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Dr. Subhashini

Physiotherapist, Chennai

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Dr. Subhashini Physiotherapist, Chennai
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Personal Statement

I pride myself in attending local and statewide seminars to stay current with the latest techniques, and treatment planning....more
I pride myself in attending local and statewide seminars to stay current with the latest techniques, and treatment planning.
More about Dr. Subhashini
Dr. Subhashini is an experienced Physiotherapist in Velachery, Chennai. You can visit him/her at Adseroga (for adults) in Velachery, Chennai. Book an appointment online with Dr. Subhashini on Lybrate.com.

Lybrate.com has an excellent community of Physiotherapists in India. You will find Physiotherapists with more than 25 years of experience on Lybrate.com. You can find Physiotherapists online in Chennai and from across India. View the profile of medical specialists and their reviews from other patients to make an informed decision.

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Adseroga (for adults)

#7, 2nd Street, Ramagiri Nagar, Velachery. Landmark: Near Baby Nagar Bus Stand,Opp to TCS, ChennaiChennai Get Directions
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Procedures That Can Help Treat Slip Disc & Sciatica!

MBBS, MD, FIMSA, FIPP
Pain Management Specialist, Delhi
Procedures That Can Help Treat Slip Disc & Sciatica!

The intervertebral discs are made-up of two concentric layers, the inner gel-like Nucleus Pulposus and the outer fibrous Annulus fibrosus. As a result of advancing age, the nucleus loses fluid, volume and resiliency and the entire disc structure becomes more susceptible to trauma and compression. This condition is called as degeneration of the disc. The disc then is highly vulnerable to tears and as these occur, the inner nucleus pulposus protrudes through the fibrous layer, producing a bulge in the intervertebral disc. This condition is named as herniated disc. This can then cause compression to the spinal cord or the emerging nerve roots and lead to associated problems of Sciatica radiating pain from back to legs in the distribution of the nerve. Other symptoms could be a weakness, tingling or numbness in the areas corresponding to the affected nerve. Sometimes bladder compromise is also present, which is made evident for urine retention and this need to be taken care as an emergency.

Excessive weight, bad postures, undue movements, improper weight lifting and other kinds of traumas may weaken the intervertebral discs. When this occurs the pulpous nucleus will bulge against the annulus, or even be squeezed through it (extruded disc).

The first steps to deal with a herniated or prolapsed lumbar disc are conservative. These include rest, analgesic and anti-inflammatory medication and in some cases physical therapy. At this point, it is convenient to have some plain X-rays done, in search of some indirect evidence of the disc problem, as well as of degenerative changes on the spine.

If in a few days these measures have failed, the diagnosis has to be confirmed by means of examinations that give better detail over the troubled area, as the MRI, CT which will show the disc, the space behind it and in the first case, the nerves. In some instances, the EMG (electromyography) is also of great value, as this will show the functionality of the nerves and muscles.

Once the diagnosis has been confirmed, one of the best alternatives existing today is the Ozone Discolysis as the results obtained are excellent and practically has no complications. This novel treatment avoids the use of surgery in 80% of those who needed it. In most patients left with painkillers as the only treatment, the symptoms eventually disappear, only that this could take weeks to months. Ozone speeds up these developments, see the same result in a few weeks. The problem has to be seen and approached integrally and frequently the combination of therapies has to be used, most frequently physiotherapy. Also, it has to be known that those who had a herniated disc have 10 times more chances of having another herniation than the rest of the population.

If despite the ozone therapy the symptoms persist, Drill Discectomy/ Laser Discectomy are good alternatives before open surgery (Discectomy) which has to be contemplated in those true emergencies, as mentioned above, this is possibly the first choice.

Once the conservative treatment fails:

Early aggressive treatment plan of pain has to be implemented to prevent peripherally induced CNS changes that may intensify or prolong pain making it a complex pain syndrome. Only 5% of total LBP patients would need surgery & 20% of discal rupture or herniation would need surgery. Nonoperative treatment is sufficient in most of the patients, although patient selection is important even then.

Depending upon the diagnosis one can perform & combine properly selected percutaneous fluoroscopic guided procedures with time spacing depending upon pt`s pathology & response to treatment.

Using precision diagnostic & therapeutic blocks in chronic LBP, isolated facet joint pain in 40%, discogenic pain in 25% (95% in L4-5&L5S1), segmental dural or nerve root pain in 14% & sacroiliac joint pain in 15% of the patients. This article describes successful interventions of these common causes of LBP after conservative treatment has failed.

