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Doç. Dr. Cavit Meclisi

We Answer Your Questions

Evidence-based medicine!

I want to have insoles, how and according to what should I have the appropriate insoles?

Insoles are often required in soles and foot pains and other pains. Ankle and foot features should be determined by examination before prescribing insoles. Then, with the analysis of how, the points where body weight is more should be determined and the insoles should be designed.

What kind of treatment do you apply for lumbar hernia?

Lumbar hernias heal at least 90% of non-surgical methods. All of these patients should receive physical and exercise therapy. If the patient's pain is severe, an epidural injection (caudal or transforaminal) should be administered so that he can start his exercises as soon as possible.

Is it necessary to have a mr or a film before coming to the examination?

If we do not require you to have an examination before coming to your examination appointment, you do not need to do it. Although we request imaging (x-ray, MR, tomography) for most of the patients, it is not necessary for all patients. Almost all patients are diagnosed with detailed history and examination.

Does public transport increase lower back pain?

Studies show that sitting and standing for a long time increase the rate of low back pain.

Are there any side effects of the cortisone you have used? Does it make weight?

The cortisone we make to joints or soft tissues is regionally effective. It is very weak to affect the whole body. If the regional effect is not at the forefront, it will not provide the benefit we want. Because of this, weight gain and other side effects are very low. In fact, it is not necessary for the patient to eat without salt.

Does the sound of the knee mean that there is calcification?

Noises from the joints are not a sign of osteoarthritis. It's normal to happen once in a while. In addition, it is common in people with congenital bap tissue loose (joint hypermobility).

What are Spinal Deformities?

1- Curvatures sideways. These are called scoliosis. It can consist of a single curve in a C shape or two curves in an S shape. The diagnosis is made by scoliosis x-ray. If the curvature is below 40 degrees, corset and exercise therapy is applied. It is followed by control x-rays. If the curvature is above 40 degrees, surgery is considered.

2- Changes in curvature from the front to the back are called flattening, kyphosis or increased lordosis. These are the most common forms of posture disorders and are seen in almost everyone. Diagnosis is made by x-ray in standing position. It is always treated with physical therapy, manual techniques, and exercise.

What is Vitamin D? Where to Find It

In the past, vitamin D deficiency was considered only in terms of its negative effect on bone tissue. In recent years, its deficiency has been detected widely around the world. While investigating the subject, important effects of vitamin D on all tissues and organs except bone tissue were observed. Deficiency has been found to cause rickets and osteoporosis, bone edema and stress fracture in athletes, fatigue and muscle weakness, susceptibility to infection, susceptibility to cancer, forgetfulness, obesity, heart disease and other problems.

The best source of vitamin D is dairy products and sunlight. Despite his healthy-looking lifestyle, he may lack it. Deficiency is more common during the winter months. People who are tired, especially in winter, should be suspicious. Children, the elderly and pregnant women need more.

Does My Numbness All Mean Nerve Stress?

When there is a complaint of numbness, the possibility of nerve compression should be investigated with history and examination. When detected, it is necessary to perform the required imaging or EMG triggers. However, numbness may accompany muscle aches, neck and waist pain caused by facet joints, muscle and fascia stiffness in the arm or leg, and posture disorder.

Why Is The Spine Painful When MRI Result Is Normal?

The pain mechanism in the spine cannot always be explained by tissue damage. Pain occurs at a point on the line of excessive flexibility and inability of muscles to detect the spine, excessive stiffness and reduced movements. The explanation in ordinary language would be:

1- Your spine, spinal muscles, shoulder and hip girdle muscles lose their strength. As a result, the spine becomes extremely mobile and does not carry any load. Excessive movement causes severe pain and stiffness in the spine joints. Not doing sports, a sedentary lifestyle or innate excessive flexibility predispose to these.

2- Spine flexibility decreases. The membranes and muscles surrounding the spine become stiff and less flexible. The nutrition and blood supply of flexible aan tissues become weak and pain begins to occur. The reason for this is a sedentary lifestyle and sometimes the congenital hard head tissue that accompanies it.

