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

Cure insomnia with natural remedies


Insomnia is the situation where someone is unable to sleep, despite being tired or having had a tough day. It also applies when a person can fall asleep but is unable to stay asleep for long. Sleep apnea, chronic pain, indigestion, stress, medications, hormones, depression, chronic pain and restless leg syndrome are few of the symptoms of insomnia. Insomnia has become quite common and increasing ever so rapidly with our daily stressful lifestyle. There are some simple ways to combat insomnia:

1. Make Sleep a habit : 
There is a general practice to cut the sleep short whenever we go behind the schedule. Be it sitting for an important examination or preparing for a challenging assignment. It is always the sleep whom we sacrifice. This is a very bad practice. We need to remember that adults needs eight to ten hours of sleep for proper mental functioning. So make sleep a habit , try to follow a simple routine. It will help you establishing  regular sleep-wake cycles which will in long run prevent insomnia.

2. Add amino acids to diet: 
Include in your diet, foods that are high in the amino acid called tryptophan because they help calm the nerve. Chicken, tuna and turkey are such types of foods.

3.Drink hot milk: 
It has been an age-old custom to have a glass of warm milk before going to sleep. So, If you are not allergic to dairy products, you can drink a glass of milk before bedtime. It has sedative effect due to presence of tryptophan.

4. Avoid caffeine after noon and Limit alcohol and nicotine intake:
Avoid Coffee, alcohol and food with high fat content and foods which can cause allergies, at least a few hours before your bedtime. Drinking water or coconut water, after drinking alcohol is advisable. This increases the hydration level in the body and helps you sleep. You should also avoid nicotine  which is also a stimulant thus adversely affects normal sleep.

5. Pick magnesium rich foods: 
Foods which are high in magnesium are known to relax our system. Foods like oats, leafy vegetables, sunflower seeds and sesame can be included in your diet for best results against insomnia.

6. Stay away from your phone at bedtime:
It has been postulated that the blue wavelengths produced by your smartphone and other gadgets (and energy-efficient LED light bulbs) significantly suppress the production of melatonin, the hormone that makes you sleepy, according to University of Basel research. So it is better avoiding surfing the phone at bed. You have enough time with it during the whole day. Is not it? Let her sleep too.

7. Practice yoga:
Practice 15 minutes of simple, yoga-like poses (such as neck rolls, shoulder rolls, and arm and back stretches) to help your muscles unwind before hitting the bed. But you should go slowly. “The goal is to loosen your muscles to prepare your body for a good night’s sleep, not increase your heart rate,” 

8. Try aromatherapy:
Studies have shown that aromatherapy aids in sleep. Lavender oil is most commonly used, It's also an inexpensive, nontoxic way to slip into a peaceful slumber. Find a spray with real lavender and spritz it on your pillow before bedtime and it may help you go asleep better.
 
9. Adopt deep breathing exercises:
Practice deep breathing  and relaxation exercises. They are simple and can be performed lying on bed. This will help you let go stress and worries that are troubling you and will therefore calm your nerves.

10. Re-organise your bedroom:
Bedroom should be quiet and dark to have proper sleep. You can use dark window curtains which will cut the lights from outside. You can try using sleep mask. Try not to watch television for at least half an hour before bed. Make your bed comfortable with extra mattress, pillows that are not too soft or too hard. Doing these simple things will make a lot of difference in your sleep habit.
 
 



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Fight insomnia naturally. #SleepWell 

Acupressure can prove to be extremely effective if you are looking for non-medicinal solutions to treat musculoskeletal problems, such as back pain, sports injuries, arthritis, etc. Acupressure is the application of putting firm pressure on the areas on the body which are swollen, agitated or tense by massaging the acupoints (specific points in the body). Acupressure believes that relieving these areas of pressure reduces the pain.

Here are some musculoskeletal problems that can be healed by acupressure:

