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Frozen shoulder is characterized by progressive pain and stiffness of the shoulder which usually resolves spontaneously after about 18 months. 

There are three phases that the condition will pass through; 
A freezing phase where the joint tightens up, a stiff phase where the movement in the shoulder is significantly reduced and a thawing phase where the pain gradually reduces and mobility increases.

Clinical features

• Age - 40 - 60 yrs
• History of trauma, often trivial followed by aching in the arm and shoulder.
• Tenderness
• Stiffness
• Wasting

Cardinal features: stubborn lack of active and passive movements of shoulder in all directions.

Treatment: 

• One should seek proffessional advise before attempting any frozen shoulder rehab.
• Treatment is divided into two modes: conservative. And surgical.
• Conservative treatment: physiotherapy plays an important role in the prevention as well as resolution of this condition. It aims to releive pain and prevent further stiffening with:
• Rest
• Non steroidal anti inflammatory drugs
• Electrotherapy - ultrasound, tens & laser treatment may also help reduce pain and inflammation.

Therapeutic exercises

1 Pendulum exercise

2 Wand exercises

3 Therapist assisted mobilizations

4 Stretches - 

• Shoulder flexion stretch
• External rotation stretch
• Chest stretch
• Posterior shoulder stretch

 
5 Strengthening exercises

• Isometrics shoulder exercises
• Postural exercises - scapular squeezes

6 Taping

• Surgery 
• Surgery is the last resort if normal treatment has failed.

The core muscles, mainly concentrated around the abdomen, hips, lower back, trunk, and glutes, are indeed a powerhouse that gets you going. The stronger the core muscles, the fitter you stay. Without a proper core strength, a lot of the day to day activities including lifting or bending gets affected. Certain health conditions can weaken the core muscles. But how to know if the core muscles are weak? There are many signs and symptoms associated with weak core muscles.

Mentioned below are some important signs that may be an indication of weak core muscles.

1. For your posture to be correct, the spine and pelvis need to be stable: The muscles of the lower back and the abdomen does exactly that, ensuring a steady and correct posture. However, when the core muscles weaken, they are unable to provide stability to the spine and the pelvis resulting in a poor posture. Left unattended, poor posture, in turn, can trigger a myriad of complications and discomfort.
2. The body loses its balance: As already mentioned, the core muscles go a long way in stabilizing the body and helping you to maintain the body balance. You can perform a small test to know if your balance is affected. Close your eyes and stand on one foot. Repeat the procedure with the other foot as well. If you have a developed core, you will be able to hold the position for at least 10 seconds, if not more (both the legs).
3. A pain concentrated to the lower back: Do not ignore a lower back pain. It could be an indication of your core muscles not being strong enough, especially the ones adjacent to the spine. The weak muscles fail to provide the necessary support to the discs and the vertebrae resulting in pain (mild to severe depending on the severity of the condition) and discomfort. Timely medical intervention may help improve the condition.
4. Weakness throughout the body: The strong core muscles are an indication of a healthy and fit body. When the muscles start to lose its strength, the entire body gets affected. A person finds it difficult to even lift things. Doing even a small and regular work leaves a person weak and tired.
5. You can also perform the Hollowing Test to check your core strength: Sit in a comfortable position. Starting breathing in and out. As you breathe out or exhale, try to pull your stomach inwards towards the spine for at least 10 seconds. Unable to pass this test (can't hold the position for 10 seconds) indicates weak core muscles.
6. You can also try the plank test: Get yourself in a push-up position with the entire body resting on your elbows, arms, and toes. The hip should be level and steady. Failing to stay in this position for 50 seconds is indicative of weak core muscles

Back pain is a common source of pain, which can be acute, subacute or chronic in nature. Back pain is classified along the segments of the spine and can be divided into neck pain, middle back pain, lower back pain or tailbone pain.

Joint Replacement Surgery is a procedure where the damaged surface of the advanced arthritic joints are removed and replaced with artificial joints, such as metallic, plastic and ceramic joints. These surfaces closely replicate the original anatomy.

