Muscle cramps often occur in the calf muscle of the back of the lower leg. It is often characterized by a momentary sharp pain along with a muscle lump beneath the skin. Just like its sudden appearance, muscle cramp disappears the same way without any botheration. However, a doctor should be consulted if you see any of the following symptoms:

    The pain keeps coming back
    The cramps result in weakening of the muscles
    It causes frequent discomfort
    It results in changed skin color, redness or swelling of the skin
    The condition doesn t improve with normal care
    Cramps are not associated with obvious causes such as playing, exercising and jogging

What causes muscle cramps?
Any strain on muscle, dehydration, muscle overuse or simply standing for a prolonged time can lead to muscle cramps. The exact cause of muscle cramps is not known in a lot of cases. There could be the following medical conditions that could lead to such muscle cramps:

    Blood supply: At times when the arteries narrow down resulting in an inadequate blood supply in the leg, a sharp pain can be felt followed by muscle cramps. This can happen while exercising or playing. It disappears as soon as one rests their legs.
    Mineral depletion: Shortage of magnesium, potassium and calcium in the body can lead to muscle cramps. Even medication for high blood pressure can lead to cramps in the legs.
    Nerve compression: Nerve compression of the spine can produce sharp pain on the leg muscles. The pain worsens with longer durations of walk. The symptoms, however, can be delayed a bit if the walking posture is changed, like the way one walks while carrying a shopping cart.

What are the risk factors associated to muscle cramps?

    Dehydration: Muscle cramps often happen among athletes when they get dehydrated and fatigued while performing in hot temperature.
    Age: People over the age of 60 often lose mass in the muscle. The remaining mass gets stressed out soon, resulting in muscle cramps.
    Pregnancy: Pregnant women face frequent muscle cramps due to the sudden increase of body weight and restricted movements in the pregnancy period.
    Medical conditions: Certain medical conditions such as nerve disorder, thyroid problems, liver failure, diabetes etc. greatly increase the chance of muscle cramps.

Some common ways to treat muscle cramps:

    A brisk walk followed by stretching relaxes the muscles and greatly helps in staying away from cramps.
    A diet consisting of magnesium on a regular basis gives relief from muscle cramps.
    A wet cloth soaked in hot water often shows magical results and gives instant relief from muscle cramps.
    Being hydrated throughout the day helps with muscle cramps. It is necessary to consume enough amount of electrolytes so that muscle contraction does not happen.

Why You Get Muscle Cramps?

Fibromyalgia is a musculoskeletal disorder that is more prevalent among women (in the age group between 25 - 60 years) than men. The condition often results in muscular and joint pain along with extreme tiredness. Further, there may be severe headaches, body stiffness, insomnia or sleeping disorders, high sensitivity to extreme temperatures, abdominal pain, Irritable bowel syndrome and also Fibro Fog ( a condition triggered by Fibromyalgia, whereby an individual is unable to concentrate on anything). In some, the condition can trigger severe anxiety, stress, and depression.

While discussing Fibromyalgia, it is important to mention about the Tender Points or Trigger Points. These are delicate points and areas located throughout the body where even a gentle tap or pressure is enough to cause pain. Some of these trigger points in Fibromyalgia include:

upper chest.
back of the head.
knees.
top of shoulders.
outer elbows.
hips
Some of the common factors that play a significant role in triggering Fibromyalgia are

Stress and Trauma: Fibromyalgia may be an outcome of extreme physical, mental and emotional turmoil (which often creates a hormonal imbalance) or Post-Traumatic Stress Disorder.
Fibromyalgia may be linked to genetics and hereditary. People with a family history of Fibromyalgia are more susceptible to the painful condition.
In some individuals, an autoimmune disorder such as Lupus or Rheumatoid Arthritis can also be a contributing factor resulting in Fibromyalgia.
Acupressure to treat Fibromyalgia

People often opt for Alternative Therapy to treat Fibromyalgia. Individuals with Fibromyalgia benefit immensely from Acupressure. Acupressure is a popular alternative therapy that finds its origin in China. It channelizes upon the use of pressure at certain points in the body to ease the pain. Some of the acupressure points that are often used to relieve the pain, especially related to the Post-Traumatic Stress Disorder, in Fibromyalgia include:

Stomach 36 (ST 36): ST 36 holds great significance in providing a soothing and calming effect in people with extreme stress and anxiety (one of the critical symptoms associated with Fibromyalgia). ST 36 is located in the depression of the tibia (lateral side), at a distance of about four fingers downwards from the patella or the knee. Gently and slowly massaging the point for 3-4 minutes is said to provide great relief.
Ren 17: Another acupressure point that goes a long way to lower the anxiety and physical stress is Ren 17 or the chest center. This acupressure point is the middle of the chest (anterior midline), at the fourth intercostal space from the second rib downwards.
Ear Shen Men: The Ear Shen Men is an important acupressure point in the triangular fossa, at the upper region of the ear. People with physical and emotional stress benefit from this acupressure point.
Pericardium 6: The Pericardium 6 is in the mid arm region (lower and inner part of the arm) between the two tendons at a distance of four fingers from the wrist crease. In addition to a great soothing effect, Pericardium 6 is beneficial for people with nausea.
Yintang: Nothing works more like the Yintang to relieve stress and anxiety. The acupressure point in between the eyes at the eyebrow level.

