage lesions (synovial chondromalasias) Elbow arthroscopy provides the opportunity to intervene in all these problems without the need for open surgery.

Ky Kyphosis; It is a definition that means hunchback, which includes the conditions that cause the spine to bend forward in the medical language. It is a structural deformity, it may be congenital or as an acquired disease, causing collapse in the vertebrae and may result in kyphosis. Humpback treatment is eliminated by the corrective interventions of spine surgery. Since it is generally an intervention performed at a young age, open surgery covers major surgeries using metal screw and rod systems. Since it is one of the most severe surgeries in orthopedics, surgical treatment of humpback and problems caused by aging was avoided. The method of bone cement injection to fill the gap created by a bone tumor in the spine, first applied by a Radiologist Drummond in 1984, when “osteoporosis = decrease in bone density” emerged as a cause of reducing the quality of life of the elderly population in societies with the increase in the elderly population after the Second World War; The definition of “vertebroplasty” has begun to be used. Osteoporosis patients were disconnected from daily life due to both deformity and pain, and they were lost due to fatal causes, from embolism to respiratory problems due to immobility. Vertebroplasty method not only fills the gap in vertebral tumors that destroy and weaken the bone structure, but also ensures the destruction of the bone tumor with the cement used. The situation is a little different in osteoporosis. Cement is injected using high pressure with vertebraplasty since there is no cavity to be injected although the bone density decreases. Its use has been restricted because the cement injected with high pressure leaks into the spinal canal and reaches the lungs through the blood. During these periods, the idea that balloons used in vascular surgery would straighten the spine of osteoporotic patients in the bone, create a gap and replace it with cement was developed and put into practice. After the first applications were carried out successfully in Chicago, the concept of “Kyphoplasty” became one of the treatment options. The final point reached in the vertebroplasty-kyphoplasty debate, in which physicians performing spine surgery in the last fifteen years question their habits, is that kyphoplasty is safer and its effect on kyphosis correction is significant. However, kyphoplasty is ineffective in the treatment of structural humpback. It is effective in vertebral collapse due to fresh osteoporotic fractures and tumors. Although there is still no consensus among surgeons on cement leakage, both methods can be safely applied, respecting the physician’s habit. My personal practice is that kyphoplasty is safer. Finally, we prefer the use of cement as a filling material only in tumor patients. We use organic products such as calcium-phosphate that regenerate bone instead of fillers that cannot be absorbed and destroyed in polymethyl methacrylate content. Although these products are not mechanically very robust, they are not different in terms of efficiency. In addition, it keeps us away from the disasters that polymethyls cause by destroying bones in the long term.

Tennis elbow, medically known as “lateral epicondylitis”, is seen in people who work in arm strength jobs. The extreme discomfort of the tissues can be defined as the lateral epicondyle unencrypted strain to which the tendons of the arm muscles adhere. Beam and bone joints are tattooed, healing in tattoos is achieved with beam fibrotic cells and bones are again with periosteal cells with very good differentiation ability. Forcing continued healing tissue is more fibrotic, about creating a scar that does not bleed very well between cartilage and bone at rest. In either case, the tissue does not resemble muscle, bone, or tendon tissue. We call this condition “Entesopathy” beam-bone attachment site disorder. In this respect, tennis player disease is a kind of enthesopathy disorder. Patients complain of not being able to bear weight, sometimes it is even possible to lift a tea glass. Pain can spread to the forearm, and there may be those who wake up with pain at night. This discomfort, which affects daily life, becomes chronic and difficult to treat if it is not treated in a timely and correct manner. The diagnosis can be made supported by examination and simple radiological tests. MRI examination should be performed in resistant and repetitive situations. MRI reveals tears in muscle structures and allows us to examine intra-articular ligament structures. If there is no muscle tear, the treatment is mostly successful with simple bandages, oral and locally used anti-inflammatory drugs. It is possible to continue medical treatment in resistant cases, up to shock therapy (ESWT), cellular therapies and steroid injection as a last resort. If all these treatments do not result in results, surgical treatments should be considered. Timing is very important in surgical treatment. Instead of a resistant epicondylitis treatment, it may be possible to return to daily life in a short time with an intervention before the recovery capacity is lost. If there is a muscle rupture, if it does not respond to plaster determination; It should be repaired without waiting, and after the plaster fixation, rehabilitation should be started immediately and adhesions called contractures should be prevented. Different methods, ranging from soft tissue surgeries such as “loosening” to bone surgeries, may be preferred in the surgical treatment of resistant epicondylitis. During open surgery, intense adhesion may unintentionally cause external connective structures to be damaged. In addition, postoperative wound care and long-lasting plaster fixations are in question. Nowadays, arthroscopic treatment not only minimizes the complications of traditional methods, but also easily eliminates scar tissue that causes pain in the epicondyle area with magnification and non-bleeding imaging. Operations can be recorded and examined during future controls. If intra-articular structures are observed, correction of cartilage problems and control of ligaments are other advantages. If there is no repair after elbow arthroscopy, plaster cast is usually not applied and the next day can be returned to work. Using a bandage, it may even be possible to use a computer. We recommend ten days of rest to our patients, unless more is required.