When do you need a knee replacement?
When you suffer from severe pain or deformity in the joint (knee in this case), the pain or stiffness and deformity makes it difficult to perform simple tasks. Severe grade IV osteoarthritic knees of  people over 50 years when have pain, swellingand deformity fail to respond to medicines, physiotherapy, injections and rest.

Aim of the surgery

1. Correct the deformity: Relieve the pain and give near full movements almost immediately after the procedure. Details including techniques and safety, it is a safe, rewarding surgery with a success rate of as high as 99.5% when done by an able and experienced professional.
2. Anaesthesia: Usually it is the spinal cord epidural where one is rendered numb for 3 to 4 hours waist down. Sometimes a general anaesthesia is given. A 4 to 5 inches cut is made in front of the knee and all the damaged cartilages, bones, loose bodies are removed from the lower end of the thigh, upper end of the tibia (usually of few millimetres) and the surface re-crafted to match the size and shape of the artificial joint (it is usually imported). They are fixed with bone cement. The ligaments and muscles are reattached and the parts closed.

Aftercare tips for joint replacement patients:

1. Recovery: Stand up and walk a few steps with a walker the day after the procedure i.e. in 24 hours. Physiotherapy in hospital for 5 to 7 days and/or walking, progressively longer walks and exercises over the following 15 days. Stitches are removed in 15 days. The patient can return back to normal activity in 4 to 8 weeks after the surgery.
2. Activities: Normal walks of 3 to 5 km per day, climbing stairs, cycling, swimming and driving can be performed with the new implant(s) now.
3. Avoid: Squatting/kneeling, playing sports like football, cricket, tennis, jumping, adventure sports,

The longevity of joints will vary between 15-35 years depending on the material used by the doctor.

Gridhrasi is what Sciatica is known as in Ayurveda. It is the disorder that causes mild to agonizing pain in the sciatic nerve or neuralgia. These nerves, emerging from the pelvis, run along the hamstring and may cause intense pain in one or both the legs when a person suffers from Sciatica. Sciatic pains fill your life with misery as the simplest of daily activities cause sudden and excruciating pain. There are two types of sciatia i.e. true sciatica and pseudo sciatica. Sciatica may be caused due to bulging disc or herniated disc, degenerative disc disease, piriformis syndrome, pregnancy or trauma etc. 

According to Ayurveda, Sciatica is caused due to impairment in Vata i.e. the dosha responsible for the functional ability and movement of the body, and also in some cases due to impairment in the Kapha i.e. the dosha that is responsible for body fluids and lubrication.

Ayurvedic herbs that improve the symptoms of Sciatica are:

1.        Babunah is also known as Bitter Chamomile. Not only is it used to relieve and reduce the pain faced by a sciatica patient, but it is also used for treating problems such as rheumatism due to the advancement of age. Compressed bitter chamomile flowers are prescribed for sciatica.

2.        Guggulu is also known as Indian Bdellium. Since guggulu is well known for its anti-inflammatory properties, it relaxes the sciatic nerves.

3.        Rasna is also known as Vanda Orchid. Intense or agonizing pain due to the sciatic nerve issues can be reduced by this ayurvedic herb due to its anti-inflammatory properties. 

4.        Juniper oil is extremely helpful when massaged onto the thigh muscles with firm strokes or pressure. It is used extensively in massage therapy for treating sciatica since the extent of reduction in sciatic nerve pain is tremendous. 

5.        Jaiphal is also known as Nutmeg. After being mixed with sesame seeds oil, nutmeg is coarsely powdered and then fried till it turns brown. This is then applied to those areas where the sciatic pain is intense for instant relief.

6.        Kumari is also known as Indian Aloe. Properties of Indian Aloe are extremely helpful in treating lower back ailments such as sciatica and lumbago.

7.        Shallaki is also known as Boswellia or Frankincense. Containing anti-inflammatory properties, shallaki is applied externally to get relief from sciatic nerve pain. 

Ayurvedic preparations such as yogaraja guggulu, Vataganjakusha, Saindhavadi taila are also very useful in treating Sciatica. 
 