Role Of Acupressure In Treating Fibromyalgia

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

Being flexible is not always about doing splits or doing some random bending. It is about achieving a level of mobility that will not hold you back from doing whatever you are able to do. Most people think that stretching or flexing your muscles and body as the first method to defend you from pain. But if stretching and flexing can be done correctly, it can lengthen one's muscles and give one relief from pains and aches. Stretching is also done to increase the functional range of one's joints and muscles. There are various ways by which one can stretch their muscles. However, the question which looms over here is which is the correct procedure and which is the wrong one.

The Wrong Vs the Right Way: Before discussing about the correct way, let us talk about the various wrong ways in which stretching can be done. The first rule is that if stretching is causing you pain or if it is hurting you, then you are probably taking it too far. A muscle needs to relax as much as possible, if it needs to stretch. If one is stretching so hard that he or she cannot relax then the muscle will not lengthen. Stretching should never be painful.

One should also avoid stretching for an insufficient length of time. Only a few seconds of stretching will not hold the therapeutic effects of stretching.

The following methods are few of the correct ways to stretch:

Always start with the warm muscles. Warm your muscles by doing some aerobic movement or by applying heat with the help of a warm bath.
After warming your muscles, monitor your level of discomfort. Let it go once you feel pain.
Hold any stretch for at least 30 seconds.
Stretching the Correct Muscle: There are muscles, which need to be stretched and there are muscles, which should not be. So getting to know the correct muscles to be stretched is as important as knowing the correct procedure to stretch your muscles. Every muscle, which does not hurt should not be stretched. There are different types of muscles that cause pain like stiff, tight, short muscles and long muscles. Muscles that are tight should only be subjected to stretching. Stretching muscles that are too long is not a good idea.

Using Physiotherapists: Most people who cannot determine which muscle should be stretched and which should not be should consult a physiotherapist. Physiotherapists can quickly and easily diagnose muscular issues. They will also show ways to stretch which are most effective for particular needs.

Stretching should be made a part of one's life. It is a way by which one can become their healthiest self and avoid muscular imbalances.

Stretches for Tight Muscles 

Ankylosing spondylitis (AS) is a type of arthritis that affects the spine. This chronic disease is caused due to inflammation of the joints in the spine and usually affects young men. It causes the vertebrae to grow or fuse together, causing a rigid spine. Actually, it affects the discs in between the vertebral column. These discs get swollen, causing a limitation of spine motility. It is an autoimmune disorder and its symptoms are lower back pain and stiffness, which usually moves to the legs.

The deformity due to AS can be mild or severe. In extreme cases, the patient gets a stooped spine. 
Early diagnosis can prevent significant deformity as well as help in controlling the pain and stiffness.
Allopathy doesn t really know the real reasons for this disease and here is where Ayurveda scores.
According to Ayurveda, AS is caused due to aggravated vata or wind, which causes an imbalance in vata dosha.
Ayurvedic treatment
Ayurvedic treatment starts with detoxification and elimination of toxins. It relies heavily on the right diet and lifestyle as well as Ayurvedic herbal preparations. The panchakarma techniques called kati vasti, sarvangadhara and patrapinda svedana are very beneficial too. The basic explanation for the disorder is that AS occurs due to an accumulation of ama or toxins in the body. Where ever ama deposits in the body, pain is caused. Ayurvedic treatments aim at digesting the ama by using herbs as medicine and balancing the aggravated vata.

Herbs used in the treatment of AS are dry ginger (saunth), guggul, turmeric, fenugreek, ashwagandha and giloy. Gugul, curcumin, amlaki, haritaki, and ashwagandha are all very effective in treating AS.
Avoid getting constipated and ensure proper evacuation of bowels.
Include ghee in your diet for lubrication and for lowering the vata dosha.
Apply heat on the affected areas to control the pain and stiffness.
Eat light foods and strictly avoid oily foods and curd which increase ama.
Avoid sleeping during the daytime.
Yoga asanas like pawana muktasana, bhujangasana, dhanurasana, paschimottanasana and vakrasana should be practised regularly.
The practice of pranayamas such as and shodhana, chandrabhedi sheethali and bhramari also helps.
Chewing 2 3 raw garlic buds on an empty stomach in the morning with water helps in alleviating lumbar pain in AS.
Use a powdered preparation of dried ginger root, celery seeds and cumin seeds in equal quantities with rock salt for taste, and have one teaspoon of this mixture with warm water at bedtime to reduce flatulence as well as lumbar stiffness.

Ankylosing Spondylitis (AS) - Ayurvedic Remedies That Help You Treat 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!

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