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!

After a tough workout session or a strenuous day at the office, your muscles may feel floppy and exhausted until you have given them a chance to rest. However, persistent muscle weakness with no apparent cause or explanation can be a sign of an underlying medical problem.

What causes muscle weakness?
Voluntary muscle contractions and movement are generated when the brain sends a signal through your spinal cord and nerves to the particular muscle. If there are any hindrances in the connections between them, it can result in muscle weakness. However hard you try, the muscle is such cases becomes abnormal.

Here are some common causes of muscle weakness:

Lack of Use: One of the most common causes of muscle weakness, lack of muscle fitness may occur as a result of a sedentary lifestyle. If the muscles are not used, then the fibers are partially replaced with fat.
Ageing: As we age, our muscles tend to get weaker and lose strength. Muscles become bulky and recovery times during injury are greater. However, with physical activity, it is still possible to increase the muscle power. So stay active and instill strength in your muscles.
Infections: Infections and inflammation can cause temporary muscle fatigue. Even though recovery is quick, if the infection is severe the weakness can last for some time. Without proper care, it can lead to permanent damage.
Pregnancy: During and just after pregnancy, high levels of steroid in the blood and low levels of iron can cause muscle tiredness. Lower back pain is common during pregnancy and all your muscles may feel floppy.
Chronic Diseases: With conditions of diabetes, heart disease, kidney disease and anemia, it can lead to muscle weakness by thwarting the essential blood or nutrient supply to the muscles. Also, chronic pain related ailments cause weakness.
Injuries: Injury or trauma such as sporting injuries, pulls and sprains can deter the muscles. Along with localized pain, it can also lead to muscle weakness if not taken care of properly.
Sleep Disorders: With disturbed or reduced sleep there is a general sense of tiredness that leads to fatigue in the muscles. Insomnia, anxiety, depression and other mental disorders also affect the muscles a great deal.
Conditions affecting Nerves: Conditions like Myasthenia gravis or motor neuron disease affects the nerves and thereby fail to relay signals to the muscles, leading to weakness.
Genetic disorder affecting muscles: There are also certain inherited diseases which can affect the muscles like muscular dystrophy.
Spine-related disorders: Conditions like slip disc and other disorders affect the muscles served by the irritated or compressed nerves of the spinal cord.

Muscle Weakness - 10 Common Reasons Behind It!

A Tennis elbow is a painful condition that affects the tendons due to a condition known as tendinitis, which causes inflammation. This condition will end up restricting the free movement of the elbow and the arm due to the pain and stiffness that it causes. This is due to the fact that these tendons are the tough band of connective tissues that hold the muscles and the lower arm with the bone. Repeated gripping motions and continued tugging as well as activities like weight lifting, tennis, squash and other like carpentry, painting writing and typing, can lead to this condition.

Here are a few methods of treatment and the questions that revolve around them.

Do I have to restrict my movements: Yes, when you have tennis elbow, the very first thing you must do is to give rest to the tendons by curbing those activities that have caused the condition or those which can aggravate the pain and stiffness. Lifting heavy objects, gripping things for prolong periods, other physical pursuits like tennis and other games and more will need to stop so that you do not stretch, strain or pull the tissue.
Can I take pain killers: Yes, you can take pain killers like ibuprofen and acetaminophen in case the pain is unbearable? Always ensure that an orthopedic specialist takes a look at your arm before prescribing the medicines to you.
Is an ice compress good for this pain: You can use the RICE method for acute pain that is less than 72 hours old. For more persistent pain, you must see a doctor. The RICE method refers to Rest, Ice, Compression and Elevation. In this method, you can keep your arm elevated and give it rest. You can also use an ice compress and keep it tightly wound with an elastic bandage so as to avoid swelling.
Can I take injections for this condition: Corticosteroid injections may be used for very severe cases. This contains the cortisol hormone and can give good results in the short run.
Are there any non-invasive methods for treatment: You can try non-invasive procedures like shock wave therapy which will help in fixing the pain and promote motion gradually. This procedure is usually conducted with the help of shock waves that are passed to the skin.
Is exercising a complete no: In this case, many orthopedic surgeons and doctors will ask you to go through physiotherapy so that you can get used to movements and motion after prolonged pain. These exercises will also strengthen the muscles of the area.
Talk to your doctor if the pain is particularly debilitating and discuss surgery for the same.

Tennis Elbow Treatment - What Are The FAQs Of It?

A menstrual cramp is something which every woman complains of for a day or two every month. Menstrual cramps are usually the pains felt in the lower abdomen, which can occur both before and during a woman's menstrual period. These cramps are caused by a hormone called prostaglandin that causes the uterine muscles to contract during menstruation. When the uterus contracts to shed its natural lining during your period it releases a hormone called prostaglandins which causes pain and inflammation. So higher the level of prostaglandins more severe the menstrual cramps.

It might be just a minor discomfort for some, but for others it can be severe. The symptoms of menstrual cramps include pain in the abdomen, pressure in the abdomen and pain in the hips, lower back, and inner thighs as well. However, if the cramps are severe you might have an upset stomach, loose stools and vomiting too.