Knee replacement is a procedure where the weight-carrying surfaces of knee joint are replaced surgically to ease the pain or any disability. People suffering from osteoarthritis, rheumatoid arthritis or psoriatic arthritis undergo knee replacement. All these conditions revolve around stiffness and painful knee. This surgery is usually performed on people aged over 50.

Surgery Types: 
Knee replacement is mainly of two main types:

1. Total knee replacement where both the sides of knee joints are replaced
2. Partial knee replacement where only single side of the joint is replaced

Procedure: In case of partial knee replacement with minimal invasion, a smaller incision, which is 3 to 5 inches, is required. This leads to minimal tissue damage and the surgeon can work between the fibres of the quadriceps muscles. Here, an incision through the tendon is not required. This may result in less pain, recovery time is reduced, and motion is better as scar tissue formation is less.

In total knee replacement, four steps are performed:

1. Removal of damaged cartilage surfaces, which is at the ends of the femur and tibia, with a small quantity of underlying bone.
2. Replacement with metal components, which help as a recreated surface of the joint
3. Incision of knee cap with a resurface made of a plastic button, which is optional based on the case
4. Insertion of a medical grade plastic spacer amid the metal components. This creates an effortless gliding surface.

After general or spinal anaesthesia, an incision of 8-12 inches is made in the front part of the knee. Joint part which is damaged is removed from the surface of the bones. The surfaces are then formed in a way to hold a metal or plastic artificial joint. The thigh bone shin as well as knee cap is attached to the artificial joint with either cement or a special material.

After Effects of the Procedure: After the surgery, patients may stay in a hospital for three to five days. Post surgery, notable improvement can be seen after a month or later. The patient is gradually relieved from pain with the construction of new gliding surface during surgery.

There will be slow progress in the movement. In the beginning, one may walk with a support of parallel bars and then with the help of crutches, walker, or cane. After full recovery in about six weeks, people can enjoy normal activities except running or jumping.

Presently, over 90% of total knee replacements function well even after 15 years of surgery. Hence, knee problem is no problem at all!

Neck pain is a common medical condition, which can be easily treated if proper care and medications are taken. It usually occurs due to strained neck muscles, often caused bad posture, though there might be other causes as well. Rarely, neck pain can be a symptom of a more serious problem as the condition is relatively mild in nature.

Ankylosing Spondylitis Overview:
Arthritis can affect the quality of life of the affected in multifold ways. Ankylosing spondylitis is a type of arthritis can affects the spine. Pain and stiffness that runs from the neck to the lower back are the symptoms of this disease. This is an inflammation that can cause chronic pain and even lead to disability. Deformity too can be caused as the pain in the spine can lead to the formation of a new bone. It is not the only the neck and lowers back region that experiences the terrible pain, but even the other parts of the body are affected by this condition.

When affected by this condition, inflammation occurs between the vertebrae. This can also affect the joints in a few people. This can limit the movement of the affected. This disease often begins in early adolescence. When the spine becomes rigid, one can start seeing the changes. The changes can start at any point of time when the disease ranges from mild to severe. Over time, the affected also get a stooped posture. The disease is more common in Native Americans, and milder in women.

Ankylosing Spondylitis Symptoms:
1.    Pain and arduousness: It is usual to experience the numbness, pain and stiffness in the back, buttocks and in the hips. When the symptoms exist for more than 3 months, the condition is moving from mild to severe. This usually begins in the lowest part of the spine, called the sacrum.

2.    Bony fusion: the Abnormal joining of bones is called bony fusion, and ankylosing spondylitis can lead to this overgrowth of bones. This can occur in major joints like the neck, hips, or back. The affected starts losing efficiency in performing the daily chores. In severe cases, the affected will also find it very tough to take a deep breath.

3.    Pain in tendons and sinews: The ligaments and sinews attached to the bones can be affected by ankylosing spondylitis. The inflammation of tendons called tendonitis is often on the cards. The pain and stiffness beneath the area of the heel can be experienced. This specific condition is called Achilles tendon. The back of the ankle is also affected, and the patient often finds it difficult to walk.

4.    Other symptoms: This disease is systematic, and this is why the pain and discomfort are not related to certain areas only. Affected people can experience symptoms like fatigue, fever, eye inflation, problems in heart and lungs, and loss of appetite.

