Naturopathic Management of Chronic Musculoskeletal Pain, Sleep Disturbance and Metabolic Concerns in an Elderly Female: A Case Study

Abstract

Chronic musculoskeletal pain in elderly individuals is often influenced by multiple factors, including degenerative changes, altered biomechanics, muscular stiffness, excess body weight and reduced physical activity. This case describes a 74-year-old female who presented with longstanding bilateral knee pain, leg pain, low-back pain, difficulty in walking and sleep disturbance. She was admitted for a 7-day holistic naturopathic management programme. The patient demonstrated symptomatic improvement along with a reduction in body weight from 74 kg to 72.3 kg during the treatment period.

Introduction

Musculoskeletal disorders are common among older adults and can significantly affect mobility, independence and quality of life. Chronic knee pain may be associated with degenerative joint changes, muscular tightness, altered gait patterns and foot-related biomechanical abnormalities. Associated sleep disturbances can further affect pain perception and functional capacity. A holistic approach addressing physical activity, musculoskeletal flexibility, nutrition, sleep and lifestyle may provide supportive benefits in the management of such patients.

Case Presentation A 74-year-old female presented with complaints of: -Bilateral knee pain for approximately 4 years, predominantly behind the knees -Leg pain -Intermittent low-back pain -Difficulty in walking -Disturbed sleep for approximately 4–5 years, mainly difficulty initiating sleep

Her past history included dyslipidaemia for 5–6 years, varicose veins and carpal tunnel syndrome. She had previously undergone bilateral carpal tunnel release surgery and cataract surgery.

She was postmenopausal for approximately 15 years and reported dust allergy.

Clinical Examination At admission, her recorded parameters were: Pulse: 70/min Blood pressure: 142/84 mmHg SpO₂: 99% Height: 151 cm Weight: 74 kg.

General examination suggested obesity with adequate hydration. Musculoskeletal assessment revealed restricted range of movement and iliotibial band stiffness, along with difficulty in walking. Flat foot was also noted as part of the provisional clinical assessment.

Investigations Laboratory investigations revealed: Haemoglobin: 13.4 g/dL Fasting Blood Sugar: 96.12 mg/dL HbA1c: 5.6% Serum Urea: 22.0 mg/dL Serum Creatinine: 0.70 mg/dL TSH: 3.720 IU/mL Liver Function Test: Normal Lipid Profile: Normal Vitamin D: 21.10 — low/insufficient range Complete Urine Examination: Normal

Overall, the investigations showed preserved normal glycaemic status and a Vitamin D level requiring attention.

Provisional Clinical Assessment The clinical assessment included: Chronic bilateral knee pain/degenerative joint disease, lumbago, varicose veins, iliotibial band stiffness, flat foot, dyslipidaemia, Vitamin D insufficiency and insomnia.

Naturopathic Management The patient underwent a 7-day individualized naturopathic programme. The treatment plan incorporated therapeutic applications and supportive interventions based on her presenting complaints and functional limitations. The documented interventions included: -Local therapeutic applications for the knee -Wax therapy to the knee region -Mud-based therapeutic applications -Lower-limb and back supportive therapies -Physiotherapy-based interventions -Yoga practices -Pranayama and relaxation techniques aimed at supporting sleep -Therapeutic dietary modification Adequate hydration and lifestyle guidance

The interventions were modified according to the patient's tolerance and clinical requirements throughout the inpatient stay.

Dietary Management A balanced therapeutic vegetarian diet was provided with emphasis on vegetables, fruits, salads, appropriate whole-food sources and adequate hydration. Dietary counselling focused on supporting healthy weight management and cardiometabolic health while ensuring adequate nutritional intake.

Outcome

Following the 7-day inpatient programme, the patient's body weight decreased from 74 kg at admission to 72.3 kg, representing a reduction of approximately 1.7 kg. The patient also showed clinical improvement in her musculoskeletal complaints and functional comfort during the treatment period. The structured programme emphasized mobility, relaxation, dietary regulation and supportive naturopathic therapies.

Discussion This case demonstrates the multifactorial nature of chronic musculoskeletal complaints in an elderly patient. The coexistence of knee pain, low-back discomfort, iliotibial band stiffness, flat foot, obesity and sleep disturbance may contribute to reduced mobility and impaired quality of life.

The patient's Vitamin D level of 21.10 also highlights the importance of assessing nutritional factors in older adults with musculoskeletal complaints. A comprehensive approach that combines appropriate medical evaluation with individualized lifestyle, dietary, movement and supportive naturopathic interventions may help address several contributing factors simultaneously.

The observed reduction in body weight during the short inpatient period may also be supportive of improved dietary regulation and lifestyle adherence, although longer-term follow-up would be required to determine sustained weight and symptom outcomes.

Conclusion This case highlights the potential value of an integrative, individualized approach in elderly patients presenting with chronic musculoskeletal pain and associated lifestyle concerns. Addressing musculoskeletal stiffness, mobility, body weight, nutrition and sleep together may contribute to improved overall functional wellbeing. Further long-term follow-up and objective assessment of pain, mobility and quality-of-life measures would be valuable to determine the sustained benefits of the intervention.