Painless joint freedom of movement. Stagnant life can lead to unexpected problems such as vascular diseases, internal organ failures, and stroke. The joint moves with the sliding cartilage surfaces. Injury on these surfaces, factors that disrupt the surface also disrupt the opposite side throughout the movement. Over time, both surfaces begin to erode each other. In a small spot, a groove the diameter of the injury appears, the articular cartilage quickly disappears. Joints are ball-slot, hinge structure that works in harmony. The axis of both surfaces must be the same, the covering areas must be the same. We can protect our joint health! Our joints become firmer and stronger as we move. A balanced, protein-rich diet and regular exercise are beneficial. Excessive weight gain should be avoided. A sprained load on the joint may be caused by weakness of muscle strength. Exercises to increase muscle strength should be done. The type of exercise should be appropriate for your level. If you have not walked on a flat road, it is inevitable that you will be injured while running on the treadmill. The fact that the items you use around you are in harmony with you (ergonomic) will reduce your chance of injury. Adapt your surroundings. Accurate diagnosis is possible with examination! When you have a joint injury, you should see an Orthopedics and Traumatology specialist as soon as possible. Radiological examinations performed after the physician’s examination determine the level of injury and the type of treatment. Once the type of injury is determined, the rate of self-repair is understood. Apart from severe injuries, splint-plaster fixations, bandages, therapeutic drugs, painkillers are used that will allow the body to repair itself. Arthroscopic treatment is the gold standard in severe injuries. Don’t let your joint stay still! During injury, recessive treatments may be aimed at restricting the movement of the joint. Immobility of a healthy joint can lead to a decrease in joint lubricity and loss of muscles. Therefore, the treatment is arranged to give action as early as possible. Devices that provide passive movement of the joint surface without weighting can be very effective in treatment. We get help from rehabilitation specialists and therapists for such treatments. Arthroscopic surgery gold standard! Arthroscopy is the gold standard in the diagnosis of delayed healing joint injuries, no matter how advanced and perfect the examination and radiological examinations are. Magnetic resonance imaging may be insufficient for cartilage lesions, plica ruptures and hardening. In this case, intervention is made before joint wear occurs. Today, meniscal tears and ligament ruptures can be treated with arthroscopic methods with excellent results. Correct intervention and stepwise approach are very important when there is a Joint Injury! Your joint may swell after injury, remain motionless and you cannot load. Don’t panic, if you don’t have a real health professional around, a simple bandage, a temporary fix and a cold application is all it takes. Do not be burdened, and rest for a while and contact the health center as soon as possible. Find out exactly what the problem is! You should know what the injury in your joint is, the recovery time and the time to return to normal after recovery. Your doctor will provide information on how joint healing will result. This information can play a key role in explaining your future ailments. Will the treatment affect your daily life and work life? Every person’s daily life expectancy and work life is different. The physician’s decision may vary from recessive treatments to arthroscopic surgical treatments while determining the rest and recovery time. Remember, your joints are the most important part of your life. After the treatment, help may be required to regain the old mobility. In arthroscopic treatments and long angle fixations after severe injuries, we should definitely seek physiotherapy assistance. In simple interventions and diagnostic arthroscopic surgeries, self-exercise may be sufficient most of the time. If it is thought to be inadequate during the controls, it can be included in the rehabilitation program.

