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Background material by Professor Omar Hasan Kasule for Year 1 Semester 1 Med PPSD session on 08-10-08
DISORDERS OF THE BONY SKELETON
Congenital and acquired disorders of the bony skeleton may limit the range of movements in salat: sideways movement of the neck in tasliim, prostration on the floor, raising the hands in takbir, and pointing with the finger in tashahhud, and bowing.
Tawaaf in hajj may be difficult with lower limb pathology. Use of an artificial limb is no bar to hajj and tawaaf. Patients can support themselves on a stick or a pillar during salat.
Pain and restricted movements of the vertebral column make bowing more difficult. Standing for prolonged periods may also be difficult. Prostration may be completely impossible. The requirement to straighten the back after bowing may be relaxed.
Back pain may also interfere with sexual function.
Restricted bending of the knees interferes with sitting properly. Knee problems may make tawaaf and sa’ay in hajj difficult.
In case of foot problems, a pilgrim may wear sandals if he has disease that makes it impossible to walk barefoot around the ka’aba. If shoes are needed for orthopedic conditions they can be worn in hajj and salat.
Wudhu may not be possible with open wounds and compound fractures and resort is made to tayammum.
Pain due to sprains and fractures may limit movements in salat. Movements will not be possible at all when the limbs are immobilized.
When a pilgrim has a fracture or becomes lame for any other reason, he is discharged from the rites of hajj and has to repeat the hajj later.
Orthopedic fixation of some joints like the hip or knee joints may limit the range of movements possible in salat. In hajj tawaaf may have to be done in a wheelchair.
Wudhu can be made on a limb stump preferably washing. If washing is difficult the stump can be wiped with a wet hand. If a leg is in a cast, the rest of the organs are washed with water and tayammum is carried out for the limb in a cast
In osteomyelitis, pain may limit movements in salat. If there is a discharging wound, tayammum will be needed instead of wudhu. Care is exercised in salat and hajj to avoid pathological fractures that are common in bones with neoplastic disease.
In osteoporosis care has to be taken in movements in salat and hajj to avoid fractures. Treatment of osteoporosis with hormone and mineral replacement is obligatory for postmenopausal women so that they can lead a normal life.
CARTILAGE AND LIGAMENT DISORDERS
Laryngeal, pharyngeal, or other oral diseases may impair the ability to recite the Qur’an. Patients with such conditions cannot be prayer leaders, imaam al salat. Public duties like leadership that require communication may be impaired. Pleas and evidence in court may also be affected. Salat is intimately related to joints because of the physical movements involved. Osteoarthritis and rheumatoid arthritis cause pain and limitation of movement. These limit the physical actions needed for salat and hajj.
Degenerative disorders of the vertebral column such as spondylosis (arthritis of the spine), intervertebral disc disease (herniation), spondylolisthesis (anterior displacement) impair ability to stand for long periods in salat as well as tawaaf and sa’ay. Tayammum is carried out in cases in which either hot or cold water worsen the pain of rheumatism.
MUSCULAR DISORDERS
Injury to muscles will necessitate limitation of movements in salat while they heal. Some diseases of muscle weakness like myasthenia make it impossible to make the full range of movements required in salat.
OTHER CONNECTIVE TISSUES
Skin lesions such as eczema, dermatitis, itch, discharges, rashes, and chronic ulcer are a reason for tayammum. If the skin is bandaged, the bandage is wiped with the wet hand. Shaving or cutting hair is forbidden in hajj. An exemption is made for those with lice in their hair but a fidyat has to be paid. Injury to ligaments may limit movements in salat.