5.    Weight loss, early morning stiffness, and anaemia are some of the symptoms experienced.

6.    Inflammation in the bowels and heart valve inflammation too are experienced as this is an inflammatory disease

Causes of Ankylosing Spondylitis:
The exact cause for this disease is not yet clear. Doctors point fingers at the genetic susceptibility. But, it is also be understood that not all who are affected by this disease carry the gene HLA B27. The major point is that people who carry this gene, have the higher risk of a hit by this type of arthritis. The risk percentage is higher by 10 to 20%.

What is risk factors Ankylosing Spondylitis:
If one carries the HLA B2 protein, the chances of getting affected are higher. The same is the case when one or more family members are affected by this disease. The symptoms are often seen beginning at the age of 20 to 40 years. This is also common in men, and women are rarely affected by this condition.

How to diagnosed Ankylosing Spondylitis?
1.    The diagnosis for ankylosing spondylitis is done through various ways. One of the major ways the doctor might identify the disease in the presence of the symptoms. Hence, it is important for the patients to ensure all the pain and discomfort experienced in different parts of the body should be intimated to the doctor.

2.    A physical examination is carried out by the healthcare professionals to identify the inflammation. The doctor also might ask to move and stretch the limbs, to identify the affected areas. Restricted movements often unveil the disease.

3.    X-rays are taken to notice the inflammation in the neck and the pelvic region. This screening offers a clear picture of the inflammation in various joints.

4.    The chest breathing examination is carried out to check if the condition has an impact on the lungs and causes difficulty in breathing

5.    The blood tests and other lab tests are also suggested by the doctor to check for anaemia, and other possible disorders that are associated with this condition.

6.    Urinalysis is also recommended by the doctors. This is because the inflation can also affect the function of the kidney. This can be checked at the right moment with the urine sample test done at the lab.

Treatment of Ankylosing Spondylitis:
It has to be understood that ankylosing spondylitis has no cure. It can be treated to ensure that the discomfort and pain are reduced. The movement functions can be improved to ensure that the patient can do the daily chores with ease. The stiffness and pain are the major problems with the condition, and these can be eradicated to a great extent by this treatment. The goal of the treatment is also to prevent further damage and help retain a good posture. Proper treatment, methods help the affected to lead a fairly normal life, without having to depend on others. A team of doctors are involved in the treatment plan. Doctor, occupational therapist, ophthalmologist, who treats eye disease,  gastroenterologist, who treats bowel disease,  physiatrist, who specializes in physical medicine and rehabilitation,  and a physical therapist, who provides stretching and exercise programs are present in the team.

1.   Physical and occupational therapy: it is important to opt for these therapies at the initial stages to ensure that deformity is not formed. These therapies are given by trained professionals, who suggest a range of exercises specific to your needs and help in improving the functions,  and also keep off from forming deformities due to reduced movements. For instance, a stooped posture can be corrected or prevented with the occupational and physical therapy.

2.   Exercises: Exercises improve the daily functioning of the individuals, and help in proper posture maintenance. Apart from the exercise schedule the occupational therapist and the physical therapists suggest, the doctors can also suggest a list of exercises that can help in promoting deep breathing. When done regularly they can immensely help a lot. An exercise that is considered to be the best is swimming. For those, who cannot swim, the other options are yoga poses that help in improving the breathing pattern without any trouble.

3.   Medications: Drugs are the important part of the treatment plan for ankylosing spondylitis, for they alone offer the much demanded instant relief from pain and stiffness caused by this disease. These drugs also ensure that the patients can do the exercises to improve the condition without facing much discomfort. Else, carrying out the daily chores too can be strenuous for the patients. The anti-inflammatory drugs that do not involve the use of steroids are often prescribed for this disease. A few examples are aspirin and ibuprofen. Disease-modifying antirheumatic drugs (DMARDs) like methotrexate (Rheumatrex)  can be used when the condition is not mild, but severe. This is because the NSAIDs are not enough to control the inflammation. Other FDA approved drugs like certolizumab pegol (Cimzia), golimumab (Simponi Aria, Simponi), infliximab (Remicade), and infliximab-day (Inflectra), a biosimilar to Remicade, and secukinumab (Cosentyx), etanercept (Enbrel), etanercept-szzs (Erelzi), a biosimilar to Enbrel, and adalimumab (Humira), adalimumab-atto (Amjevita), a biosimilar to Humira,too are prescribed currently. The chronic back pain can also be dealt with a few anti-depressants.

