Matthew Hospital

The anterior cruciate ligament is one of the most delicate yet vital ligaments that holds the knee bones in place and stabilizes the movement. Injury to the ligament, on account of a sprain, can prove to be a cause of severe distress. This may lead to a partial or a complete destabilization of the knee joints and impair the normal movements to a great extent.

Causes
Some of the most common causes of this sort of a ligament tear are accidental injuries during a sporting activity, unexpected collision or incorrect body postures. This is a fairly common occurrence among the athletes. However, the physiological and neuromuscular controls make women more susceptible to damage to the Anterior Cruciate Ligament than men.

There are two cruciate ligaments in our body, i.e. the anterior and the posterior cruciate ligaments. They run in crosses to connect the insides of the knee joints. They regulate the back and forth movement of your knees. They therefore, may incur substantial damage through sudden movements like jerks or an abrupt change of direction; the degree of tear may vary from minor strains to complete detachment. Accordingly, treatments are available to cure the distress. The treatments may either be surgical or nonsurgical, depending about the extent of the injury as well as the age of the patient. A complete tear in the ligament necessitates surgery for recovery. However, one may choose to opt for other non - surgical methods to minimize the damage.

Some of the most effective treatments for a tear in the anterior cruciate ligament have been enlisted below:

1. Bracing: Wearing a brace or using a crutch for the purpose of movement can accord the knees with some stability. It also keeps the joints intact and alleviates pain.
2. Physiotherapy: Once the inflammation reduces, you may opt for physiotherapy to restore movement and reduce the pain. Heat and Ice therapies work as ideal adjuvants to physiotherapy in such cases.
3. Surgery: Regrowth of the anterior cruciate ligament may be possible through a surgical process of grafting. This enables the tissues to repair themselves. Knee caps and adequate rest accord better rehabilitation. The recovery is faster and steadier in this process.

If you are suffering from back pain, you should know that the tiniest of movements can trigger the same. Back pain may occur due to several factors or reasons and it hampers your daily activities and standards of life to a great extent. However, you need to become active instead of being immobile for relieving back pain. If any movement increases your pain, you must avoid doing it.

There are several exercises which help in strengthening your back muscles and performing these on a regular basis will provide you relief from back pain drastically. Here are 7 common  exercises which you should carry out:

1. Pelvic tilt: You have to lie on your back and keep your knees bend, but touching. Your feet should stay flat on the floor. By flattening your lower back against the wall and tilting your pelvis downwards, you must maintain the position for 20 to 40 seconds. Meanwhile, you must breathe slowly and deeply and then release. This stretch requires small movements for reducing tension, thereby easing your back pain.

2. Lumbar stretch: You need to sit on a chair, roll your head, chest, neck and lower back forward till your head gets between the knees. Hold the position and take deep breaths. Slowly, get back to the sitting position. Repeat this twice.

3. Cat position: You have to kneel on your fours and keep the knees and hip width separate. Keep the stomach muscles tense, arch your back like a cat does and maintain the position for five seconds. Repeat this and then allow your stomach to drop towards the floor direction and hold it for five seconds again.

4. Curl ups: For this exercise, you should lie on your back with the knees bent and your feet kept flat on the floor. Placing your hands behind the head will make the stomach muscles tense. Then, lift your shoulders, head and upper back from the floor. Do this around 10 times. This is ideal for strengthening your back.

5. Dry swimming: Begin by lying on your stomach, keeping a rolled-up towel under your belly for support. By tightening your buttocks, raise one arm and the opposite leg simultaneously. Switch your arms and legs and perform this for about two minutes.

6. Leg lift: For leg lifts, you should lie on your back with the knees kept bend and the feet kept flat on the floor. You have to press your lower back to the floor and straighten a leg with the knees aligned. After bending your leg, return to the starting position and repeat the exercise on the other side.

7. Cobra stretch: The cobra stretch is another ideal movement for stretching your tight abdominal muscles and lower back. You need to lie on your stomach with your legs extended and your palms planted on the sides of your head.

The knee is known as the largest and one of the most complex joints in the human body, and also one of the most vulnerable, as it supports the weight of the entire body. The knee joint is made up of several elements including the knee cap, meniscus, connective tissue, tendons, ligaments, cartilage, and muscles. Damage to any part of the knee can cause chronic pain. So how can you protect your knee from damage and injury? Take a look at these three points!

• Dealing with Load: Weight is a big one. Carrying around extra pounds and kilograms can be detrimental for your knees in the long run. Your knee is not equipped to handle the excessive weight. It already supports three to five times your weight when you get up and walk around or indulge in some mild jogging. One must be careful of those extra pounds to take the load off the knee and keep it from falling prey to damage.
• Exercise: Moderate to intense exercise is prescribed for one and all. This, of course, depends on one's overall health and age. If you are already suffering from joint pain, then you may want to go easy on the exercise with a focus on building muscle strength and foundation. If you are healthy, then some amount of daily exercise as a routine will keep those knees in prime working condition and well lubricated as well. Inactivity and a sedentary lifestyle can affect the knees very badly.
• Do not Ignore: Warning signals such as chronic or acute knee pain should not be ignored. Remember to see a doctor or an orthopaedic specialist to find out if you have contracted an infection or if you may have suffered a fracture due to an injury. Also, it is important to take a bone density test regularly, especially after the age of 40 or for women going through menopause, as this will point to any deficiencies and even warn you in case there is any trace of osteoporosis.

