THE FREEDOM TO MOVE

One doesn't value what boon is to move freely and without pain until the moment something unexpected happens: trauma during an accident or sport, a disease  triggered, old age, or the accumulation of unfavourable factors like bad posture, leading to physiological changes and acute pain. No one is protected – from children to people who do actively exercise.

The human skeleton is the internal construction that not only keeps us upright, but also allows the whole functioning of organism. With the help of sinews, the cartilage and the muscles, the bones protect vital organs like heart, lungs, brains and the central nervous system.

The human skeleton is a complicated, finely calibrated system that is stable, so stable indeed, that we don't notice it when we are healthy. But even the smallest negative change in some of its elements can trigger a line of connected events, leading to severe, painful diseases.

"The diseases of the locomotor system are among the most common in Bulgaria, ranking third in ocurence after infections of the respiratory tract and cardiovascular diseases," says Prof. Plamen Kinov, head of the Clinic for Orthopaedy and Traumatology at Queen Johanna University Hospital – ISUL (Sofia, 8 Byalo More St; Private practice: Sofia, 25 Byalo More St). "They include traumas and disabilities, as well as degenerative changes like the wear of joints and sometimes tendons and soft tissues as a result of inflammation or degeneration." Most affected are large joints, like the knee and hip ones, and the ones on the spine and the fingers. "In traumas, a significant percentage is caused by traffic accidents and osteoporotic fractures in elderly patients as a result of lowered quality and strength of the bone, when even the lightest of trauma can cause fracture," says Prof. Kinov.

Prophylaxis is important for prevention of diseases of the locomotor system. "The government is working on lowering the number of traffic accidents, and the Health Ministry and NGOs have developed programmes for prophylaxis of osteoporosis and traumas in elderly patients," explains Prof. Kinov, who is also a national consultant in orthopedy and traumatology. "Prophylaxis of patients in risk of developing osteoporosis is complex and includes drug treatment and changes in their lifestyle, like an active fitness regime, healthy eating, correction of some diseases, development of sense for  balance. The education of patients, like the benefits of healthy living and how to protect themselves of trauma, is also important for prevention. A wholesome programme can give a chance for lower number of heavy trauma that disables a significant part of the elderly population."

Age is a defining factor that negatively influences the musculoskeletal apparatus. Such is the case with osteoporosis, a disease linked with lowered bone strength that is the most common cause for fractures in the elderly people.

Genetic predispositions shouldn't be underestimated as well. Osteoarthrosis is the most common degenerative disease in the world. It is the progressive degradation of the joints, and causes acute pain, swelling, decreased mobility.

"Osteoarthrosis, or as it is also known as joint 'wear-and-tear,' is a disease that is genetically determined; the patient cannot do anything to avoid it," says Dr Orlin Filipov, MD, manager of the boutique private hospital for orthopedy and traumatology Vitosha (Sofia, 108 B Simeonovsko Shose Blvd, round the clock: 02 962 22 92, www.vitosha-hospital.com). "Osteoarthrosis, however, can be speeded up by excessive physical activity. Once it has appeared, arthrosis gradually begins to worsen. Together with the first symptoms, are already present mechanical problems in the joint – defects and unevenness of the joint surfaces, free bodies in the joint, and others. There is no evidence that food additives or drugs can delay the damages on the joints," adds Dr Filipov. The solution for this health problem is a treatment method that is gaining popularity: endoprosthetics. "When a certain level of pain symptoms is reached, the moment for endoprosthetics has come, says he. The aim of the endoprosthetics is to return the patient to normal, pain-free life. You don't deserve to stay at home, because of a joint, while life is passing by."

Children are, too, in a risk of developing musculoskeletal conditions, like scoliosis. "Scoliosis is the lateral distortion of the spine and the rotation of the vertebrae around the spine's axis, meaning, the spine is twisted," explains Dr Ivaylo Kamenov, orthopedist and traumatologist, who also treats children with scoliosis (Queen Johanna University Hospital, Clinic for Orthopedy and Traumatology: Sofia, 8 Byalo More St; 23th Diagnostic and Consultative Centre: Sofia, 20 Klisura St; Appointments: 0888 886 612, www.drivaylokamenov.com). "The deformation of the rib cage in scoliosis patients is not mere cosmetic defect; it can cause serious heart and lung problems. That is why early diagnostics, follow-up and treatment of scoliosis are important."

How to fight scoliosis? "The most important thing in treatment of early stage scoliosis are medical gymnastics, breathing exercises, balance exercises," explains Dr Kamenov. "Swimming is recommended. Treatment of advanced stages includes medical corset, and if the disease progresses quickly, surgery is recommended."

Children can also develop a condition that is most often associated with adults: flat foot. "Until 5 years of age children's feet are still developing, but if after this age the longitudinal arch of the foot remains low in unburdened state and when on toes, we have a flat foot," explains Dr Kamenov. The result can be pain after longer walk or play. "Walking barefoot is one of the best ways for children to develop normal, healthy feet," recommends Dr Kamenov. "Medical gymnastics for feet include walking on toes, folding, unfolding, spreading. Grabbing toys and objects and moving them from one place to another is also good. Orthopedic insoles, for their part, help in the correct development of the feet."

Sport is good for keeping fit and for the general health, but you shouldn't forget that it is also connected with risk of trauma and triggering of diseases, if it is performed without the supervision of a qualified specialist.