What is Tennis Elbow Problem?

Tennis elbow problem is mostly seen in housewives. So, it's not a tennis problem. Most of the cases resolve spontaneously within 6 to 12 months. If there is an obstacle to sports, the physician must treat it. The normal structure of the tendon is damaged due to excessive increase in connective, nerve and vascular tissue that causes pain. Sometimes there can be tears. Physical and exercise, PRP, prolotherapy and needle tenotomy are effective in the treatment. We know that cortisone injection has no lasting benefit.

What is Clinical Exercise?

It is the exercise of patients with problems such as high blood pressure, high cholesterol, diabetes, obesity, past heart disease without putting them at risk in the clinical environment. The aim is to reduce the complications of the disease, reduce the patient's complaints, reduce the need for medication, and maintain the patient's activity level.

For example, after each workout, the blood pressure of a person with high blood pressure drops by half to one value after exercise and for 8-12 hours following. Heart rate, blood pressure and blood sugar are checked before and during the exercise program. Exercise is organized to ensure that these are at pre-determined values.

How Should Children Do Weight Training?

The American College of Sports Medicine recommends physical activity for an hour a day to prevent children from developing diseases such as diabetes and obesity. This should basically consist of at least an hour more activity in the form of games.

From the age of 12, children can start weight training. The primary goal should be for the child to learn the correct technique of the exercises. The number of wheels in the exercises should be at least 12 in order not to interfere with the height expert. So you shouldn't use excessive weight.

Aerobic activity (running, cycling) and a stretching program should be added to weight exercises.

Why should I drink water every 20 minutes during training?

Fluid loss is inevitable during sports. This causes a loss of performance. To prevent, the ACSM rule is to drink two glasses of water 20 minutes before training and 1 glass of water every 20 minutes during training.

Why should I drink juice after workout?

The sooner the energy items we use during training are replaced, the sooner recovery will begin. Also, during the 2 hours after training, the muscles absorb the energy substances in the blood more and faster than normal.

What is the art of medicine?

With the musculoskeletal pain lasting for more than 3 months, the pain that the patient complains of becomes an experience. This consists of a combination of increased pain sensation, feeling sick, thoughts affected by pain, restriction or change of daily activities due to pain, and restriction of the social plate. The skill to solve this is called the art of medicine, which is the combination of the physician's knowledge, experience and the ability to understand the patient.

What is Evidence-Based Medicine?

Evidence-based medicine has 3 pillars. It is possible with the combination of these. It cannot be said that it is based on evidence if one or both is missing.

  1. Evidence means diagnostic and treatment methods that have been proven to be correct by scientific research. The physician is obliged to be aware of these. The way to do this is through continuing education and research.
  2. Thus, the accumulated knowledge is applied over the years of the physician's work and combines with experience.
  3. The physician should select the most appropriate evidence-based treatment for the patient, combining scientific evidence, personal knowledge and experience with the patient's expectations, culture and lifestyle. Must have knowledge and experience in applying this treatment.

What is prolotherapy? Does it have scientific evidence?

Prolotherapy is the injection of serum with dextrose into the joints or spine ligaments, tendons and muscles. Sugar settles in the vineyard and hardens the bond. It causes some damage to the tissue. For 3 days, the tissue thickens as it tries to heal itself. Thus, a harder and thicker bond is created. Prolotherapy has been shown by ultrasound and MRI follow-ups that it hardens the connective tissue. In addition, studies have shown that the treatment process of patients is accelerated in terms of pain and recovery.

Are there any side effects of cortisone injection on joints, soft tissues and spine?

The cortisone we use is regionally effective if it is injected to reduce edema and pain. Storage and crystalline ones stay in the place where we made the injection for about 7 days. A small part of it is distributed throughout the body. Therefore, after the injection, the patient does not need to eat salt-free, and weight gain side effects are rarely seen.

Why do athletes train in our clinic?

