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:

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.

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.

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.

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

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.

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.

Multimodal Pain Relief After Total Knee Replacement

Summer vacations can make you very lazy and it becomes difficult for you to indulge in physical activities because of the hot and sweaty weather. However, here are a few ways in which, you can avoid weight gain during the season:

Never Arrive Hungry: Eating before hand can help you stay away from different kinds of temptations as you go to a celebratory event or a gathering. This way you do not end up eating a lot of junk food.
Redirect Your Attention: Many people overlook that there is a whole other world to an event or a party than the food. Try not to look at the gathering as only a feast occasion.
Pace Yourself: In case that you pack in as much as you can in thirty minutes, you bite faster. Biting slowly will fill you up easily and this way you do not consume too much.
Number Your food items: At the point when there are food items that you can count as you eat them, put a toothpick in your pocket for every bite you take. Set the farthest point for a number of toothpicks you can collect.
Outmanoeuvre the buffet: At the point when food is served in buffet-style, use a small plate and do not stack your food. Restrict your servings to a small amount. 
Restrain Alcohol: Abstain from drinking an excessive amount of liquor at parties. It is not just about calories but rather about control. In case that alcohol does tempt you, try to drink some water and then ask yourself if you still need that drink. Most of the times, it is because of lack of water that you feel the urge to drink other beverages.
Be Choosy About Sweets: With regards to sweet, be extremely particular. Confine your desires to little servings and only to what is exceptionally tempting to you. In case that you know you are the type who cannot stop at one chomp, it could be very unhealthy for you. Try to tell someone else about it and let them help you.
Present to Your Own Treats: Whether you are heading off to a gathering or an office potluck, think about bringing as a low-calorie treat that you know you will appreciate. Bringing your own pastry will make other options less enticing.
Confine "Tastes" While Cooking: In case that you do a great deal of cooking during the occasions, get serious about every one of those "tastes." People lose their cravings when they have been cooking than they have been eating the entire time.
Walk It Off: Other than consuming some additional calories, this will make tracks in an opposite direction from the food for a while. Get people off the chair and move. Go out for a stroll as a family before or after the dinner.

10 Tips To Avoid Weight Gain During Summers!

There is probably no house in India, where dishes are prepared without the use of ginger. It forms an amazing spice that is savoury, both for spicy and sweet dishes and as a result, most Indian dishes include this spice for making them tastier and healthier. But did you know that both fresh and dried ginger has medicinal properties as well?

Here are the top 13 benefits proffered by ginger

Healing properties: Ginger can be used as a fresh root or a milled powder for healing all kinds of sores and cuts and it prevents spread of infections.

Helps in relieving pain: If you can boil ginger for a short time and drink the liquid, it can help in alleviating the chronic and acute pain caused by arthritis, rheumatism, abdominal cramps, back pain, bronchial asthma and bronchitis, neck stiffness, inflammation in the kidney and liver.

Regenerating properties: Ginger can help in increasing the blood circulation, eliminating toxins and regenerating the tissues that have been harmed with any kind of disease.

Fat burning abilities: Ginger can act as a fat burner and aids in weight loss. It can create a feeling of fullness and reduces sudden food craving so that you will not have to snack in between meals.

Anti-inflammatory properties: Regardless of what has triggered the cause of pain, ginger has the potential to set you free from it owing to the anti-inflammatory properties contained in ginger roots.

Helps in relieving sinusitis: Ginger has a notable impact on the health of those suffering from sinusitis. If you are suffering from asthma, you may have it too.

Alleviating nausea: Ginger root can soothe the nerve and can prevent headache, vomiting and migraine. It can relieve you from tiredness and soreness of muscles caused due to long voyages.

Fighting abdominal discomfort: By consuming ginger tea on regular basis, your digestion, as well as food absorption, can be prevented.

Reduction of inflammation: Ginger root helps in soothing swollen joints and tired muscles. It is also recommended for relieving pain and burning sensation.

