As you age, many parts of the body start to wear down. Your spine is no different in this regard. When age affects the condition of the cervical section of the spine, it is known as cervical spondylosis. Other names for the disorder are neck arthritis or cervical osteoarthritis.

Even though age causes most cervical spondylosis, other factors may also be responsible for the onset of the disorder. Here is a look at some common causes for the same.

Causes for cervical spondylosis:

  Bone spurs - Your body may try to strengthen the joints by growing additional bone tissues. These are known as bone spurs. These spurs can pinch down on the nerves and the spinal cord, leading to pain and other symptoms.

  Dehydrated discs - The spine houses shock-absorbing pad-like structures between the vertebrae, called discs. These discs contain a gel-like substance that gives them its unique shock absorbing properties. Over time, the gel dries out, causing greater friction between bones during movement.

  Injury - A neck injury can lead to cervical spondylosis. The disorder may not appear as soon as you suffer from the injury but may take years to develop.

  Excessive physical strain - Some profession may require people to lift heavy weights or overexert themselves physically. These people may develop cervical spondylosis later on because of this work.

Symptoms of cervical spondylosis:

Here are some symptoms that are commonly associated with cervical spondylosis.

  Shoulder pain - Patients suffering from cervical spondylosis often complain about pain in the shoulder blade. This pain increases while the person is standing, sitting, coughing, sneezing and tilting their head backwards.

  Weakness - People with cervical spondylosis also suffer from muscle weakness. For instance, you may not be able to grab things tightly in your hands, if you suffer from the spinal disorder. Furthermore, lifting the arms may be difficult.

Other minor symptoms of cervical spondylosis include stiffness in the neck that grows worse with time and headache that affects the back part of the head.

Treatment for cervical spondylosis:

Treatment is not necessary in many cases due to the absence of any distinguishing symptoms. However, if the spondylosis interferes with normal life, medical intervention is required. Treatment for the disease includes-

  Physical therapy - Physical therapy sessions often help deal with the pain and stiffness resulting from the cervical spondylosis. Your doctor will prescribe weekly sessions, which will aid to reduce the symptoms of the condition after some time.

  Medications - Pain medications help manage the discomfort related to the condition. However, these drugs do not have any long-term effect on the body. They only provide temporary relief from the pain.

  Surgery - Surgery for cervical spondylosis is uncommon. However, if the condition does not respond to other forms of treatment, the operation may be required to remove bone spurs, herniated discs and rectify parts of the spinal column.

You can also ask your doctor about home remedies to follow to manage the symptoms of the disease.

Cervical Spondylosis - How Can It Be Treated?

Sciatica refers to the pain one experiences due to the irritation or compression of nerve roots contributing to formation of Sciatic nerve. The sciatic nerve is the longest and widest nerve in the body, running from the lower back, down to the back of each leg. The pain can occur in the lower back and spread to the hips, buttocks and leg. Sciatica generally affects one side of the body. There are numerous causes of irritation of the sciatic nerve and sciatica.
 
Some of them are:
 
1. Spinal Stenosis
The narrowing of the spinal canal caused by natural wear and tear of the vertebrae (individual bones in the spine protecting underlying nerves) of the spine is known as spinal stenosis. The narrowing may put pressure on the roots of the sciatic nerve, causing pain.
 
2. Herniated Disc
A disc is made up of cartilage and acts as a cushion between vertebrae, allowing flexibility of the spine. A herniated or slipped disc occurs when a disc is temporarily pushed out of place, putting pressure on the sciatic nerve.
 
3. Spondylolisthesis
It is a condition where one of the lower vertebrae slips forward over another. This also causes a collapse of the disc space between both, causing the nerve to get pinched. This may cause sciatica.
 
4. Piriformis Syndrome
Piriformis is a muscle found deep inside the buttocks, which connects the lower spine to the upper thighbone, running directly over the sciatic nerve. Spasming of this muscle can pressurize the sciatic nerve, triggering symptoms of sciatica.

5. Sacroilitis
Sacroillac joints are the place where the lower spine meets the pelvis and inflammation of one or both of these joints causes sacroilitis. This can give rise to symptoms of sciatica as it causes pain in the lower back, buttocks and legs.
 
6. Spinal tumors
Very rarely, tumors growing inside or along the spine may put pressure on the sciatic nerve.
 
7. Infection or injury
Muscle inflammation, infections, fractures or any other spinal injury may lead to irritation or compression of the sciatic nerve.
 
8. Pregnancy
Pregnant women may suffer from sciatica due to weight gain, expansion of the uterus or increased fluid retention or other changes occurring in the body, which put pressure on the sciatic nerve.
 
9. Other causes
Osteoarthritis and fractures caused by osteoporosis may also affect the sciatic nerve, producing symptoms of sciatica.

Top 9 Causes Of Sciatica Nerve Pain - You Need To Know About

The causes and symptoms of chronic lower back pain

Lower back pain is characterized by a feeling of pain around the lumbar region (curve of the back connecting the upper back and glutes- muscles in the buttock that are responsible for thigh movement) caused by muscle or ligament injury. The spinal area is most likely to be affected by lower pain as it may impair routine activities like walking and standing. Any lower back pain that lasts for more than ninety days can be considered as chronic.

Causes of lower back pain

There are plenty of causes for lower back pain. Anything that exposes the lumbar area of the spine to a level of stress beyond its capacity can cause lower back pain. These causes are-

1. Disorders of the discs

The spinal area in the lower back comprises of small bones called the vertebra, which are connected to each other by pieces of cartilage known as discs. These discs act as shock absorbers, and when exposed to excessive shock can cause the disc to bulge, resulting in herniated discs. Wear and tear of the discs can also occur.