Perhaps the best part of tennis is that it can be practiced at any age. While trying to get away from the pressure of busy work life, we must question whether our musculoskeletal system is ready for the physical strains encountered on the court. Otherwise, problems start in our musculoskeletal system by trying to do sports. Firstly; Is our musculoskeletal system ready for new loads? Is our endurance enough to return to sports or participate in tournaments? Do we practice and attach importance to enough before we get started? We have to ask ourselves many questions like. We should know well that Endurance is an attribute that we will gain with practice over time. Exercises to increase the strength contribution of fibers with different properties in the muscle mass require regular training. As the athlete regularly participates in the exercises, the endurance will develop automatically. You have been doing sports for a long time, but if you have exceeded your stay on the court a little that day, you have an unbearable heel pain, you have become almost unable to step, you should start the treatment by paying attention to your shoes. If the court floor is not soil or grass, the usual tennis shoes on the hard ground will cause the abnormal loads of the under-heel fat pad to reflect directly on your heel bone. This situation may cause heel pad compresibility synd. You should choose shoes that have shock absorbing structures at the sole and that grip the heel. Our foot transfers our weight to the floor at three points. These are the protrusion under the heel bone (calcaneus), the end of the comb bone of the 1st and 5th fingers. The hard floor will cause pain in the normal foot by exerting pressure effect on these points. The second problem may be dynamically disturbances of the common beams of the inner foot muscles (plantar fascia). The common beam plantar fascia provides movement with the spinning wheel mechanism. Plantar fasciitis is when muscle groups with insufficient endurance give the load before the adhesion and cause problems such as tearing. Although this situation requires a physician’s intervention, it once again reveals the importance of shoe selection. Let’s not forget that the famous Achilles tendon is attached to our heel bone. It attaches to the heel as the common beam of the muscles that start from our Achilles leg, performing the function of jumping and walking. In cases where the durability is low, loading may cause similar breaks. If the loading occurs to the place of direct adhesion, it is “insertional-adhesion” tendinitis, above it noninsertional. In these two cases, whose treatments are different, your physician’s guidance will be required. Finally, if we touch on the problems our joints will encounter on the court, torsions can injure ligament and cartilage structures. Since strong muscle structures will provide balanced weight transfer, the risk of joint injury is minimal. When the joint limit is forced, respectively, our capsule, our ligaments, then our bones resist the forces. In a balanced load, ligament rupture, fractures and more importantly, cartilage injuries do not occur. Let’s not forget, our freedom on the court depends on our technique, our endurance, as well as our musculoskeletal health. Do not hesitate to consult a physician for foot pain that does not go away despite changing your shoe preferences. Healthy sports. Note: This Article is the text of the article I wrote for the Sports International magazine.

