Podcast: WHAT DOES YOUR DOCTOR SAY?

Episode: When to see an orthopedist? #01

Leading: Dariusz Litera

Guest: Dr. Tomasz Góral, specialist in orthopedics and traumatology

Duration: 17 minutes

Back pain, strain from sedentary work, sports injuries, poor posture in children, and degenerative joint disease are among the most common reasons patients consult an orthopedist. In this podcast episode WHAT DOES YOUR DOCTOR SAY? Dariusz Litera asks Dr. Tomasz Góral, orthopedist and traumatologist, about what orthopedics does, when it's worth seeing a specialist, and what symptoms a patient should notice.

The episode also covers the prevention of musculoskeletal disorders: physical activity in children, avoiding unnecessary time off from physical education, the impact of a sedentary lifestyle on the spine, the importance of breaks from computer work, and the role of body weight and diet. The expert also explains why an aging population is associated with an increase in the number of degenerative diseases and joint replacement procedures.

Full podcast transcript

[00:00:00] Introduction: why might we end up seeing an orthopedist sooner or later?

Dariusz Litera:

Sooner or later, we'll all find ourselves in an orthopedist's waiting room. For some, a visit is necessary due to long hours spent daily in front of a computer, while for others, it's due to injuries sustained on ski trails, cross-country skiing trails, or at training centers. Furthermore, an aging population significantly increases the incidence of degenerative diseases.

Is there any way to avoid painful symptoms? Today, your doctor is orthopedic traumatologist Dr. Tomasz Góral. Good morning, doctor.

Dr. Tomasz Góral:

Good morning, ladies and gentlemen. Good morning, gentlemen.

[00:00:29] What is orthopedics and what does traumatology deal with?

Dariusz Litera:

Let's start with the basics. What exactly is orthopedics?

Dr. Tomasz Góral:

Orthopedics and traumatology deal with diseases and injuries of the musculoskeletal system. Nicolas Andry is considered the father of orthopedics, having published his work in 1741, laying the foundations for orthopedics, and in its very name, encapsulating the discipline's scope.

Orthopedics, or the art of preventing and correcting bodily disorders and deformities in children, is a combination of two Greek terms: "orthos," meaning straight, and "paideia," meaning the education and treatment of children.

Orthopaedics also deals with diseases of the musculoskeletal system, and traumatology deals with injuries to this organ.

[00:01:21] When to see an orthopedist?

Dariusz Litera:

Okay, when and why should we go to an orthopedist? What should prompt us to do so? Because we probably don't go to an orthopedist just for preventative reasons. We go for very specific reasons.

Dr. Tomasz Góral:

It's always worth making an appointment with an orthopedist if you experience any musculoskeletal problems. Injuries, pain, or dysfunction of a specific joint or muscle group occur. We treat such injuries and conditions daily.

[00:01:50] What hurts most patients who come to see an orthopedist?

Dariusz Litera:

So they come and say, just like me: "Oh, it hurts, it hurts. Doctor, what should I do?" What hurts most often? What are the most common reasons for which patients come to an orthopedist?

My back hurts, because it usually does. I'll sit at the computer, get up later, and say, "Oh my, that hurts.".

Dr. Tomasz Góral:

Spine problems are one of the main reasons why patients come to our offices. Unfortunately, this is often the result of neglect, and we consider it a disease of modern civilization.

The process of degradation of the quality of our musculoskeletal system and skeleton means that anyone who has not had contact with an orthopedist in childhood will certainly have such contact in old age or advanced age.

It is estimated that over 50% of the population will have contact with an orthopedist during their lifetime, most often due to degenerative disease.

[00:02:44] Should posture control begin in childhood?

Dariusz Litera:

Exactly, but to what extent should we start our adventure with an orthopedic clinic in childhood – with the control and correction of posture defects?

Is it that we generally neglect to ensure that our children sit upright, move well, and know how to run? Well, we simply don't care.