At least half of sports injuries can be prevented. For this, we identify the areas of the athlete prone to injury in the athlete analysis, which is a detailed examination approach, and correct it with special training.

I had Physical Therapy. However, I could not recover. What could be their reasons?

If the diagnosis is correct and definite, if the mechanisms on the ground causing pain are explained, the appropriate treatment plan is drawn, and the plan is fully implemented by the physiotherapist and the patient, recovery will be at the maximum level. If there is no improvement at the expected pace, the questions to ask are:

  1. Is the diagnosis correct?
  2. Have the biomechanical causes in the ground been explained?
  3. Is the treatment plan correct?
  4. Has the plan been implemented?

If the answer to any of these questions reveals a problem, it is necessary to arrange physical and exercise therapy or see it again at another center.

Which Complaints Does Excessive Movement in Shoulders Cause?

Segmental dysfunction, also known as segmental instability, is the excessive movement of one or several vertebrae compared to other vertebrae. As a result, the facet joints in the back of the spine become painful and often radiate pain elsewhere. A few examples of the syndrome facilitate this condition:

Neck origin headache (Cervicogenic headache): Headache occurs as a result of the angulation position and excessive movement in the top 3 neck vertebrae.

Arm or leg pain originating from the facet joint. Movement irregularity in the middle or lower neck or lumbar vertebrae causes arm and leg pain. If there is a hernia appearance in MRI, the patient may undergo an unnecessary surgery as a result of misdiagnosis.

Thoracolumbar junction syndrome, movement irregularity in the junction area of ​​the back and lumbar vertebrae, in other words in the angle change area where the back hump turns into a waist pit, causes pain in the groin and leg. I had patients who underwent surgery for ovarian cysts and appendicitis with misdiagnosis.

Is Pain Always a Bad Sign?

Yes. Almost always. Our first goal in treatment is to get rid of pain as quickly as possible. For this, we apply rest, ice application, antiedema drugs, and physical therapy. In the next stage, we organize progressive exercises and have the patient do it. We do not choose exercises that cause pain during the exercise program.

There Is Nothing Significant in My Blood Tests and MR Results But What Cause My Pain?

It is important to remember that pain is not always caused by the touch. The most important tool in the diagnosis process in all patients is detailed examination. However, some patients can only be diagnosed by examination. During the examination, we can find inelastic muscles, stiffened joints with reduced mobility, muscles with less strength, and painful tendons. In all of these cases, MR results can be completely normal.

Injection Treatment. But Why Didn't My Pain Go On?

When choosing injection therapy, the diagnosis must be precise. In other words, we must be sure in advance that the patient will benefit from the injection we will do. If the physician confirms his diagnosis with sufficient findings and history information, the success of the injection will be very high.

Also, before you were on your main injection, you may be given a diagnostic injection to make sure the pain is coming from the point where you intended the injection. If the area that is thought to be the source of pain is brought to a painless state with local anesthetic injection, one can be sure of the place of the pain. The next day therapeutic basic injection can be made.

What is Edema?

Edema is not a diagnosis. In the case of tissue damage or pain, the body's cells associated with inflammation attack the area. Meanwhile, fluid accumulates in the area. When reflected on the surface, it is seen as swelling, redness and pain. It can be detected on MR. There is always a problem in the edematous area that needs to be diagnosed. If a definite diagnosis is not made, the cause cannot be explained and effective treatment cannot be arranged.

What is Sinus Tarsi Syndrome Causing Long-Term Ankle Pain?

Especially after ankle sprains, if the joint looseness continues as a result of the initial damage, edema develops in the Sinus Tarsi. It is a structure that has the ability to create a lot of edema in the ankle. This causes persistent ankle pain. In some of the patients or athletes, this can be detected on MRI imaging. If it cannot be detected by this method, the diagnosis is made with findings from previous sprains and mites.

Once confident of the diagnosis, the most effective treatment is cortisone injection into the sinus. The safest way to do this is by using fluoroscopy or ultrasound guidance. With treatment, the person has the opportunity to return quickly in his old life. In order to minimize the repetition of sprains, ankle balance and stabilization exercises are organized for 3 months.