2. Spinal stenosis

Spinal stenosis occurs when the area around the spine becomes narrow. It may affect the nerves surrounding the lower back, resulting in pain.

3. Wear and tear of the joints and ligaments

Normal wear and tear of the joints and ligaments cause difficulties in holding the spine in its proper position and this progresses with age. This may cause a vertebra to slide over another and affect the nerve endings, giving rise to pain.

Symptoms of lower back pain

The symptoms of lower back pain are usually a dull or excruciating pain in the lower back. It can also affect other parts of the body such as the hips and the legs. In case of severe pain, simple activities like walking, bending and sitting will be impaired.



The Causes and Symptoms of Chronic Lower Back Pain

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.

Procedures That Can Help Treat Slip Disc & Sciatica!

Pain related sleep disruption has affected a large number of people around the globe. Statistics has it that, in India, about 25% of the population suffers from pain-related sleep deprivation. Studies call it  the vicious cycle of pain and sleep  as pain affects your ability to sleep and lack of sleep makes the pain even worse.

Back pain and arthritis are examples of some common pain-related medical disorders. People with these types of chronic pains have reported persistent sleeplessness or have had immense trouble falling asleep.

The following are the primary sleep disorders associated with chronic pain:

Insomnia: It is a medical condition that is characterized by an inability to fall asleep no matter how physically exhausted you are. Insomnia can be acute (lasting for one night to a week) or chronic (that lasts for more than 3 weeks).
Hypersomnia: It is a condition wherein you tend to sleep excessively; in this condition, you will have trouble being awake throughout the day or can fall asleep at any point of time.
Sleep Apnoea: This is a sleep disorder wherein breathing pauses and resumes repeatedly. Risk factors include obesity, age and gender; it is more commonly observed in men. This condition can be chronic with symptoms such as snoring loudly or feeling very tired even after one has had a night s sleep.
Restless leg syndrome: It is a sleep disorder wherein you continuously move your legs while sleeping. However, this condition can also cause you to move your legs even if you aren t sleeping.
Some of the causes of sleep disorders due to chronic pain are:

Pain
Worry and anxiety
Sweating at night
Depression and other mental disorders
Treatment

A pain and sleep disorder should be simultaneous as both the components of it, pain and sleep, are interrelated. Some of the ways people with chronic pain can still have a good night s sleep are:

Limiting caffeine intake
Abstaining from alcohol and smoking, as these disrupt the sleep cycles, thus aggravating the existing pain.
Practicing meditation and other relaxation techniques
Pain killers or sleeping pills can be administered, but only with the doctor s advice.
Hot water fomentation over painful area during night, for better sleep.

Back Pain and Bad Sleep

If you have a desk job that involves sitting right in front of your computer throughout the day or for a major part of the day, you could be unknowingly putting yourself at augmented risk of reduced hip mobility. The hips are one of the major muscles in your body that are used in a number of activities you do everyday.

Causes of Hip Immobility-

1. Sitting for long hours at the same place and working. This is common to people who work in front of the computer screens for extended hours continuously.

2. Toxic Synovitis, which is an inflammation of the hip joint. It causes pain and stiffness.

3. Juvenile Arthritis

4. Rheumatoid arthritis

5. Tendinitis or inflammation of the tendons that causes severe discomfort in movement

6. Ankylosing spondylitis that mainly affects the spine. It can cause extreme pain and discomfort in the movement of the hips. This makes it difficult to sit, stand or lie down.

7. Injuries

8. Fractures and breakage

9. Muscle and tissue ruptures near the hip region

10. Sprains and strains

11. Lack of proper blood circulation

12. Pain and injuries in the lower back region which can spread to the hip, causing stiffness and swelling

Physiotherapy for Hip Mobility-

Physiotherapy alias physical therapy is considered as one of the fastest growing allied areas of present generation medicine. Being an important rehabilitative service needed in a community and a vital therapeutic supplement of the medical profession, it's the treatment of diseases and disabilities using physical exercises, heat radiations, cold therapy, hydrotherapy, acupuncture and therapeutic massage. 

As doctors, physiotherapists or physical therapists are essential in helping the patient to recover and rehabilitate from a state of incapacity, due to genetic defect or the result of an accident or an illness. Physiotherapy for Hip Mobility involves certain exercises. Below give are some of the most common exercises for hip mobility-.

Lying Hip Rotations. One has to lie on the back on a padded mat, then put one leg over the other, exactly over the knee on one s lower thigh. Now, use either a towel or the hands to get to the leg that is placed below and without hyperextending, slowly pull this leg s knee closer to the chest.

Butterfly Movements and The Frog Posture.

The Kneeling Lunge. Here, one has to lunge forward with one knee on a padded mat. Then position the foot carefully beyond the knee that is put forward. Place your hands over the knees; straighten hip of the rear leg while leaning with the hips forward. Hold this particular stretch and repeat with the opposite side.

The Squatting Position.

The Pigeon Posture. In this, your knees need to be right below the hip on the padded mat. Then lower the outer side of the right buttock to the mat. You have to position your right heel in such a manner that it is exactly in front of the left hip. Hold this stretch for about 5-6 breaths and exhale deeply through the nose.

Bending forwards or backwards, guided and assisted by a physiotherapist.

Stretching Exercises.

Hot compresses on the area of inflammation.

Ice packs can also be applied alternately on the spot of injury.

Massage helps to regulate blood circulation and is an important part of physiotherapy.

Physiotherapy for Hip Mobility

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