“Friend looks head to head and enemy at feet ..” Our feet are the most important part that carries our weight, which some proudly display, some lamented when hidden in shoes during the winter and come to light in summer with open slippers, which complement our beauty. In healthy individuals with foot structure; Three points are used in contact with the ground. The heel, thumb and little finger comb bone end parts transfer our body weight to the floor. In the foot architecture, the comb in the front and two arches on our longitudinal sole serve as a shock absorbing spring. While both arches are supported by the common beam of the muscles on the soles of the foot, the spinning wheel mechanism distributes the loads between 3 points without injury, so that our weight-bearing feet can resist the loads. While the middle long arc distributes the load to three points between the heel and the anterior arc, it can reduce the riding force by one tenth as a lever. While a healthy foot structure is like this, when the arc disappears in the flat sole, the outer muscles of the foot have to work harder to balance this structure. Therefore, long walking and running fast on flat soles becomes difficult. For whatever reason, when the load distribution is disrupted, calluses, protrusions in the bones that touch the ground or adhere to the beams, deterioration and erosion in the joints begin to occur. Foot problems can be examined in three areas. Back foot problems (Heel pain, bone spurs around the heel, Achilles problems) Midfoot (Plantar fascia problems = heel spur ?, sinus tarsi syndrome, nerve traps) Forefoot problems: Metatarsalgia, Thumb problems, Morton’s neuroma, hammer finger, tailor’s finger, Hindfoot and Heel Is the heel spur real? This diagnosis, which alternates between medical reality and urban legend, divided medical professionals all over the world. The common view of both sides is the presence of ossification at the attachment site of the combined tendon to the heel bone. Is their point of departure the bone problem? Is it resolved by eliminating the causing tendon discomfort. This difference of opinion has also led to heel support and treatment options for them. From simple to complex diagnosis and treatment methods, if the problematic area is not relieved with arch reinforcements, heel supports, and ESWT (External Shock Wave therapy) methods do not help, we can endoscopically shave the combined tendon. The permanent solution can be completed with post-surgical rehabilitation. Heel Cushion Syndrome This situation, which decreases in a few minutes, gives the feeling of walking on a thorny road in the morning; It is caused by the rupture of the natural fat pad wall that surrounds our heel and absorbs the shock on the floor. Challenge with a simple Heel cup with a patient rehabilitation It will disappear automatically. Heel Spurs- Bursitis (Calcaneal Bursitis) Bone Spurs (Haglund deformity) Bursitis, which develops due to the pressure of hard and narrow shoes on the Achilles beam, is the healing tissue caused by the irritation of the bone and the side of the Achilles facing the bone surface. If not treated well, it can become ossified and horned. Comfortable slippers worn on summer days are a great opportunity for treatment. If it is not possible to disintegrate this tissue from the outside like ESWT treatment, it is possible to remove this hard tissue in front of the tendon by closed surgery with ankle arthroscopy. Achilles tendinitis Although it does not seem directly related to the mechanics of the foot, it is very difficult to solve this situation caused by excessive strain without correcting the foot arch. Apart from rest and medical treatment, the heel of the foot that will trigger this situation should be corrected with varus insoles, which pushes the heel outward (flat foot, valgus) or disrupts the inward alignment, and plantar fascia tension should be reduced. If Achilles tendinitis is not treated well, it can result in breakouts. ESWT can be effective. When medical treatment is insufficient, radiofrequency can be applied with tenoscopy. Peroneal Tendinitis Back foot heel is one of the causes of pain. Just like Achilles, it occurs after foot mechanics deterioration and excessive strain. Occurs frequently in ankle fractures, in cases of malunion. Outsole wedges relax in medical treatment. ESWT is useless in this region. Ankle arthroscopy gives extremely good results in resistant cases. Midfoot Plantar Fasciitis Our tendon, which adheres to the heel of the foot, adheres to the heel where all the inner muscles of the foot are strengthened, and the spinning wheel acts as a force arm in walking mechanics. The injury of this structure, which is extremely important in gait mechanics, becomes chronic when it is not supported with the right insoles and its alignment is not regulated, causing the other structures of the foot to become open to load and injured. ESWT can support healing by increasing regeneration in complaints that are not reduced by choosing the right shoes and insoles. Injection treatments are successful. Tenoscopy and endoscopic debridement of the plantar fascia are among the surgical options. Sinus Tarsi Syndrome It includes the discomfort of the joint between the two bones that make up the heel that increases with pressure, which gives a feeling of fullness and swelling in the foot. It is frequently injured after foot sprains and strains. It may progress with the involvement of the joint surfaces between the two bones or with joint inflammation due to purely mechanical reasons. If the insoles do not decrease with intra-articular injection and drug treatment, if intra-articular problems are revealed in radiology, we apply sinus tarsi arthroscopy. Foot Trap Neuropathies Tarsal Tunnel It is the compression of the tibial nerve, which goes to the sole of the foot, without giving the plantar branch or after narrowing the space between the muscles and tendons. It is characterized by heel pain, burning in the sole and numbness in the big toe. EMG test is negative in half of the patients. Treatment is surgical release, cortisone injection can be tried. Dorsal Nerve Compression It is the result of compression of the nerve that goes to the toes on the back of the foot. It may be characterized by numb pain and burning in the second and third fingers. It is common in dancers and runners who wear tight strappy shoes. Treatment is surgical loosening if the injection does not respond. Forefoot Problems Metatarsalji It is one of the most common foot ailments. The metatarsal region is the area formed by the metatarsal bones. A similar dome of the foot is also present here, this time along the toes. Its deterioration causes “Splay Foot” discomfort and is one of the causes of forefoot metatarsalgia. Injury of the foot nerves and their healing in the form of knots, “Morton’s neuroma”, which is characterized by numbness in the fingers and pain in the form of pressing on a pebble, or phantom nerve injury is another cause of foot pain that is very difficult to diagnose. In this case, the treatment is surgery and the nerve node is removed. We frequently use metatarsal pad supports in the treatment of metatarsalgias, and patients benefit from appropriate support insoles after foot analysis. Thumb deformities (Hallux Valgus, Bursitis) The presence of deformity and bone protrusions in the big toe is the fearful dream of many people who care about aesthetics. In particular, mistakes made in surgical treatments and failures that lead to long plaster treatments cause patients to avoid surgery and to be exposed to complex treatments from simple preventive solutions. Not every bone protrusion is Hallux Valgus It is very important to correctly define haluk valgus, which has become an urban legend. First of all, it is a complex condition in which the toe turns inward (pronation) along with the outward orientation of the thumb, and the inner muscles of the feet are shortened. If you have a scalloped foot and the comb bone is directed inward, this is another situation that we call metatarsus primus varus, which is another condition that should be corrected near the completion of the bone development that occurs in puberty or even congenital. If there is no rotation of the metacarpal bone in our thumb, shortening of the ligaments, and no outward curvature of the finger, our bony prominence may be a simple bursitis. The treatment of this condition, which we can describe as a bunion, is simple bursectomy. Contrary to what is known, bone protrusion is not removed during surgery. Rather, it is to harmonize the joint and provide the alignment. After this procedure, the joint should work and be able to press without pain. After the correct surgery, patients can walk with or without a cast within 3 weeks and return to their normal lives. Articular Cartilage Problems Our finger joints can suffer from cartilage injuries, just like knees and large joints. In this case, there may be swelling and pain in the joint. A painless joint can be achieved when the problem on the joint surface is resolved by arthroscopy or small joint surgery. Hammer Finger Deformity Clawing may occur in people who wear loose shoes or move their toes forward when there is no foot box support. It can also occur in certain neurological diseases. This is a condition that should be known to people who want to get rid of bursitis and calluses on their toes during pedicure, and if splint and band treatments do not benefit, it can be surgically corrected. Tailor’s Finger It occurs as a result of forcing the little finger inward on the comb bone, especially in people sitting under their feet. Over time, the bunion becomes painful in the form of bone protrusion. Surgical treatment is required if it is not corrected with splints with early intervention.