What Are Pain Relief Medicines?

Often, there are patients who apply because they do not benefit from pain medication and their pain complaints continue. There are a number of medications I use in musculoskeletal medicine:

1- Simple pain relievers. Ex paracetamol. In the first place, they are drugs that can be used without consulting a doctor and are sold without a prescription. These do not have an anti-edema effect. Although it has antipyretic effects, this effect is not beneficial in terms of pain.

2- Anti-rheumatic drugs. For example, diclofenac, naproxen. These have anti-edema effects. It has mild antipyretic and blood thinning effects. In addition, it may have water retention and blood pressure increasing effects in the body. Unfortunately, long-term use has serious side effects on Orhans such as heart, kidney and liver. Since edema is also accompanied by many musculoskeletal problems, they are the first drugs prescribed. It is beneficial not to use it for more than 5 days due to its side effects.

3- Local medicines. These are creams and ointments. They may contain anti-rheumatic drugs, heaters, coolants, herbal extracts, capsaicin, local anesthetic, etc. The effectiveness of capsaicin and local anesthetic agents in nerve pain has been scientifically demonstrated. Unfortunately, there is not enough scientific evidence on the effectiveness of other substances.

4- Injection forms. These are the needle forms of anti-rheumatic drugs. However, there is no scientific evidence that they are more effective than tablets. These needle forms were not available in some western countries.

How Can Athletes Perform High?

The way to high performance is to prevent injuries. Many people who work with athletes are not aware of this relationship. The joints and muscles of the athlete must function properly in order to avoid injury. Fitness means stability for some joints and mobility for some joints. Fitness means flexibility, strength and control for the muscles. Injuries decrease when you match them to the book. We also keep injuries low in this way.

Additionally, when you match them to the book, strength, coordination, explosive power go faster. Increasing performance and preventing injuries requires the same knowledge and methods. Permanent performance is not possible in the athlete or team with frequent injuries. Unfortunately, these two fields in our country are areas that need to be improved and studied in terms of knowledge and practice.

What Does the Sensitivity of Examinations Mean?
The percentage of accuracy of the examination and examination results that we use for diagnosis is called the sensitivity of the test. If what is seen in the examination or examination shows the presence of the disease, its sensitivity is at the level of 100%. There is no such test!

For example, if the lumbar hernia appears in the lumbar MR examination, the patient's low back pain is 50% likely to arise from a hernia. So, in half of the patients, MR diagnosis is not correct. So, MR is not a good diagnostic tool for low back pain.

So how do we make the correct diagnosis? By combining the information provided by the patient or the history of the disease, the examination and examinations consisting of as many tests as possible about the complaint.

Is the Effect of Spinal Infections Temporary?

It is not temporary. Studies show that patients who maintain post-injection exercise therapy report a longer feeling of well-being. This day applies to spine injections: caudal epidural, transforaminal, median branch radiofrequency, prolotherapy.

If the movement capacity of the spine and other joints and muscles is brought to normal after the pain is relieved, the well-being is temporary. In all musculoskeletal problems, recovery is not complete after the pain is gone. The spine, joints and muscles must be in active working order to complete the recovery.

What is Degraded Biomechanics?

Most of the musculoskeletal pain that develops without impact is due to defective biomechanics. Here, the change in the joint and movement angles, increase or decrease in the amount of movement developed.

Let me give a few examples where X-ray or MRI results will be normal: Due to the stiffness in the ankle joints, the knee and hip are forced to move excessively in running and changing direction. Over time, muscles, tendons and other tissues emerge, which become tired and aching. Most of the movement occurs in the hip joint during squatting and sitting. If the hip joint of the person is stiff and his mobility is reduced, more movement in the lumbar spine is required for squatting and sitting. As a result, pain occurs in the facet joints of the waist as a result of excessive movement in the lumbar vertebrae.

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