4.   Surgery:  When the inflammation has affected the hips and waist joints very much, a joint replacement surgery is done. This has to be decided by the doctor, and various factors can be responsible for the doctor going against the same.

Apart from the treatment options, there are certain do’s and doughnuts that are instructed by the doctors to live with this condition.

1.    Smoking exacerbates the condition. In many diseases, smoking can see to be aggravating the complications, and it is the same in the case of ankylosing spondylitis too. Smoking can impact inflammation. So, the patients are restricted from smoking.

2.    Sleeping on the firm bed is a must. Too soft mattresses can aggravate the pain. Sleeping on the back is what the patients are supposed to do. It is also advised not to use large and soft pillows. Very thin pillows or cotton bed sheets can be folded under the head. This is because the neck fusion can be triggered by using large pillows.

3.    Propping legs on pillows is another thing the patients are restricted to do. This is because, in the bent position, hip and knee fusion can result.

4.    The tables, chairs and other work surfaces should be in such a degree that the stooping posture should not be encouraged. 

5.    Using armchairs is a good option, for they offer ample of support to the arms and shoulders.

6.    Jumping, falling, and dancing can cause severe damage in the severe cases of the disease. The patient should take immense care in such cases.

Prevention of Ankylosing Spondylitis:
It is not easy to prevent ankylosing spondylitis. In fact, it is near to impossible. Majorly because the cause is unknown, the prevention is also yet to be known.  However, if there are 1 or more family members diagnosed with this condition, then it is a good option to find the risk chances. Yearly health checkups can help in avoiding this condition. Leading a sedentary life too can add to the chances of getting affected by this condition. So, involving physical activities, and doing regular exercises can prevent this disease to a certain extent. Exercises can help in improving the flexibility, and in people who are very active, the symptoms are identified soon, making it easy to get treated even at the initial stages. It is also essential to stay off from smoking and tobacco. Even when not diagnosed with any form of arthritis, these substances can increase the risk factor and aggravate the condition. Eating a healthy diet is also recommended. This inflammatory disease can also lead to inflammation of the heart. So, when adding the junk and fatty foods, the heart can lose its efficiency sooner.  A healthy diet can cut out the risk by half. 

Complications of Ankylosing Spondylitis:
1.    Fusion of the spine can lead to a curvature, which is called kyphosis. This can lead to a stooped posture when ankylosing spondylitis is left over time untreated.

2.    The pain is often felt in the groin area when the hi; tp and shoulder joints are affected. This is called referred pain, which can be felt in the thighs too. This can have an impact on the occupational front of the patient too.

3.    In most severe and rare cases, the heart’s electric functioning is also affected. This is because of the inflammation of the heart valves. A pacemaker must be brought in to ensure the proper functioning of the heart in such cases.

4.    In 10% of the cases, the joints near the jaws are affected. This can lead to the problem not able to open the jaw fully to eat.

5.    In the case of a few patients, the eye inflation can affect the quality of life, in case proper treatment is not given on time.

Myths:
Myth #1:    Ankylosing spondylitis affects only runs in families: only the risk factors high, and doesn’t mean it cannot occur to someone who has none in the family affected by this disease.

Myth #2:    Exercises can prevent the occurrence: While exercising can keep symptoms at bay for long, and help in easy diagnosing at early stages, it does not guarantee to stay far from this disease.

Myth #3:    Women are not affected: the risk factor for women is low. Men are affected 2 to 3 times higher but do not mean, women are spared by this disease.

It is not easy to lead a normal life with ankylosing spondylitis. It takes immense determination to fight this progressive disease. Sticking to medication and active lifestyle can only help to live with this disease.