From marathon runners to footballers, amongst athletes, 'pulling a hamstring' is the most common type of injury. The hamstring is a group of four muscles at the back of your thigh. When one of these muscles gets overloaded or begins to tear, it is known as a hamstring injury. While a hamstring injury is painful, it does not indicate the end of an athlete's career.

Minor hamstring injuries may heal by themselves. In cases where one of the muscles is torn, surgery is required to repair and reattach the muscles. Recovery time depends on the severity of the injury. Stretching and exercising the muscles of the leg are the most important parts of rehabilitation. The healing of a hamstring injury can be divided into four stages.

1. Acute phase: The first five days after a hamstring injury is known as the acute phase of rehabilitation. The aim of treatment at this phase is to reduce inflammation and keep the other muscles from atrophy. For minor hamstring injuries resting the leg, using ice packs and keeping the leg elevated can accelerate the healing process. Once the pain and swelling has decreased, patients can use a cane or crutch to exercise the leg.

2. Subacute phase: From the fifth day to the 3rd week after the injury, the focus of the treatment shifts from minimizing swelling to strengthening the leg and increasing the range of possible motions. At this time, an athlete can resume cardiovascular training. Swimming and other forms of aquatic training are said to be especially beneficial to the treatment of hamstring injuries.

3. Remodeling phase: The remodeling phase continues upto 6 weeks after the injury. Strengthening the leg is the focus of this stage of treatment. Using ankle weights can be beneficial towards strengthening the leg muscles. It is important to be careful about the weight being used and to gradually increase this weight to avoid an added injury.

4. Functional stage: This stage can last upto 6 months until the athlete can regain full function of his or her leg. As the athlete's gait gets back to normal, they may start jogging and short sprints. Gradually, more sport specific exercises may be added to the workout.

There is no fixed time when an athlete can return to active sports after a hamstring injury. While players with minor injuries may return to the field after 3 weeks, athletes with muscles tears may take upto 6 months to recover completely. Hamstring injuries tend to reoccur and hence before they can get back to active sports, an athlete must pass an isometric strength test and flexibility test. This ensures that there are no subtle after effects of the injury that can increase the risk of a repeat injury.

Hamstring Injury Recovery and Return to Sports

The causes and symptoms of chronic lower back pain

Lower back pain is characterized by a feeling of pain around the lumbar region (curve of the back connecting the upper back and glutes- muscles in the buttock that are responsible for thigh movement) caused by muscle or ligament injury. The spinal area is most likely to be affected by lower pain as it may impair routine activities like walking and standing. Any lower back pain that lasts for more than ninety days can be considered as chronic.

Causes of lower back pain

There are plenty of causes for lower back pain. Anything that exposes the lumbar area of the spine to a level of stress beyond its capacity can cause lower back pain. These causes are-

1. Disorders of the discs

The spinal area in the lower back comprises of small bones called the vertebra, which are connected to each other by pieces of cartilage known as discs. These discs act as shock absorbers, and when exposed to excessive shock can cause the disc to bulge, resulting in herniated discs. Wear and tear of the discs can also occur.

2. Spinal stenosis

Spinal stenosis occurs when the area around the spine becomes narrow. It may affect the nerves surrounding the lower back, resulting in pain.

3. Wear and tear of the joints and ligaments

Normal wear and tear of the joints and ligaments cause difficulties in holding the spine in its proper position and this progresses with age. This may cause a vertebra to slide over another and affect the nerve endings, giving rise to pain.

Symptoms of lower back pain

The symptoms of lower back pain are usually a dull or excruciating pain in the lower back. It can also affect other parts of the body such as the hips and the legs. In case of severe pain, simple activities like walking, bending and sitting will be impaired.



The Causes and Symptoms of Chronic Lower Back Pain

Unlike muscle aches, neuropathic pain or nerve pain is usually a lifelong condition. This usually affects the feet. In some cases, it can get better over the years but in most cases, nerve pain stays persistent or worsens with time. Neuropathic pain is caused by nerve damage and commonly triggered by conditions such as diabetes or is a result of the side effects of medication or chemotherapy.

Medication is usually the first line of treatment when it comes to dealing with neuropathic pain. Medication prescribed for such conditions can be categorized as:

Antidepressants
Anticonvulsants
Local anesthetics
These may be prescribed individually or in a combination of two or more types of drugs. additionally, topical creams may also be prescribed for pain relief. Conventional medicine can provide temporary relief from nerve pain. However, in the long run, making a few lifestyle changes can help control nerve pain. Here are a few tips.

Exercise: Nerve pain may tempt you to sit in one place, but you must force yourself to walk about and exercise a little on a regular basis. Exercising increases blood flow to the extremities of the body and releases endorphins that act as natural painkillers. It can also expand blood vessels and nourish damaged nerves.
Avoid alcohol: If you suffer from nerve damage, alcohol can aggravate the damage and increase pain. Hence it is best to skip alcohol and all other kinds of stimulants.
Heat therapy: Soaking your feet in a warm bath or using a heat pack can be very effective when it comes to dealing with nerve pain. The heat temporarily increase blood flow and reduces pressure on the nerves. However, be careful to avoid burning yourself.
Get a good night's sleep: Nerve pain is usually aggravated at night, thus disturbing your sleep. To get the required 8 hours of sleep a day, try maintaining a schedule of going to bed and waking up at the same time everyday. Drinking a cup of warm milk may also help you fall asleep faster. Ensure that the last cup of coffee you drink is in the afternoon.
Massage: As with muscle pains; a massage can help ease and reduce nerve pain. Your choice of oils also has a role to play in the effectiveness of the massage. While lavender oil helps people relax and takes their mind of the pain, geranium oil can help directly reduce nerve pain.