Rest, exercise, and food should be kept in fine balance for a healthy body. These are a few measures that one can take to keep knee pain at bay. Yet, it is also advisable to speak with a doctor at length regarding measures to protect your knees.

The spine plays a very crucial role, both from a person’s movement and sensation point of view. It carries the nervous supply for a lot of internal organs and the lower body. By virtue of its structure, it also helps in movement through the disks. Due to various reasons, spinal injury is common, causing pain along the back, lower extremities, neck etc.

Medicines and exercise are the first line of treatment for most spinal injuries. The issue, however, is that these only provide relief from the pain and the medicines, but do not actually ‘rectify’ the underlying problem. Whether it is a herniated disk or a pinched nerve, the medicines and exercise can relieve the symptoms, but the disk continues to be herniated and the nerve continues to be pinched. Definite treatment is in the form of surgery, and with recent advancements in the field of spinal surgery, there are minimally invasive surgical options, which provide complete cure with minimal recovery time. Some of the benefits of this are listed below-

1. Smaller incision compared to traditional surgical procedures, where only the injured area is accessed

2. The surrounding tissues are untouched, unless they are injured and require repair

3. Lesser bleeding compared to earlier techniques

4. Lesser painful procedure

5. Reduced hospitalization period

6. Quicker recovery and return to normal activities

The question, however, is whether this is indicated in everybody. A detailed discussion with your surgeon keeping the below points in mind will help identify the answer for this. The main driver should be the answer to the question – will the surgery be able to effectively relieve you of the pain and symptoms? Additionally, the following factors help in getting better results out of a minimally invasive spinal surgery.

1. Presence of symptoms relating to nerve compression, including pain from the spine down the leg.

2. Recent onset of symptoms, with pain starting days to months before seeing the doctor. This indicates the condition is relatively new and so damage is minimal, indicating favorable outcome. Chronic pain conditions take slightly longer time compared to recent injuries.

3. People with active lifestyle who engage in regular physical exercise are likely to have better benefits from the minimally invasive procedure.

4. Smoking reduces blood flow to the spine, leading to disk degeneration and weakening of bones. Healing is highly slowed down and recovery is overall delayed.

5. Excessive weight puts strain on the back, and so healing can be delayed or badly affected with more complications. It is not a contraindication, but be prepared for a longer recovery period.

Talk to your doctor keeping these points in mind, and you can bid farewell to your back pain forever.

Knee replacement can be extremely painful. Previously, opioids or narcotics were administered for pain relief. But excessive addition of opioids is not exactly effective for controlling pain.

Multimodal pain management has become an important part of the perioperative care of patients undergoing total joint replacement. The principle of multimodal therapy is to use interventions that target several different steps of the pain pathway, allowing more effective pain control with fewer side effects. Many different protocols have shown clinical benefit. The goal of this review is to provide a concise overview of the principles and results of multimodal pain management regimens as a practical guide for the management of joint arthroplasty patients.

Multimodal denotes administering two or more than two types of medications that work with different mechanisms. The following are the techniques used:

1. Pre-operative Femoral Nerve Block: Prior to the surgery, a catheter is placed beside the femoral nerve for blocking it. This nerve is located in the upper thigh. Medication is delivered through the catheter for the nerve to be numbed for 24 hours. Thus, pain signals to the brain are blocked. This method reduces the use of narcotics and the consequent side effects.

2. Patient Controlled Analgesia (PCA): This method is also known as ‘Pain Pump’. An intravenous pump is used to administer pain relief medications, such as oxymorphone or morphine, after the surgery. The control button of the machine could be pressed, by the patient for 6 to 10 times per hour. The machine is used for two post-operative days.

3. Oral Medications: The oral medications include Non-Steroidal Anti-Inflammatory drugs or NSAID; such as Celebrex which is similar to aspirin, structurally. Alternatively, acetaminophen, such as Tylenol or its equivalent composition, can also be used.

4. Acetaminophen: It acts on the Central Prostaglandin Synthesis and relieves the patient of pain through multiple mechanisms.

5. Epidural Analgesia: It produces lower pain scores and involves less time for achieving physical therapy goals. However, this is subject to side effects such as dizziness, urinary retention and itchiness.

6. Gabapentinoids: These medications include membrane stabilizers such as Gabapentin and Pregabalin.

The objective of multimodal treatments is to provide quick relief to the patient and immediately so. Earlier the rehabilitation, more successful will be the knee replacement surgery.