Dr. Tomasz Góral:

Childhood neglect will certainly have a significant impact on the development of degenerative disease and the appearance of ailments in old age.

Fortunately, Poland has an early childhood prevention program in place. Thanks to pediatricians and family medicine specialists, children are screened for congenital orthopedic conditions in the first few days of life.

Later, during check-ups – at the second, fourth and sixth years of age – and also during routine medical examinations, the musculoskeletal system is assessed.

Any deformation, any suspicion of disease, which is noticed either by parents or during these check-ups, should then also be assessed orthopedically.

The first screening test is also performed by the parents themselves, and then by pediatric and family medicine specialists.

[00:03:58] What should a parent pay attention to in a child?

Dariusz Litera:

What should a parent pay attention to first of all?

Dr. Tomasz Góral:

A parent can notice any change in their child's behavior, as well as any change in their posture. We treat this as a standing posture.

A parent is very good at detecting any muscular defenses, dysfunctions, or limitations in range of motion. They can quickly identify and observe these issues, and when necessary, consult a specialist—as every parent wants the best for their child—they will consult a specialist.

[00:04:36] Is exemption from PE a good solution?

Dariusz Litera:

Because every parent wants the best for their child and that is why exempting them from PE is not a good idea.

Dr. Tomasz Góral:

As orthopedists, there's a strong stigma attached to granting physical education leave. We strongly dislike granting such leave, responding to parents' attempts to influence our decisions, and granting such leave.

However, there are, of course, medical conditions that require such leave. We always regret it because, as I mentioned earlier, certain childhood conditions will affect later musculoskeletal function.

Orthopedics focuses on treating musculoskeletal disorders, including congenital conditions. Therefore, there is a certain group of children who will require sick leave from physical education.

The lack of proper movement patterns and the lack of the correct frequency of PE classes will affect the development of the figure.

Let us remember that the greatest influence on our body and our system is, of course, exerted by genes, i.e. possible genetic burdens may cause certain deformations, but environmental conditions and living conditions are also important.

Therefore, when caring for our children, we should strive to encourage them to be active, encourage certain movement patterns, and improve their motor skills. When we see how a child sits down for class, or how heavy their schoolbag is, we should help, but also encourage and stimulate them to be active.

[00:06:16] Why is physical activity from childhood important?

Dariusz Litera:

Therefore, a healthy body will also result in a healthier mind. And the earlier we begin physical activity, the better it will be for us in later life.

Because sooner or later we all sit in front of computers and it turns out that, unfortunately, this sedentary lifestyle - as statistics show - and long-term work at the computer are some of the most serious factors that affect our movement and, as a result, we have orthopedic problems.

Dr. Tomasz Góral:

Apart from obesity, which we will probably be able to talk about later – yes, this sedentary lifestyle is already a disease of civilization.

Also, long-term work in forced positions or repetitive movement in a given joint will affect our ailments and the quality of the skeleton, i.e. the quality of our spine and joints.

[00:07:14] How to work at a computer to put less strain on your spine?

Dariusz Litera:

Dear Poles, dear listeners, let us get up from behind our desks from time to time.

During the podcast recording with an ophthalmologist, some very specific advice was given, as a sedentary lifestyle plays a role there as well. Sitting at a computer and staring at a single point on the screen causes our eyes to stop accommodating, and at some point we simply need to look up, stare at the green for two minutes, look far, far, far away – and we limit the negative impact of the computer on our eyesight.

What should a person do if they spend eight hours at work and most of those eight hours sit at a desk, at a computer?

Are there any tips we can share right now? For those of you working at a computer, every half hour you need to get up and do three bends and two squats? Are there any tips that might suggest we should position our bodies a bit differently when sitting at a computer?

I know programmers who have special kneelers.

Dr. Tomasz Góral:

A sedentary lifestyle is an important factor in abnormal movement patterns.

We should stop working frequently, get up often, and exercise. We don't need any equipment for this.