"Sports medicine is not just for athletes. Anyone who may work out occasionally or who has a job that requires a lot of physical movement can benefit from sports therapy principles," says Dr Encho Stoyanov, a specialist with years of experience as both the doctor of professional athletes, and the head of a private practice (Burgas, Perla VIP Complex, block 2, entrance 1, ground floor, phone: +359 877 325 461, www.sportsmedicinedoctor.eu). "For the 'weekend warrior' or 'industrial athlete,' who experiences an injury, the same expertise used for the competitive athlete can be applied to return the individual as quickly as possible to full function. The secret of success in sports medicine is to take a broad view of the patient and his or her problem. The narrow view may provide short-term amelioration of symptoms but will ultimately lead to failure. The treatment has two components – treatment of the presenting injury/illness and treatment to correct the cause. A combination of different forms of treatment will usually give the best results."

Non-invasive treatments of sports trauma are fast developing, and include technologies using laser and shockwave to provide fast and effective pain relief in cases from sport trauma to arthritis, back and neck pain, and many others. Physiotherapy is a vital part of the effective treatment. "When a person's function or mobility is affected by pain, ageing, injury, disease, disability or long periods of inactivity, with the help of physiotherapy we can have a full medical check up of the patient," explains Dr Stoyanov. "This check up focuses on the person as a whole, not only the physical but also the psychological, emotional and social wellbeing of each patient with the view to reaching a diagnosis and developing the most appropriate treatment plan."

Structural correction chiropractic is an alternative treatment that, when done properly by trained specialists, can have long-term effect on patients suffering from spinal trauma. "There are three phases that the patient gets through," explains Dr. Thomas Nowak, Doctor of Chiropractic, working at American Spinal Clinic (Sofia, 76-A James Boucher Blvd, free phone number: 0700 11285, www.americanspinalclinic.com). "The first is the acute one, when we need to decrease the patient's pain. Then is the cracker phase, when the patient can function and move again, and we have a better chance to correct what causes the structural problem. The maintenance phase is when we put a stress on the body every day. A lot of patients see great benefits due to the maintenance treatment, and feel that they function and live better. Depending on the individual case, common maintenance can be once a month, every six weeks, or once a week."

Taking care of the spine is not something we are being taught, but it is something we need to do, just like we regularly clean our teeth. "Taking care of your spine and your body is a lifelong journey," Dr Nowak explains. "It is not only exercises and keeping fit, but also have better ergonomics at your work space, for example. The human body was designed for a hunter gatherer lifestyle, not for sitting all day long in front of a computer or looking at a smartphone."

Keeping fit, however, also has its intricacies. "In the gym, you should not overdo yourself with the weights, because when you don't lift them properly and your body is not prepared for this, you can get yourself injured," advices Dr Nowak. "Hire someone to teach you how to exercise properly. You should also see if you are not already having a condition that can get worse from this type of exercise. Posture is the first screening tool for that."

Migraine is one of the many results of bad posture. "It is one of the most common types of headaches and in a lot of cases it is caused by loss of the natural curve of the neck," says Dr Nowak. "We at American Spinal Clinic have a number of successful cases in treatment of migraine. The correction of the spine alignment allows the nervous system to do its job and function properly."

Modern technologies find a wide application as well in physiotherapy and rehabilitation.

Laser physiotherapy is an innovative procedure using the development in modern technologies to offer quality and fast recovery after orthopedic diseases and trauma. "Laser treatment is a pleasant procedure that is relatively short; the therapy course lasts between 5 and 15 consecutive sessions every day or every other day, depending on the diagnosis and the goal of the treatment," says Dr Janet Dumanova from the Solaris Medical clinic for laser physical and rehabilitation medicine (Plovdiv, 57 Maritsa Blvd, registration: 0884 550 034, personal: 0888 358 266, FB: Соларис Медикъл). "The effect of the therapy is immediate and sometimes it is hard to convince the patient that he or she needs to complete the whole therapeutic course. Patients who undergo the procedure see immediate anodyne effect," says Dr Dumanova. "As a result of laser therapy, patients with chronic diseases experience long-term lack or decrease of moments of acute pain, their motor skills improve, and their quality of life gets better," adds she.

Thanks to the specialised hospitals and clinics, and to the ambitious specialists who keep in line with the latest technological novelties and discoveries in orthopedy, traumatology, sport medicine and physiotherapy, Bulgaria offers excellent healthcare in this field.
Technological innovations in treatment, however, not only arrive to Bulgaria from the outside – local scientists also develop new methods of treatment. Professor Plamen Kinov, MD, Dr Stefan Tserovski and Dr Simona Georgieva from the Orthopedy and Traumatology Department of the Medical University in Sofia, for example, are working in the field of using 3D printing for preparation of anatomical models of the parts of the skeleton and surgical guides for intraoperative application. The aim of their work is development of individual implantology in Bulgaria and its accessiblity for both doctors and patients.

Professor Boycho Boychev Specialised Hospital for Active Treatment in Orthopedy (Sofia, Gorna Banya district, 56 Nikola Petkov Blvd, registration: (02) 818 15 00, www.usbalortho.com) at the Medical University in Sofia, is named after Bulgaria's greatest authority in orthopedy for a reason. The hospital has established year-long traditions in treatment and innovations. Located in an area famed for its mineral springs and clean air, if offers diagnostic and consultation, treatment in clinics specialising in orthopedy's main fields of study (orthopedic oncology, spinal surgery, paediatric orthopedy, arm and upper limb surgery, endoprosthetics), as well as rehabilitation. All clinics at Prof. Boycho Boychev are managed by habilitated specialists. The hospital is modernly equipped, and the combination of excellent tutors and amenities in it is the reason why students and post-graduate students specialising in orthopedy, traumatology, anaesthesiology and reanimation train in it.

We don't know what new discoveries in the treatment of diseases of the musculoskeletal system await in the near and the distant future, but we can be sure that if the need arises, there are places where to seek professional and modern treatment and rehabilitation.