LESI: Lumbar Epidural Steroid Injection

Indicated in – Acute radicular pain due to irritation or inflammation.

  • Symptomatic herniated disc with failed conservative therapy
  • Acute exacerbation of discogenic pain or pain of spinal stenosis
  • Neoplastic infiltration of roots
  • Epidural fibrosis
  • Chronic LBP with acute radicular symptoms
  • Epidural- lumbar injection

ESI Treatment Plan

Compared to interlaminar approach better results are found with a transforaminal approach where drugs (steroid+ LA/saline +/- hyalase) are injected into anterior epidural space & neural foramen area where herniated disc or offending nociceptors are located. Whereas in interlaminar approach most of drug is deposited in posterior epidural space.Drugs are injected total 6-10 ml at lumbar, 3-6 ml at cervical & 20+ ml, if caudal approach is selected. Lumbar ESI is performed close to the level of radiculopathy, often using paramedian approach to target the lateral aspect of the epidural space on involved side. Cervical epidural is performed at C7-T1 level.

SNRB- Selective Nerve Root Block 

Fluoroscopically performed it is a good diagnostic & therapeutic procedure for radiculopathy pain if

  • There is minimal or no radiological finding.
  • Multilevel imaging abnormalities
  • Equivocal neurological examination finding or discrepancy between clinical & radiological signs
  • Postop patient with unexplainable or recurrent pain
  • Combined canal & lateral recess stenosis.
  • To find out the pathological dermatome for more invasive procedures, if needed

Intradiscal Procedures 

Provocative Discography - Coupled with CT

A diagnostic procedure & prognostic indicator for surgical outcome is necessary for the evaluation of patients with suspected discogenic pain, its ability to reproduce pain(even with normal radiological finding), to determine type of disc herniation /tear, finding surgical options & in assessing previously operated spines.

Percutaneous Disc Decompression (PDD)

After diagnosing the level of painful offending disc various percutaneous intradiscal procedures can be employed

Ozone Discolysis: Ozone Discectomy a revolutionary least invasive safe & effective alternative to spine surgery is the treatment of choice for prolapsed disc (PIVD) done under local anaesthesia in a daycare setting. This procedure is ideally suited for cervical & lumbar disc herniation with radiculopathy. The total cost of the procedure is much less than that of surgical discectomy. All these facts have made this procedure very popular at European countries. It is also gaining popularity in our country due to high success rate, less invasiveness, fewer chances of recurrences, remarkably fewer side effects meaning high safety profile, short hospital stay, no postoperative discomfort or morbidity and low cost.

Dekompressor: A mechanical percutaneous nucleosome cuts & drills out the disc material somewhat like morcirator debulking the disc reducing nerve compression.

Epidural Adhenolysis or Percutaneous Decompressive Neuroplasty for Epidural Fibrosis or Adhesions in Failed Back Surgery Syndrome (FBSS)

A catheter is inserted in epidural space via caudal/ interlaminar/ transforaminal approach. After epidurography testing volumetric irrigation with normal saline/ L.A./ hyalase/ steroids/ hypertonic saline in different combinations is then performed along with mechanical adenolysis with spring loaded or stellated catheters or under direct vision with epiduroscope.

In case you have a concern or query you can always consult an expert & get answers to your questions!

4492 people found this helpful

As detected ,patient is having D VT and now taking XERALTO 15 mg. Tab. But now developed a back pain on left side beside the spine. Do we need to have a second opinion and whether the pain developed for the on going medicine.

BPTh/BPT, MPTh/MPT
Physiotherapist, Noida
As detected ,patient is having D VT and now taking XERALTO 15 mg. Tab. But now developed a back pain on left side bes...
Postural Correction- Sit Tall, Walk Tall. Extension Exercises x 15 times x twice daily. Apply Hot Fomentation twice daily. Avoid bending in front.
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im suffering with heavy back pain my job is marketing so i'm travel daily more then 60 km daily I think that's the reason for my back pain please suggests me how to solve my back pain.