In fact, stretching, stretching or a few well-chosen calisthenics exercises – everyone can do something like this while working, and it will certainly have great benefits for the quality of the work performed.

So let's just get up from this desk.

[00:08:53] Is working standing better than sitting?

Dariusz Litera:

What about that standing position? I know some people organize their work so that they can, for example, move their laptop higher and work standing for a while.

Is it more burdensome, less burdensome, or is it the right kind of change?

Dr. Tomasz Góral:

This is going from one extreme to the other. Working in a standing position will carry the risk of other loads – axial loads.

As much as we like to move, we look at impact sports that put axial load on the spine – they are great, but unfortunately not always advisable in the long run.

The same applies to working while standing. Always strive to maintain balance. If you must work in a sitting position for extended periods, try to stand up and alternate between standing and sitting.

We often do not take into account that commuting to work itself is quite a heavy burden on our system, and also disturbs the functioning of the muscles of the lower limbs and contributes to other diseases, including those already considered civilization changes - changes in the vessels of the lower limbs.

[00:10:04] What symptoms should prompt an orthopedic consultation?

Dariusz Litera:

What symptoms should prompt us to consult an orthopedist? What should this signal be?

Because people cope in many ways. Many also become accustomed to certain ailments.

Dr. Tomasz Góral:

Above all, don't be afraid to ask questions. Ask an orthopedist, ask doctors experienced in treating musculoskeletal disorders.

Any abnormality we notice in ourselves—whether it's chronic pain, acute pain following an activity or injury, noticeable muscle stiffness, or limited or dysfunctional mobility in a given joint—we should ask about it in every case that's relevant to us. This is how we can determine it.

[00:10:44] What else reduces the risk of musculoskeletal disorders?

Dariusz Litera:

But besides the daily exercises we've discussed, even in this work? Changing position – what else can we do to reduce the risk of these musculoskeletal disorders?

Dr. Tomasz Góral:

First of all, let's start with diet, nutrition, maintaining a healthy body weight.

Obesity is a disease that affects more and more patients every year.

[00:11:07] Why does body weight matter for joints?

Dariusz Litera:

When we invite a doctor to the podcast, and today our guest is Dr. Tomasz Góral, an orthopedist and traumatologist, it's immediately obvious: too many kilos.

But there must be something to it, since every one of these specialists is observing this excess weight in their office. Is it really such a big problem?

Dr. Tomasz Góral:

This is a huge problem. Obesity is a chronic disease. Many people around the world struggle with it from a young age.

This has a significant impact. It is one of the main factors in the development of degenerative joint disease.

There's a metric we should evaluate: BMI, which is the ratio of weight in kilograms to height in meters. The corresponding values of this metric tell us which group we fall into.

Dariusz Litera:

There are even special scales that measure everything.

Dr. Tomasz Góral:

That's an oversimplification. Let's also use our brains, in addition to our bodies and muscles, to calculate this. It's not too difficult.

Dariusz Litera:

Of course. And mathematics is the queen of sciences, so it's worth surrendering to it.

[00:12:11] What diet supports the musculoskeletal system?

Dariusz Litera:

Since the doctor mentioned diet, what is the healthiest diet for our musculoskeletal system?

Dr. Tomasz Góral:

I'm afraid I won't be a very good medium here to talk about diet itself.

First of all, let's try to eat often enough, i.e. try to eat five meals a day and not overeat.

Dariusz Litera:

And not for the night.

Dr. Tomasz Góral:

And not just at night, yes. Of course, the diet must also be balanced according to the type of professional and sporting activity we engage in daily, as well as the appropriate amount of calories.

And what it should contain – this is a question also for dietitians.

[00:12:56] Does jelly help with joints?

Dariusz Litera:

There are methods that our grandmothers used to say: "Eat some of this jelly, because it's good for your joints.".

Dr. Tomasz Góral:

Our grandmothers happily said this back when medical development was not so advanced.

If someone likes it, of course we do not prohibit eating these jellies, but they do not have a significant impact on the quality of our joints.

