Cervical spondylosis is an age related disorder affecting the discs and joints in your neck. The overuse of the bone and cartilage in the cervical spine of your neck leads to cervical spondylosis. While it is mostly caused by age, it can also be caused by other factors. Stiffness and severe, chronic pain are the most common problems with patients afflicted with cervical spondylosis. While in others, it might not cause problems and they can go about their daily activities.

Physiotherapy for Cervical Spondylosis
There is no cure for cervical spondylosis, but its symptoms can be treated with physiotherapy. If you have chronic pain in your neck, shoulder blades or arms, a physiotherapist can provide effective pain relief by strengthening your vertebrae and neck. This will improve your posture and prevent any relapse of the pain.

Firstly, the physiotherapist will evaluate your condition; check your reflexes and strength. Then, the physiotherapist will move on to the following treatments:

Stretching, strengthening and straightening exercises: Before beginning these exercises, your physiotherapist will first apply cold or heat to the affected area and then proceed with a deep tissue massage or electric stimulation. When your muscles are relaxed, the exercises will begin only then. These exercises are performed to strengthen the muscles in your neck. Through these, you will learn how to improve your range of movement and posture.
Neck traction: Pulling your head to stretch out your spine is called neck traction. This technique is used to improve movement and ease the pain. Traction is used to open the spaces between the vertebras gently in order to ease pressure on the distressed discs. Traction is done continuously or sporadically, with short periods of rest in between. If you cannot find the right physiotherapist to do this for you, there are devices to help you stretch your spine.
Cervical collars and pillows: Neck pillows or cervical pillows, are made to keep your neck steady while you sleep. Cervical collars are also called neck braces which are used to support the neck. While cervical collars have been proven to be quite beneficial, there isn t much evidence to support cervical pillows in treating cervical spondylosis. You can always consult your physiotherapist before purchasing a cervical pillow.

Cervical Spondylosis - How Physiotherapy Can Help Treat it?

As life expectancy is increasing so is the incidence of vertebral body (VB) fractures now being the commonest fracture of the body. PVP is an established interventional technique in which bone cement is injected under local anaesthesia via a needle into a fractured VB with imaging guidance providing instant pain relief, increased bone strength, stability, decreasing analgesic medicines, increased mobility with improved quality of life and early return to work in days.

In this era of minimally access surgery replacing open surgeries, PVP is a novel procedure & should be in the first line of management in place of conservatism or major spine surgery for painful uncomplicated compression fracture spine.

Morbidity & consequences of spinal fracture:

Traumatic VB is a painful condition requiring bed rest restricting daily activities markedly
Left untreated it can cause DVT, increase osteoporosis, loss of VB height, respiratory & GI disturbances, emotional & social problems secondary to unremitting pain, loss of independence with high cost of rehabilitation.
High risk of primary or consequential damage to neural, bony or disc element
Increased wedging, deformity & increase incidence of adjacent VB
Chronic pain of altered spine mechanics
Uncomfortable braces & sleep disturbance because of pain & discomfort with its sequels.
Cost of surgery and hospital treatment
Cost of implants
Phobia of surgery
Prolonged recovery period & Extensive rehabilitation
Changed spinal mechanics & transition syndrome
Major surgery & anesthesia with its own complications
Results / Outcome

PVP is a novel procedure with high benefit to risk ratio, which is highly underutilized in relation to the high prevalence of the vertebral.
Different studies show an immediate pain relief in (85   90)% of patients with low complication rate ranging from (1-5)% depending upon the type of lesion.
PVP does augment height of VB but ideal would be kyphoplasty
Patient is either off medicine or on reduced doses.
Patient feels so well that he almost forgets if he had VB

Percutaneous Vertebroplasty (PVP) is an emerging interventional technique in which surgical polymethyl methacrylate bone cement is injected under local anaesthesia via a large bore needle into a vertebral body (VB) under imaging guidance providing increased bone strength, stability, pain relief, decreased analgesics, increased mobility with improved QOL and early return to work. Started in 1984 by Galibert PVP is done in host of indications.

Senile osteoporotic compression remains the commonest Indication. Other indications are Metastatic VB, Multiple myeloma VB, VB haemangioma, Vertebral osteonecrosis & for strengthening VB before major spinal surgery. The benefit has been extended to the traumatic stable uncomplicated VB compression (VCF) which is commoner in younger age group with active life profile and prime of their career where strict bed rest and acute or chronic pain are unacceptable and they are more demanding for proactive treatment approach so as to be back to work ASAP.