It is possible to collect 5 Types of Shoulder problems under the following headings. 1. Frozen Shoulder 2. Shoulder impingement syndrome (impingement) 3. Rotator cuff injury and tear 4. Shoulder instabilities (recurrent dislocations) Bankart lesion 5. Acromioclavicular joint problems (collarbone dislocations or calcifications) It is possible to eliminate all of these problems with shoulder arthroscopy. After arthroscopic shoulder surgery, action can be started immediately and it is possible to leave the hospital the next day. Returning to daily life is extremely fast.

The most common applications from tumors, infections and non-traumatic problems in the hip area 1. Hip Impingement syndrome 2.Labrum injuries 3. Cartilage lesions (joint mouse) 4. Hip calcification 5. Hip dislocations and half dislocations (subluxation) Apart from hip dislocation and calcification, hip arthroscopy can relieve compression and prevent future abrasions. Arthroscopy free cartilage can be removed and labrum tears can be repaired. We perform prosthetic surgery on worn or calcified hips and delayed hip dislocations.

The most common applications from tumor, infection and non-traumatic problems in the wrist area 1. TFC tear 2.Ulnar instabilities) 3.Cartilage lesions 4. Gangshoon cyst 5. Carpal instability 6. Ostenecroses (keinböck) Wrist arthroscopy offers the opportunity to intervene in all of these problems without the need for open surgery.

Our hand consists of tens of joints whose function is extremely complex. We evaluate the problems of each joint separately. Problems specific to the hand 1.Tendon jams (trigger finger) ruptures (hammer finger, buttonhole deformity, swan neck) 2.Nerve compression (carpal and ulnar) 3. Fascia contractures (dupuytren) It can be solved with minor surgical interventions.