Fighting menstrual problems: Dipping a towel in ginger tea and putting in the region of the uterus can aid in relaxing the muscles.

Relieving stress: A cupful of ginger tea can aid in improving the mood and reducing stress and tension.

Empowering the immune system: The antioxidants contained in ginger roots can help in strengthening the immunity system by reducing stroke risk and cleaning arteries.

Treating cancer: It has been proven that ginger tea can kill cancer cells.

There are specific rules and ways of consuming Aadrak (ginger) by people of different constitutions and regions. An Ayurvedic constitutional examination can help you in understanding which and when is the best way for you to consume ginger.

Ginger - 13 Health Benefits You Never Knew

Osteoporosis wreaks havoc in many senior citizens, especially women. This is a disorder that systematically weakens the bone and can fracture the spine and the hip. If not treated early, it poses a serious threat to mobility. While medicine is a prerequisite to treating this condition, exercise goes a long way in helping patients of osteoporosis. Regular exercise can improve balance and strengthen the muscle. This being said a doctor should be consulted for a fitness assessment and bone density test before going ahead with any exercise routine.

What is the right exercise for you?
Exercises are recommended depending on the degree of osteoporosis a person is suffering from. Some exercises may not be suitable for a person while some can greatly help. It is therefore suggested that a doctor or physiotherapist is consulted before starting any exercise. Here is a list of exercise that doctors often suggest:

    Strength training: Strength training aims at strengthening the spine and other muscles. It includes the usage of free weights and lifting own body weight. In case the exercise involves the usage of weight machines, utmost care should be taken to ensure that the spine does not get twisted. Resistance training, on the other hand, should be designed in such a way that it fits the tolerance and ability to cope up.
    Flexibility exercises: When the joints are allowed to go through the range of motion, it helps in muscle function. Stretching, for instance, should only be done when the muscle is warmed up. Care should be taken that stretching is done gently which is devoid of any bouncing. The spine should not be flexed. Any exercise that demands to bend towards the waist should also be avoided. An experienced physiotherapist should be able to suggest which stretching exercise is suitable for patients with osteoporosis.
    Aerobic training: Aerobic training necessarily means that the bone supports the body weight. This exercise helps the bone from mineral loss and is good for body balance strength and flexibility. Some aerobics that can be easily performed by patients with osteoporosis include dancing, stair climbing, cycling and walking. These exercises also help in blood circulation and cardiovascular diseases.
    Exercises you must avoid: High-impact body activity exercises such as jogging, jumping and running should be strictly avoided in order to avoid bone fracture and weaken muscle. Unlike exercises with controlled movements, these exercises can twist the spine and cause severe immobility in movement.
    Twisting: For patients with osteoporosis, an exercise that involves forward bending resulting the waist to come down should be avoided. Exercise such as this can cause compression fractures leading to restriction in physical movement for a temporary to longer duration. Any sort of bending and twisting, therefore, should be avoided. 

Suffering from Osteoporosis - Know Which Exercise is Right and Wrong for You?

It is normal and alright to feel pain in the knees occasionally after a physical activity or prolonged walking. However, it is a serious cause of concern if the pain is experienced every now and then. Not responding to your knee pain for long can lead to the extreme disability. Knee pain does not crop up in a day and it may surprise you when it first appears. 

Initially, you may notice slight pain and discomfort. If you have identified knee pain at this level, managing it is easy. You can perform different exercises to prevent pain from occurring. If the pain severe, you need to go consult a doctor, who will then help identify the real cause of pain. The following exercises, along with medications, can help you overcome knee pain and restore the mobility of the joint.