Dariusz Litera:

So let folk wisdom remain folk wisdom, and let us focus on the state of our health.

Dr. Tomasz Góral:

Medicine draws on this folk wisdom and of course we know why these jellies were so popular years ago, but thanks to the development of medicine we can now treat and control it in a different way.

[00:13:40] Does every senior need a hip or knee replacement?

Dariusz Litera:

Thanks to the development of medicine, among other things, we are living longer and longer, and there is talk of aging societies and diseases that will affect everyone one by one.

And here the question arises: are hip and knee replacement surgeries a procedure that awaits all seniors?

Because that senior age is shifting. Today's fifty was once forty. A forty-year-old used to look completely different. We remember from the TV series what "The Forty-Year-Old" looked like back then and what he looks like now. He's a slightly different person.

So what's the deal with these endoprostheses? Is this what awaits us all?

Dr. Tomasz Góral:

Fortunately, life expectancy is increasing. Cardiology has made a significant contribution. Orthopedics is one field that is trying to keep up.

Unfortunately, we see that as life expectancy increases, the number of people suffering from degenerative diseases increases exponentially.

This is an imbalance between the processes of cartilage destruction and synthesis. It is caused by many factors. Genetic predispositions also play a significant role.

In addition, there are all the factors that occur in adulthood, but not only that. The impact of congenital musculoskeletal disorders, such as congenital hip dysplasia, and later stresses related to occupational activity and sports are also significant. Injuries play a significant role, as does body weight.

Dariusz Litera:

So we're back to obesity.

Dr. Tomasz Góral:

Often the kilograms we carry and a whole host of factors influence the process of joint cartilage degradation.

Will everyone undergo joint replacement? No, not everyone. However, the number of people who will require surgery in the future is constantly increasing.

It's estimated that the percentage of joint replacements currently performed in the United States will double over the next 10 years. Our race isn't really any different, and we can say that Europeans face the same fate.

A lot of people will need to have their hip or knee joints replaced.

[00:16:04] End of conversation

Dariusz Litera:

We'll return to arthroplasty in the podcast "WHAT YOUR DOCTOR SAYS." Today, our guest was orthopedist and traumatologist Dr. Tomasz Góral. Thank you very much, Dr.

Dr. Tomasz Góral:

Thank you very much.

Key takeaways for patients:

• Orthopedics deals with diseases of the musculoskeletal system, while traumatology deals with injuries to this organ.
• It is worth seeing an orthopedist in case of pain, injury, joint dysfunction, limited mobility or disturbing changes in the musculoskeletal system.
• Back pain is one of the common reasons for visiting an orthopedist and may be related to, among other things, a sedentary lifestyle and previous neglect.
• Observing the child's posture and movement is important, and any disturbing changes should be assessed by specialists.
• Unjustified absences from physical education are not beneficial because physical activity supports the development of correct movement patterns.
• Sedentary work should be regularly interrupted by movement, stretching and changing position.
• Working solely while standing is not ideal; it is important to maintain a balance between sitting, standing and movement.
• Maintaining a healthy body weight is important for joint health, and obesity is one of the factors in the development of degenerative diseases.
• The diet should be balanced and adapted to professional and sports activities, and detailed nutritional recommendations should be discussed with a dietitian.
• Not every patient will need a joint replacement, but the number of people requiring surgical treatment for degenerative diseases is growing.

Information about participants:

Guest: Dr. Tomasz Góral, A specialist in orthopedics and traumatology, he specializes in the diagnosis and treatment of musculoskeletal disorders and injuries, with particular emphasis on hip and knee replacement and foot surgery.

Presenter: Dariusz Litera, medical editor, health communications specialist, and creator of the podcast CO NA TO TWÓJ ELEKARZ. He has been involved in patient education for years, conducting interviews with specialists in various fields of medicine.

ATTENTION!

This material is for educational purposes only. It does not replace a medical consultation. If you experience any disturbing symptoms, consult a doctor.

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