Back pain is one of the most common debilitating disorder in the world today. The pain affects 90% of people at some point of their lives. Human back comprises of various structures (see figure) which are nerves, bones, muscles, ligaments, and tendons, any or all of which can be a source of pain. Once back pain occurs, it may become chronic (more than 4 weeks) and you shall need to consult a pain physician for relief and accurate diagnosis.
Since prevention is always better than cure,  you can save yourself from having back pain if you follow these basic tips.
Regular Exercise in Correct Form: Regular exercise is important to maintain proper muscular strength of the back. Human back is supported by several big muscle groups (see figure). They serve two functions - one is to facilitate the posture and movements of the back itself and the other is to help movements of the rest of the body appendages (arms, head, pelvis and legs).The health of these muscle group is important to take stress off the spinal bones and maintain proper function. Most of these muscles are red muscle fibers as they need to maintain their activity for prolonged periods of time. Just to give you an idea - your biceps (arm muscles) have to work only when you bend your arm. But your back muscles have to function all the time - whether you sit, walk, stand or even sleep. But the point is what kind of exercises are good for your back? The best exercises for back include body weight low impact aerobics like brisk walking, swimming, stationary bicycling, extension exercises and yoga. What is important to remember while doing these exercises if that you need to be gentle in your movements and achieve correct "form" - this is possible if you can ask someone (preferably a trainer) to observe and point out whether the back stays straight during the exercise. It has been seen that arching and excessive bending is associated with injury to the back while exercising.
Stay Hydrated and Eat Natural Nutritious diet:The inter vertebral discs contain 70 - 80% water. The muscles and tissues have 60% water content. Therefore, it is important to stay hydrated. In addition, you must eat a nutritious diet consisting of green leafy vegetables, good protein source and just enough carbohydrates. Deficiencies of essential nutrients like Vitamin D can result in diseases like osteoporosis. Another important aspect is to maintain body weight within healthy limits. This is very important as increased belly fat is linked to increased back pain due to mechanical factors.
Lift objects correctly and maintain proper posture:While lifting objects, keep them as close to body as possible. Do not slouch or bend excessively while lifting. Just keep your back straight at all times. You may bend your knees a little if required (see figure). Think before you lift and get help if needed.
While working, you must not sit for more than 45 minutes at a stretch. Walk for two minutes, go to a colleague's desk and say hi or even just drink some water or visit the washroom. Humans evolved as hunter - gatherers and our bodies are more adapted to walking / standing than to sitting for prolonged periods. Those of you who travel more and have to sit for long periods of time also need to follow above tips - avoid prolonged sitting in same posture.While exercising, improper position can do more harm than good. Therefore, proper form and posture is a must.
Bonus tip: Avoid cigarette smoking and those who smoke cigarettes to decrease your chances of having degenerative disc diseases leading to chronic back pain early in life.
Word of caution to prevent permanent damage: In case of back pain, which is not responding to home remedies or over the counter painkillers, please contact a Pain Physician to pinpoint the diagnosis and appropriate management.

3 Essential Tips to Prevent Back Pain

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

Facial paralysis is a loss of facial movement because of nerve damage. Your facial muscles may seem to hang or may become distinctly weak. It can happen on one or both sides of the face. Usual reasons for facial paralysis include:

Infection or swelling of the facial nerve
Head injury
Head or neck tumor
Stroke
Facial paralysis can increase all of a sudden or happen slowly over a span of months (mostly if one has a head or neck tumor). Based upon the cause, the loss of movement may keep going for a short or a long period of time. However, physiotherapy can prove to be very beneficial. Here is how:

1. Electrical stimulation: A few specialists suggest utilizing electrical stimulation and biofeedback as technique for physiotherapy for facial paralysis, yet different specialists believe that it does help in recovery. Talk with your specialist or advisor about whether electrical stimulation is ideal for you. Electrical stimulation uses little amounts of electricity to relieve the muscles in your face. This causes your muscles to jerk as though electrical signals from your brain reacted to them. During this time, your face is most incapacitated, which might be the main cause for you to enact these facial muscles.

2. Manual massage: Face rub can be performed in conjunction with other treatment choices. It is possible to enhance mental relief. Massage methods on the face include:

Effleurage
Finger or thumb massage
Tapping
Stroking
3. Kabat rehabilitation: Kabat recovery is a sort of engine control restoration procedure. During Kabat, specialists increase the compression of the weakened muscle by applying a global stretch and then massaging the solid segment. They encourage movement by verbal info and manual contact. While performing Kabat, there are namely three phases - the upper (temple and eyes), intermediate (nose), and lower (mouth). Before Kabat, ice compression needs to be performed to the particular regions, with a specific end goal to build its contractile power.