    Arthritis: Those who seek acupressure as an alternative treatment for pain are mostly suffering from arthritis (a disease characterised by chronic joint inflammation and cartilage degeneration). Acupressure applies pressure on the inflamed joints.
    Back pain: Back pain is a common problem that can affect anyone irrespective of his or her age. Acupressure acts to relieve the points where the muscles are too tense and helps to tone or support the muscles which have become weak with disuse.
    Chronic pain: Unrelenting pain can stem from many causes. Acupressure focuses on the pain and the pain signals when treating chronic pain. The acupoint of the pain and the nerves are gently massaged to relieve the pain.
    Fibromyalgia: Traumatic injury to the soft tissue, emotional trauma or severe illness can cause fibromyalgia. It is non-inflammatory in nature and often leads to Chronic Fatigue Syndrome (a troublesome disorder with symptoms of deep fatigue, sleeping problems, pain, etc.). Acupressure can greatly improve the fatigue and sleeplessness that fibromyalgia causes.
    Tendonitis: The tendon connects the tissue to the bone, and tendonitis is the condition when the tendon is inflamed. Acupressure helps in reducing the inflammation and easing mobility restrictions.
    Sciatica: The sciatic nerve is the longest nerve in the body, stretching from the lower spine to the back of the foot. So when this nerve is agitated, pain radiates from the lower back to the foot. This condition is called sciatica. The acupoints in sciatica are the lower back and the hip. Acupressure effectively loosens the muscles in these regions and reduces inflammation.
    Sports injuries: Strains and sprains are common sports injuries, which mostly affect athletes. Acupressure has anti-inflammatory benefits that can help heal severely injured tendons, ligaments or muscle. Acupressure also plays a huge role in restoring and retraining the body, especially if you are an athlete and play high-demand sports.
    Carpel Tunnel Syndrome: Carpal tunnel syndrome is a condition in which the pressure increases on the median nerve as it goes through the carpal tunnel, and this causes wrist pain. Acupressure involves the use of directed pressure to specific acupuncture points on the surface of the body.
    Insomnia: Insomnia is a sleep disorder. The Acupressure Points between your heel and anklebones (on both sides) have traditionally been used to relieve and prevent insomnia.
    Migraines: Acupuncture is used to effectively treat primary headaches, namely tension and migraine, which are the most common.

Acupressure: The Non Medicinal Solution to Musculoskeletal Problems

Depression is a clinical, mental and emotional condition that may give rise to feelings of hopelessness and chronic sadness. It slows down the way people process everyday activities and leads the patient to a sense of constant gloom and doom. It is a disabling mental condition as per who and may be caused due to reasons like genetics, changes in the balance of hormones, stress, grief, trauma and prolonged, chronic physical ailments.

Symptoms of depression are:

    Sleep irregularity: It relates to either insomnia or oversleeping that is, either you sleep too much or do not sleep at all. This could be because of work or other stress in your personal or professional life.
    Irritation or unnecessarily getting angry: You start losing your temper easily and that too for silly reasons. You think you are losing control.
    Feeling hopeless and sad: The first signal or symptom is the feeling of hopelessness. In this, case the patient loses the hope in everything. They feel like being trapped in some kind of cage, from which they are not able to come out.
    Lack of interest in anything: Everything seems to be of no use or interest, even your daily work. You don't want to do anything; even the things, which you loved to do like your hobbies and passions, which you no longer find interesting.

Here is a comprehensive list of homeopathic medicines which most doctors are likely to recommend for treating depression:

    Sepia: This medicine is beneficial to women suffering from post-partum depression (sadness or emotional conflict after giving birth) and menopause. Feeling of solitude and hopelessness with no energy to continue with life are some common symptoms that can be reduced with Sepia.
    Arsenicum album: This medicine is prescribed to control the symptoms like diarrhea, gastric problems, indigestion which patients often suffer from as a result of intense anxiety. Patients, appropriate for this medicine tend to be fastidious and restless. It is made of white arsenic and should be taken in prescribed potency because an overdose can cause gastroenteritis.

The above mentioned medicines are just some of the medicines, which should only be taken only after consulting your doctor, as causes and symptoms differ for each person.

Can Sleep Irregularity be a Sign of Depression?

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!

4 exercises to strengthen your knees

Knee pains and pains in the joints are not restricted to a certain age group anymore. Younger people of today face this problem too. To stay active all your life and escape the severe aches associated with weakening of muscles, joint pains or arthritis, you must start now. The only way to keep your knees fine and working is to exercise. 
4 moves that help you strengthen your knees.
1. Leg lifts (inner thigh) - lie on any one side, lay your head on the arm of the side below you. Make sure this hand is straight above your head, touching the ground. Keep your legs straight, one above the other. Lift the leg on top a few inches above, hold for few seconds and bring it back. Do this for 10 times and then with the other leg, on the other side. This exercise strengthens your inner thighs, eventually strengthening the knees.
2. Hip raises: lie flat on your back, your shoulders touching the ground. Bend your legs comfortable, your feet resting firmly on the ground. Raise your hips and thighs so that from your head to feet, you form an angle. Wait in this position for about 10 seconds, lower your hip until it touches the ground. Repeat for ten counts.
3. Lunges: stand straight. Take a step ahead with your right leg. Left leg remains in its place. With your back straight, bend your knees so that both are at 90 degrees. Go back to standing position; take your right leg back to where it was. Do the same step with your left leg. Repeat both sides ten times.
4. Bent leg extensions: this is pretty easy and all that you need to do it sit on a chair comfortably, with your back straight first. Your feet firmly flat on the ground in front of you, lift the right leg straight extending to the front. Make sure your thighs stay on the chair. Bring your leg back to the original position, firmly planted on the ground. Do the same with your left leg. Repeat 10 times on both sides.
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The Only 4 Moves That Strengthen Your KNEES

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