Ways to Control Nerve Pain

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?

Cervical spondylosis is fast becoming the bane of modern life. An age-related wear and tear problem affecting the spinal discs in your neck, cervical spondylosis is increasingly affecting the young because of the use of cell phones, laptops and the like.

Cervical spondylosis is a general term used to define shrinkage of discs in between vertebrae in the neck region. Along with disc degeneration, bony projections also form in the area and are called bone spurs.
Other causes of cervical spondylosis are dehydrated discs. Discs are thick, pad-like cushions in between vertebrae that act as shock absorbers. They are made of a gel- like material that can dry over time. This causes the spinal vertebrae to rub together causing pain. The discs also crack which allows the internal gel-like material to spill out and impinge on spinal nerves causing symptoms.

There is a narrowing of the space required by the spinal cord and nerves that emanate in the upper spine to go to various parts of the body. Pinching of these nerves can cause alarming symptoms like

Numbness and weakness in your arms, hands, legs and feet
Lack of coordination and difficulty in walking
Loss of bladder or bowel movement
Stiffness and pain in neck
Treatment and management
Usually, cervical spondylosis doesn t cause any symptoms. But when you start experiencing pain, stiffness and weakness of muscles, it s best to go to a doctor who will diagnose the problem and then treat it.
Treatment for cervical spondylosis depends on the severity of your symptoms. Its goal is to get rid of pain, allow you to carry on your daily activities and prevent any permanent damage to your spinal cord and nerves.

Medicines

Anti-inflammatory drugs are prescribed to reduce pain and inflammation. Example Ibuprofen.
Corticosteroids are oral medications to get rid of the severe pain. If these don t work, your doctor can suggest steroid injections.
Muscle relaxants medicines relax the muscles in the upper part of the spine and help in curing neck pain and stiffness
Anti-seizure medications are also prescribed to dull the pain of damaged nerves in the spine. These include epilepsy medications, such as gabapentin and pregabalin.
Physiotherapy

Non surgical treatments are usually very effective in treating cervical spondylosis and surgery is usually not required. Physiotherapy is a bulwark for patients as it helps manage the condition very well.
Neck exercises that help stretch and strengthen muscles in your neck and shoulders can help manage debilitating symptoms of cervical spondylosis.
Few patients also benefit from traction, which can help provide more space for nerve roots within the spine.
Surgery

Surgery is the last resort for treating cervical spondylosis.
It is suggested when non-surgical treatments fail and the pain and neurological signs such as weakness in your arms or legs get worse.
It is done to create more room for your spinal cord and nerve roots.
Cervical spondylosis surgery typically involves removing:

Herniated disk
Bone spurs
Part of a vertebra

Cervical Spondylosis - How to Treat It?

One month, the injury is still healing, two months, just a little bit longer, three months? Well, you, believe it or not, it has probably become a chronic pain and is affecting every aspect of your life. Chronic pain may be a novel notion to accept but is now understood to be a disease and generally defined as pain persisting for longer than 12 weeks. Pain management in such cases is traditionally treated through prescription drugs, the other option being amputation.

This is a major cause of patients having qualms about these pills and a need for an alternative. In response to this, doctors have a new tool to help decrease the perception of pain which is a small implant placed in the back to help patients shake off the pain. This small device that could bring you back to your feet is the spinal cord stimulator.

What is spinal cord stimulation?

Theoretically, the spinal cord stimulation is a type of neurostimulation which produces an effect that interferes with the brain s ability to interpret the signal as pain by using electrical pulses. The brain, instead, experiences it as a pleasant numbing sensation. The implant is placed which takes place in two parts i.e. placing the lead device in the spine and placing the pulse generator in abdomen or buttock.

For test stimulation, the several stimulation settings are tried so that the pulse generator can be programmed using these settings. The procedure typically takes 1-2 hours and post-procedure, patients are given a handy device to control the simulations which they are to use in their day-to-day lives.

It has been observed to reduce the pain by at least 50%. However, this too has its limitations. Typical candidates are people with chronic back and limb pain who may have a failed back or disc procedure. The most common risks associated are device-related, example, unintended movement of the leads. Serious effects include hemorrhage in the epidural space or injury to a spinal cord leading to neural damage, but these are highly uncommon.

Quick facts about it

The best product which works for spinal cord stimulation is a long-lasting solution with a need to change the battery of the lead device every 9 years.
The most recommended device today is the implant because of its compact size and the device costs is quite nominal.
The quality of the product matters a lot as there are ample of cheap products available on the same lines. The same can be fitted within the body via a procedure.
The procedure conducted is also called the pain pacemaker.
Earlier, the procedure was used to conduct only in the international countries, but nowadays the implant can be done in India as well. If you are apprehensive about consuming painkillers for your chronic pain, you can explore this option with your Interventional Pain Specialist.
As it is said, lasting pain can lead to damage, hence don t wait until the damage repair has a complete null chance, rather reach out to your doctor to understand more about the concept of SCS so that you can get treated in no time. Explore the option with your "Interventional Pain Specialist".

Spinal Cord Stimulator - How Is It Beneficial In Pain Management?

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