4. Icing: Ice helps in decreasing the aggravation surrounding the facial nerve, which might be in charge of the loss of nerve movement or conduction leading to facial paralysis. You can either use an ice pack or any cold compressor.

5. Facial exercises: These include doing essential activities with the distinctive muscle surrounding your face. In case you consult a specialist or physical advisor for your facial paralysis, he or she will suggest particular exercises for your level and stage of paralysis. If not, have a go at flexing the different muscles in your face through and through. Frown, raise your eyebrows, gradually flicker your eyes, and proceed down to your jaw.

Facial Paralysis - How Can Physiotherapy Help You Get Better?

Paralysis is characterized by loss of movement, muscle function, and sensation. The patient is unable to function normally in the aftermath of a paralysis attack. The disorder affects people in different ways. It is either partial or complete. It afflicts one or both sides of the body. It arises in one or several areas and can either be short-term (post a stroke) or long-term (due to spinal cord damage). There are different types of paralysis such as Monoplegia, Hemiplegia, Paraplegia, and Quadriplegia. Some symptoms that are associated with paralysis include loss of memory, loss of hearing, clumsiness, drooling, and changes in behavioural patterns.

Why Physiotherapy for Paralysis?

Physiotherapy is recommended for people affected by paralysis for many reasons. Physiotherapy helps relax the muscles and boosts the flow of blood within the body. Patients are advised to use braces, splints, orthosis, and canes by physiotherapists to facilitate movement in their condition. Wheelchairs are also advised so that the patient can move about a little if they have lost sensation in the lower limbs.
In case of brain injuries, the practice can reduce the swelling and promote healing.
Paralytics are also given counselling sessions for boosting their morale. They are encouraged, educated by their practitioners and can go a long way in improving their condition.
Physiotherapy exercises are also useful for restoring lost strength in the afflicted muscles, which, in turn, prevents deformity in the limbs. Physiotherapy exercises can restore sensation and subsequently the movement in the affected area.
The health problems of the patients are also addressed during physiotherapy. Also, the underlying causes of the disorder are treated, and this helps in restoring mobility for the patient.
Physiotherapy treatment helps the patient to adjust to daily life after suffering a stroke. The efforts are directed towards making them independent. As part of the treatment program, the patients are advised about various aspects, including exercises, surgical procedures, medicines and other self-care methods. Physiotherapy produces results over time and is not an immediate solution to the problem.
Paralysis   What type of diet should you go for?

Physiotherapists advise the patients suffering from paralysis to eat a nutritious diet. Intake of B-complex vitamins is very important, such as vitamin-B12 and niacin, the patients can improve the functioning of their nervous system.
Essential fats are also recommended due to their anti-inflammatory properties and ability to restore the health of the nervous system. Some food sources of these nutrients include walnuts, flaxseeds, beans, bananas, pumpkin seed oil, potatoes, and lentils.
It is important to note that physiotherapy practices can help people with paralysis in several ways. Most importantly, the victims receive encouragement and counseling from the physiotherapists who guide them towards a treatment option that can help restore normalcy in their lives.

Paralysis - How Physiotherapy Will Help In Treating It?

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!

Slip disk is a condition of the spinal column which consists of a stack of vertebras from the cervical, thoracic and the lumbar spine.The bones of the spine are cushioned by disks that are present to absorb shocks. Trauma to the spine may cause the disk to bulge or be ruptured. This may lead to pain in the neck and the back. 

Causes of slip disk

Slip disk is caused when the jelly like substance present in the disks bulges out. The damaged disk thus puts pressure on the adjacent nerve causing excruciating pain. The various causes of a slipped disk are:

1. Incorrect form during exercise: If you are into weight lifting, it is important that you use proper form during exercising. Moves like barbell squat and deadlifts can put pressure on the spine and lead to disk problems, if not done correctly. Make sure you work on your core strength and keep your lower back straight while exercising. 

2. Smoking: Smoking causes the disks to lose their flexibility and thus, increases the risk of slipped disk.

3. Ageing: Ageing decreases the content of water in the spine, thus leading to inflexibility.

The symptoms of slip disk are:
1. Pain on one side of the body that tends to aggravate over time
2. Activities such as sitting and coughing may lead to pressure on the spine causing pain
3. Your range of motion on certain movements may be restricted
4. Pain in the neck while moving it
5. Numbness in the shoulder and the neck region
6. You may experience tingling sensations in the genitals, hips and the legs
7. You may have muscles spasms which lead to sudden contraction of the muscles
8. It may also lead to partial paralysis of the lower body

Prevention
1. If you are overweight, try to reduce weight and then focus on maintaining healthy weight levels
2. Maintain proper posture while sitting or standing
3. Exercise on a regular basis to build strength and keep your joints healthy
4. Don't remain in seated position for an extended period of time. Take small breaks in between to stretch

Slip Disk Problems

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