Discovering the fact that VB is the commonest of body, its incidence >the hip, it becomes imperative to take it more seriously. With increasing life-span there is more of aged osteoporotic population, more so due to sedentary indoor lifestyle and post menopausal osteoporosis. Diabetics, smokers & alcoholics are at higher risk of developing osteoporosis. I have seen such alcoholic patient developing six spine fractures in just three months time from a single fracture being on complete bed rest.

Quick fix of fracture spine makes patient walk back same day instead of bed rest of months together avoiding morbidity & mortality of prolonged bed rest, making bedridden patient walk, in a way bringing patient back to normal life.

In this era of MAS replacing open surgeries, PVP is a novel procedure & should be in the first line of management in place of conservatism or major spine surgery for painful uncomplicated compression.

Morbidity & consequenses of spinal 

Traumatic VB is a painful condition requiring bed rest restricting daily activities markedly.
Left untreated it can cause DVT, increase osteoporosis, loss of VB height, respiratory &
GI disturbances, emotional & social problems secondary to unremitting pain, loss of independence with high cost of rehabilitation.
High risk of primary or consequential damage to neural, bony or disc elements.
Increased wedging, deformity & increase incidence of adjacent VB
Chronic pain of altered spine mechanics.
Uncomfortable braces & sleep disturbance because of pain & discomfort with its sequels.
Morbidity and complication of spinal surgery 

Cost of surgery and hospital treatment
Cost of implants
Phobia of surgery
Prolonged recovery period & Extensive rehabilitation
Changed spinal mechanics & transition syndrome
Major surgery & anesthesia with its own complications
Preparation & Procedure:
X-ray spine in a/p & lat view. CT is more informative of bone & morphology. MRI is good for soft tissue injuries. Ask for pedicle size in all dimensions and construct a 3D image aiming needle placement and cement filling in scan room itself as rehearsal of PVP. This reduces operative time & gives better results. Conventionally PVP is done by hammering the vertebroplasty needle through the bone. Here we use light weight drill to bore through the vertebra. It is important to set the needle at exact entry site & side with right trajectory aiming the defects.

In lateral view needle should go through middle of the pedicle going up to anterior 1/3 of VB. In P/A view the needle can be in midline or paramedian depending upon & if uni/bipedicular approach is planned. Approach varies as per location of vertebra, anterolateral in cervical, costotransverse/parapedicular in thoracic & transpedicular in lumbar vertebra.

Do bone biopsy if there is any doubt about lession. Do dye test (vertebral venography). Make cement more radiopaque by adding barium /or tungsten. Inject cement with 1or2 ml luerlock syringes strictly under fluoroscope in lateral view & cross checking in P/A view. Stop injecting either there is adequate filling or at the first sight of ectopic cement leak. Keep sample cement to see for hardening. Remove needle with rotational movement before cement hardens.

Pain relief is by virtue of different mechanisms postulated :

Cementing of fragments.
Thermal neurolysis of VB nerve ending due to heat of polymerization.
Washing away of nociceptor chemicals.
Neurolytic action of liquid monomer.
By allowing early ambulation decreasing pains of immobility & bed rest.
Complications 

PVP is generally safe with low risk.
Ectopic cement leak is frequent but generally inconsequential.
Outcome 

PVP is a novel procedure with high benefit to risk ratio, which is highly underutilized in relation to the high prevalence of the vertebral
Different studies show an immediate pain relief in (85   90)% of patients with low complication rate ranging from (1-5)% depending upon the type of lesion.
PVP does augment height of VB but ideal would be kyphoplasty.
Patient is either off medicine or on reduced doses.
Patient feels so well that he almost forgets if he had VB

Vertebroplasty (PVP) / Kyphoplasty - Approach To Management Of Vertebral Body Fractures!

Arthritis is a disquietingly painful condition that causes inflammation and stiffness in the joints. Arthritis usually occurs due to the wear and tear of cartilages and ligaments with the onset of age, but recent studies have concluded that many foods present in our daily diet may actually trigger or aggravate symptoms of the condition. Yet also there are some superfoods that help combat and prevent arthritis. Avoiding the former and including the latter in your meals can reap surprising benefits. Some of these ailing superfoods for arthritis are:

1. Leafy greens: green, leafy vegetables like spinach, broccoli, cabbage and lettuce have a high content of antioxidants, calcium and magnesium which help in neutralizing the negative charges in the body. In case of arthritis, it prevents the further progression of the disease. 5 servings of steamed vegetables per day can work wonders for your joint pain. 
 