Stair Step ups: Choose a comfortable stairway. Place your hand on the wall or banister. This is to ensure that you are balanced. Your left foot should be on the taller step. Your right foot should be on the ground. Stay in this posture for a second. Now, step back, and bring left foot to the right foot. Repeat this 6 times. Reverse the legs and continue doing for 6 times. If you want to take rest between the steps, feel free to do so.
Ups and Downs: You need an armless chair that is strong. Sit on the edge but comfortably. Your arms should be at your side, relaxed and loose. Sit erect and your feet should be flat. If you feel you need balance, and then cross your arms. Start standing up. This should not be instant but deliberate, controlled, and gradual movement. Stand slowly up to the full height, and hold on for 2 seconds. Again sit down. Repeat this 5 times.
Straight Leg Raise: This can be a part of your everyday exercise regime. This is a strengthening workout that does not put too much effort on the knees. Lie down on your back. One leg should be straight on the ground and the other one should be bent. Now, slowly lift the leg that is straight, and the toes should point upward. Raise your leg up to 30 degrees, but you can start with 15 to 20 degrees in the initial stage. Repeat 15 times and perform at least 3 sets of this exercise. Keep alternating legs. This workout strengthens the knees, thigh muscles, and the ankle joints, thus offering multifold benefits.
Wall Hamstring Stretch: Hamstring muscles too can be the cause of knee pain and discomfort. To strengthen the hamstring muscles and alleviate knee pain, this exercise helps a lot. Lie down on the floor flat. Your feet should be flexed. Choose a space that is close to a wall, or a sturdy table. Your right leg should be propped on the wall or table. If you don t prefer any, a resistance band is a good alternative. When stretching, you can find your flexibility level and when you feel that you have reached the deepest point, start relaxing. Keep alternating contracting and relaxing every 5 seconds. After 10 to 15 sets, you can try the same with the left leg.
Knee Rolls: Use an exercise mat or a carpet that is cozy. Lie on your back. Bend the knees, and ensure your feet are flat. Your arms should be stretched on the sides. Look at the ceiling, and hold the knees together. In the same posture, slowly roll the knees towards the right. When you feel a gentle twitch or after 5 seconds, move to original position. Then lower the knees to the left. Hold and release. For each side, repeat 10 times.
These exercises strengthen the knees and improve the quality of life by bidding bye to the pain. Understanding that these are magic remedies that work overnight is the key to stay focused and keep going without quitting.

Exercises That Can Help Relieve Knee Pain!

Your bone is a living tissue that constantly undergoes the cycle of breakage and replacement. Osteoporosis is a condition wherein the rate at which new bones form cannot match up to the worn out bones, thus making the bones fragile and brittle. Osteoporosis mainly affects the wrist, hip or spine and can result in a stooped posture accompanied by height shrinkage and back pain caused due to a collapsed vertebra.

Reasons Behind Osteoporosis

Hormones: Lowered estrogen count in women and testosterone in men as a result of ageing or other treatments can result in this condition. Excess thyroid secretion in the body, an overactive adrenalin gland or parathyroid gland can also accelerate bone loss. Women are more vulnerable to osteoporosis during menopause.

Prolonged use of injected: Prolonged use of injected or oral corticosteroid medications such as cortisone or prednisone messes with the bone-building process. Medicines used to combat cancer, gastric reflux and seizures can be responsible as well.

Medical Conditions: Certain medical conditions such as Rheumatoid arthritis, cancer, liver or kidney disease increases the risks of acquiring osteoporosis.

Sedentary Lifestyle: A sedentary lifestyle with not much physical activity along with an excessive consumption of alcohol and tobacco makes you susceptible to osteoporosis.

Treatments for Osteoporosis:

Medication: Commonly prescribed medicines for remedying fractures include bisphosphonates such as Zoledronic acid, Ibandronate, Risedronate and Alendronate.However these medicines are not free of side-effects such as abdominal pain, nausea or heart burn. In case, your regular medicine doesn t work, you can use Denosumab and Teriparatide as alternatives but only after consulting your physician.
Hormone Therapy: Estrogen therapy for women after menopause helps sustain bone density. However such procedures can escalate the dangers of getting afflicted with cancer, heart diseases or conditions such as blood clotting.
Alternative Medicine: Ipriflavone, a laboratory manufactured product, when combined with calcium can curb chances of bone loss and alleviate pain.

Osteoporosis - How It Can be Treated?

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