BPTh/BPT, MPTh/MPT
Physiotherapist, Noida
im suffering with heavy back pain my job is marketing so i'm travel daily more then 60 km daily I think that's the re...
Apply Hot Fomentation twice daily Avoid bending in front. Postural Correction- Sit Tall, Walk Tall. Extension Exercises x 15 times x twice daily – lying on tummy, take left arm up for 3 seconds, then bring it down, right arm up for 3 seconds, bring down. Bring right leg up, hold for 3 seconds, bring it down. Then right leg up and hold for 3 seconds and bring it down. Repeat twice a day- 10 times. Bhujang Asana ? Lie flat on your stomach, keeping the palms out, bend the neck backward, take a deep breath and while holding it for 6 seconds, raise the chest up. Release breath and relax your body. Repeat the exercise 15 times twice daily. Core Strengthening Exercises- Straight Leg Raised With Toes Turned Outward, repeat 10 times, twice a day.
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Recently, I had a back pain. Doctor said I have a slip disc, but my age is just 30, moreover I hit the gym regularly. Maintained a healthy weights. Just because of this slip disc, I have stopped everything as because having a good and healthy body but a painful life is not a worthy thing. Doc had suggested a few exercise and not to bend forward. How could it be? Is it curable? please suggest me.

FRHS, Ph.D Neuro , MPT - Neurology Physiotherapy, D.Sp.Med, DPHM (Health Management ), BPTh/BPT
Physiotherapist, Chennai
Recently, I had a back pain. Doctor said I have a slip disc, but my age is just 30, moreover I hit the gym regularly....
Do Take IFT and laser Therapy for pain relief for about a week and followed by strengthening exercise from Neuro physiotherapist best wishes
2 people found this helpful
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I am 37 and fractured pelvis right side during an accident. After consulting with doctor. He advice me to bed rest of 20 days with traction right leg. But after 15 daysmy left leg swollen from hip to anckle. What is cause of this and what do I do ? Please advice me.

MCh Ortho, ATLS (AIIMS), Diploma In Orthopaedics (D. Ortho), MBBS, MS - Orthopaedics
Orthopedist, Kolkata
Dear , you could be having a serious condition called deep vein thrombosis. Get immediate help from an experienced orthopaedic surgeon (if possible pelvic specialist). Send me a photo of your xrays and your leg.
1 person found this helpful
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Dear Sir/madam, my wife is suffering with little chest pain from yesterday. She has also leg pain

BHMS
Homeopath, Delhi
Dear Sir/madam,
my wife is suffering with little chest pain from yesterday. She has also leg pain
Hi lybrate user. Chest pain can be due to gas or acidity also. Give her sauf (fennel) and water boiled together. Give her light food. Note for any other symptoms. If it still persists or becomes severe then consult a doctor. Take care.
1 person found this helpful
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Hi myself I'm a regular gym goer and the issue is from last few days I'm feeling pain in my back and that is also in the lower half specially in the nights while sleeping pls help me in this regards.

CCP, MBA, Bachelor of Ayurveda, Medicine and Surgery (BAMS)
Ayurveda, Karnal
Hi myself  I'm a regular gym goer and the issue is from last few days I'm feeling pain in my back and that is also in...
Backacke can be due to numerous reasons like back strain, big tummy, slip disc, lumber spondylosis. You can do following home remedies: 1) mix camphor in coconut oil and boil it. Massage it followed by hot fomentation. 2) have turmeric & honey milk. 3) put a hot-water bag on back supported by a cushion. 4) add ginger while brewing your tea 5) if you are overweight, go for weight loss program 6) stay away from cold, go for hot water baths.
2 people found this helpful
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I am 38 years female suffering fro knee pain in left knee after x raya report there is starting stage of osteo probelem please advise me medicine

Diploma in Acupuncture, Pranic Healing, MD - Acupuncture
Acupuncturist, Bangalore
Neck massage will give good results. Use little good oil or plain water and massage from either side on the mid shoulder blade. Use your thumbs and move it slowly upwards on the back of neck up to the lower level of ear. Repeat 5 to 10 times. Do not do from top to down. Finally move your neck up and down, sideways left and right. Results are excellent. Take some calcium supplements for 2 months.
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I have a pain in my toe. But I am not getting recovered from it. What should I do now?

BPTh/BPT
Physiotherapist, Mumbai
I have a pain in my toe. But I am not getting recovered from it. What should I do now?
Get yourself clinically examined by physiotherapist as xray may be needed for further investigation. Apply cold water fomentation. wear shoes with comfortable cushion.
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