2. Fishes: fish, especially oily fish goes a long way in reducing joint pain and stiffness. They are highly rich in omega-3 fatty acids which contain anti - inflammatory properties. 2 to 4 portions of oily fish per week can have an impact on you for many years to come.
 
3. Olive oil: olive oil contains mono - saturated fats and antioxidants, which have anti - inflammatory properties. Increase in the intake of olive oil can reduce risks of rheumatoid arthritis and prevent associated conditions. It can be used as both raw oil in preparing salads and also as cooking oil. 
 
4. Apples: an apple a day keeps the doctor away. As true as it may be, among many other nutrients, apples are a rich source of antioxidants and magnesium which are beneficial for the bones. A daily intake of 100g of apples eaten as a sole snack, or mixed with salads would in the long run prevent the risks of arthritis.
 
5. Onions: onions apart from fostering good digestion is also loaded with quercetin which is a bioflavonoid antioxidant that suppresses inflammation. It effectively removes the free radicals within arthritis joints and also reduces the release of protein- destroying enzymes. It can be consumed raw, can be served as a sauce and can also be used for cooking. Arthritis is a disquietingly painful condition that causes inflammation and stiffness in the joints. 

Arthritis usually occurs due to the wear and tear of cartilages and ligaments with the onset of age, but recent studies have concluded that many foods present in our daily diet may actually trigger or aggravate symptoms of the condition. Yet also there are some superfoods that help combat and prevent arthritis. Avoiding the former and including the latter in your meals can reap surprising benefits.

5 Superfoods Good for Arthritis!

Concentrated pain in the neck can be especially tormenting. Before you look for a cure for this pain and start treating it, it is important that you try and find out the underlying cause behind it as well. Contacting a physiotherapist in time will allow you not only to avoid any and every side effect posed by neck pain, but also assist you to get good riddance from it.

Causes of Neck Pain:
There can be multiple causes of neck pain. The treatment of the same depends wholly on the factor that is causing the pain. Some of these causes of neck pain include

Misaligned hips,
Misaligned Spine,
Misaligned shoulders,
A constantly forward-tilted head,
Lack of movement of the head from one specific position,
Tensing up of the muscles in the upper back,
Tensing up of the muscles in the neck region, etc.
It is all these factors and a few more that end up resulting in stiffening of muscles in and around the neck and causing you intermediate to unbearable pain.
Side effects of neck pain:
Neck pain also has some side effects, which includes temporary loss of consciousness, nausea, vomiting, blackouts, temporarily blurred vision, headache, spondylitis, etc.

Exercises for neck pain:
Neck exercises are a predominant part of the treatment extended by every physiotherapist, to cure neck pain. Some of the most vital and effective exercises for neck pain are listed below.

Frog: Funny as it way sounds, the frog is one of the best exercises when it comes to treating neck pain. All you have to do is lie down on the floor with your knees apart, your feet joined, your hands laid upward on the floor at a 45-degree angle to your body and just stay there in that position for two minutes. This will force your back to arch naturally, slowly giving some relief to your neck.
Sitting floor: Try sitting floor for neck pain. All you have to do is sit straight with your back rested on a wall, with your legs laid straight forward. Bring together your shoulder blades and bend to help them meet your knees while curling the toes outward to optimal. Stay in this position for a good 3 minutes, without bending the legs.
Static wall: Lie down on the floor with your bottom against a wall and your legs up it. You can always scoot back a bit if there is the slightest of discomfort. The aim here is to help the tail bone lie comfortably on the floor. Tighten your thigh muscles but curling your toes outward and pointing your feet straight out from its previous position. Maintain this position for 3 minutes for maximum effect.
Static back: The static back is the most common and most helpful exercise for neck pain. All you got to do is lie down on the floor, while placing your legs on an elevated surface, such as an ottoman or a chair at a 45-degree angle to your body. Now put your arms at an angle of 45 degrees to your body as well, only sideways on your shoulder. Follow this position by lifting your palms and staying in that position for five to ten minutes.
All these exercises are aimed to positively influence one muscle or the other in and around the neck region and to help you get rid of that pain. Consult a physiotherapist first, and he/she will advise you on the best neck pain exercises.