Three out of four women experience menstrual pains and every one out of 10 women experiences severe cramps. Here are few remedies that might help in relieving the pain:

Exercise, brisk walking or any type of physical activity can help to ease your belly pain as by being physically active your body pumps more blood, which helps in releasing endorphins to counteract the prostaglandins and reduce your cramps.
Apply heat on the lower abdomen or the area where you feel the pain as it helps to relax the contracting muscles in your uterus.
Improve your diet by reducing fat and increasing vegetables. However, avoid foods that contain caffeine and salt.
Take a warm bath as it may also provide some relief.
Add ginger in your food as it helps in lowering the levels of the pain-causing prostaglandins.
Drink chamomile tea at least three times a day.
Take fish oil supplements, vitamin B1 or both.
Make sure to get enough vitamin D.
Have an orgasm as it releases endorphins which has a pain-relieving effect and helps in boosting your mood as well.
Include more dietary magnesium such as dry almonds and boiled spinach as it helps to ease the pain of cramps.
Acupuncture also has an anti-inflammatory effect.
Take a safe painkiller to reduce pain.
Birth control pills may help relieve painful cramps, but they do come with side effects which may include spotting, breast tenderness, nausea and low sex drive.
Refrain yourself from smoking and drinking alcohol.
Finally, have appropriate rest.
Note: If you still do not get any relief despite trying some of these options then you must visit your doctor to rule out more serious health issues as the menstrual cramps are sometimes caused or worsened by other conditions and any sort of medications for such cramps are to be taken after consulting a Gynaecologist.

How to Get Relief From Severe Menstrual Cramps

Taking into account the hectic lifestyle we lead, most of us end up suffering from aches and pains. But that does not mean we have to continue to suffer from them. There are plenty of easy exercises that one can follow in order to keep themselves healthy and problem free!

In order to avoid aches and pains, the first thing that a person needs to do is 

Practice hamstring stretches regularly: What this entails is that he or she needs to lie on the back, raise a leg and hold the back of it with both hands. While it may be called the hamstring stretch and one would probably normally think that the beneficial impact of doing it would be limited to the hamstring, it works quite a bit of special magic which has an ability to ease the pain in the lower back. Now, for an exercise which is so simple, is it not worth it?
Side Stretch: Talking about stretches, another form of a stretch happens to be the side stretch. Even this is rather simple and all that needs to be done is to lie on one s side and pull the ankle of the leg which is not in contact with the ground towards the back. While this is being done, the ankle of the lower leg should apply pressure on the thigh.
Straight leg raise: It may seem that most of the exercises which reduce pain are stretches! However, this is not really the case as there is a place for exercises such as the straight leg raise and the like. What exactly is the straight leg raise? Well, it can be done when a person is either in a sitting position or is lying on his or her back. The toes are to be kept pointed upwards and the leg is to be raised. It is to be kept in mind that the challenge of the straight leg raise is that the knee should not be bent, at all.
The cat and camel exercise: The terms cat and camel generally refer to members of the animal kingdom. However, jointly, in terms of exercises, the cat and camel is an exercise well worth remembering as it can save the individual quite a lot of pain. All that needs to be done is to alternatively arch one s back towards the floor and the ceiling while resting on one s hands and knees.
While our way of living may come with certain side-effects ,but it would not be right to say that we are helpless. We need to take charge and make little changes to enjoy a healthy and happy lifestyle.

4 Easy Exercises for Aches And Pains

The trapezius muscle is a triangular muscle which extends from the neck, down to the middle of the upper back and across the shoulder. It is one of the largest muscles in the body. It helps in stabilizing and moving the scapula. When you rotate your neck, move your arms, or even shrug your shoulders, you are able to do it because of the trapezius muscle. Over use of the muscle can cause it to strain.

Trapezius strain can be quite annoying and uncomfortable as you will have difficulty in moving your shoulders. It also causes any upper shoulder movement very difficult as it gives out an excruciating pain whenever you try to move your head or rotate your neck. It generally happens when you repetitively put stress on the muscle.

Causes:
1. Poor posture while sitting, standing or lying down
2. If you sleep in a wrong or uncomfortable position
3. If you bend over a desk for hours(This is more relevant to office workers)
4. If you have to carry heavy weights on your shoulders(This is relevant to school and college students who have to carry heavy bags every day)
5. If you over work your trapezius during work outs
6. If you suddenly twist your neck
7. If you met with a fall or accident which injured your back.

Symptoms:
The symptom that characterizes a trapezius strain is the searing pain in the muscles which is scattered around from the shoulders to the neck. The pain might interfere in your daily activities such as moving your arms when you push or pull. It might also cause discomfort while trying to sleep. A trapezious strain might even cause a bit of swelling in the muscle. Sometimes, due to the neck pain, you might even get headaches.

Treatment:
1. Resting: Rest as much as possible. Any strain or swelling can be easily cured with proper rest.
2. Ice packs: Ice packs help to reduce the swelling and get some relief from the pain.
3. Exercise: Stretchingthe muscle will help loosen it.
4. Blood flow stimulation therapy: After the inflammation is reduced, you should take up this therapy as an increase in the blood flow in the affected area will help cure the strain.
5. Care for the scar tissue: The scar tissue will take longer to heal than the muscle. Hence you have to follow your doctor's instruction very carefully to get a speedy recovery.

All About Trapezius Strain!

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