Neck Pain - 4 Exercises to Control Pain

A Simple Guide to Arthritis

One of the most common ailments the elderly suffer from is arthritis. However, arthritis can affect people of all ages. It is a rheumatic disease as in, it affects joints and bones. It can be of many types and the term covers a number of inflammatory and non-inflammatory joint diseases. Some of the most well-known types of arthritis are rheumatoid arthritis, bone spurs, gout, and osteoarthritis.

The causes of arthritis have not been defined but there are a number of factors that increase a person's chances of getting it. Foremost amongst these is increasing age and excess weight. Arthritic conditions such as rheumatoid arthritis, ankylosing spondylitis, and lupus are said to be hereditary and linked to certain genes. Sometimes, injuries can also cause arthritic conditions. Misuse of steroids can also result in arthritis.

Here is a look at the most common symptoms of the disease :-

Pain around the joints is the most well-known symptom of arthritis. Along with pain, you may also notice swollen or stiff joints.
Increased body temperature around the affected joints and redness in the area is also a symptom of arthritis. These symptoms range from mild to severe, and can be constant or may come and go.
Everybody suffers from occasional joint pains but if any of the above symptoms persist for a long duration, it is best to consult a doctor. The sooner you seek treatment, the easier it becomes to deal with arthritis. If left untreated for too long, arthritis can result in permanent joint damage.

While there is no single cure for arthritis, it can be effectively controlled if treated in time. Since the type and severity of arthritis differ from person to person, treatment for the same must also be tailored to the needs of the individual.

Drugs for arthritis can be categorized as those that treat symptoms such as pain and stiffness, and those that suppress inflammatory conditions.

In some cases, surgery may be advisable. 

Physical therapy and regular exercise are very important when dealing with arthritis.

It is equally important to eat a healthy, nutritious and well-balanced diet. If you are overweight, try and lose the excess kilos.

You must also look after your joints to ensure that there is no further degradation of bone or muscle tissue. Avoid staying in one position for a long time, and try and maintain a good posture. These simple techniques can be very effective when dealing with all types of arthritis.

A Simple Guide to Arthritis

Staying healthy involves a wholesome state of being where the mind and body are in perfect sync. A less than properly functioning body can leave you in a state of potential depression after a certain point of time, while a depressive mind can leave you feeling less than stellar where you end up imagining and experiencing pain. The health of your bones and joints is one such area that requires even more care as you start growing older. Wear and tear is just one of the reasons for degeneration while fractures and injuries can lead to a sudden halt of normal functioning of the bones and joints too. So how can you ensure bone and joint health in the long run? follow our tips!

Eating right: pick calcium rich food like dairy products that have a low fat content, including milk and yogurt. Also, have a daily dose of green, leafy vegetables and plenty of citrus fruit and juices for your fill of calcium. Further, food like eggs and soybeans which have lots of vitamin d can also help in retaining good bone and joint health. Vitamin c rich fruit like watermelon, oranges, squash and tomatoes also help in natural tissue and cartilage repair. And finally, get plenty of vitamin k to retain good bone density for a prolonged period with ingredients like leafy green vegetables, eggs and cheese.

Exercise: this is the key to good bone and joint health. Much like machinery and tools, the bones and joints of your body can also wither with disuse and prolonged inactivity. Make sure that you indulge in exercises like long walks and muscle strengthening exercises which will give your joints and bones good amount of strength as well. Remember to speak with your doctor before you start a new exercise regime so that you avoid anything that may be harmful in case you have any other ailment. Low impact exercises will strengthen the spine, while fat burning and weight loss exercises will ensure that there is less pressure on the knees and lumbar area. Swimming and resistance building exercises can also be practised for these purposes.

Abstinence: a major factor in promoting better bone and joint health is abstinence from all those things that can create problems in the long run, like smoking, drinking excessively and even too much consumption of caffeine and fatty food. All these things can create depletion of the natural bone mass. Also, switching to a lower heel for everyday wear footwear and changing your position during your time at your workstation are a few things that will go a long way.

Take care of your bones and joints the right way today, for a healthier tomorrow.

Bone and Joint Health

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