Knee is a hinge joint where the lower leg bone tibia meets the thigh bone femur. During osteoarthritis, cartilage or ligament defects and degenerative arthritis, knee replacement surgery is recommended world-wide to get relief from extreme pain. Knee replacement surgery, also known as knee arthroscopy, is a surgical procedure, in which the affected knee joint is replaced with synthetic material. The most likely candidates for total knee replacement are the patients with severe destruction of the knee joint coupled with progressive pain and impaired function.

Modern technological advances have made computer assisted knee replacement surgery extremely popular around the globe. In this surgery, the surgeon is assisted by a computer to remove the optimum amount and angle of the bone, which otherwise is done by inspecting manually. This is an excellent example of surgery through small incision and it eliminates the chances of human error. A perfect alignment and balance is achieved and hence longevity is also increased to 20 - 30 years. Knee replacement surgery is also specific to gender as the anatomy of male and female patients is different.

There are many types of knee replacements, most common being the total knee replacement or Total Knee Arthroplasty. In addition, there is partial knee replacement, bilateral knee replacement, revision knee replacement and knee arthroscopy.

In knee replacement surgery, the worn out surfaces of joints of knee are replaced with artificial implant of plastic and metal. The lower end of the femur bone is removed and replaced with a metal shell. The upper end of the lower leg bone (tibia) is also removed and replaced with a channelled plastic implant with a metal stem. A plastic ball is also added under the kneecap depending on its condition. These artificial components are commonly referred as prosthesis. The design of these highly flexible implants replicate knee, with the rotating knee replacement implants assist in backward and forward swing of the legs.

Patients whose knee joints have been damaged by either trauma or progressive arthritis should consider total knee replacement surgery. Post-surgical hospital stay after knee joint replacement is usually three to five days. The surgery has a very high success rate and shows dramatic improvement after a month. This improvement is most notable one month or more after surgery. The pain caused by the damaged joint is reduced significantly when the new gliding surface is constructed during surgery. Initially, patient will walk with the help of a walking aid until the knee is able to support full body weight. After six weeks, patient can walk comfortably with minimal assistance. Patients with artificial joints are prescribed to take antibiotics during the course of any elective invasive procedures including dental work. Physiotherapy is an essential part of rehabilitation and it will increase the muscle strength and patient can enjoy most activities, except running and jumping.

Knee Replacement

The term Sciatica is used to describe leg pain, tingling, numbness or weakness that travels down the low back via the sciatic nerve to the back of leg. Sciatic nerve arises from each side of lower spine and passes deep in the buttock along the back of thigh and legs. The pain of Sciatica may be irregular/ infrequent or persistent causing severe agony to the patients. The pain of Sciatica may be confined to low back or hips or may extend up to toes. The pain of Sciatica can be excruciating and "not relieved by painkillers".

What causes Sciatica?

Pain in Sciatica is due to irritation or pinching of Sciatic nerve within the spine. This occurs most commonly due to prolapsed intervertebral disc (slip disc) causing nerve compression resulting in pain.

Is surgery the only treatment for Sciatica?

Most patients can be managed with medication/exercises. So surgery is not the only way out. Patients who have severe pain can also benefit from "Epidural Steroid Injection". This treatment has proven to be effective in avoiding spine surgery in such patients.

What is Epidural Steroid Injection?

Epidural Steroid Injection is a procedure done by a Specialist (Interventional Pain) in an Operation Theatre using X-Ray (Image Intensifier) to locate exact level of injection. A drug mixture consisting of Steroid with Local Anaesthetic is injected at the epidural space of affected nerve root. The steroid washes away inflammatory mediators from the epidural space which decreases the pain. Steroid also decreases the inflammatory response of body to the prolapsed disc. As a result the pain arising from nerve inflammation is decreased. This is a day care procedure i.e. the patients are discharged the same day.

How is the possibility of surgery ruled out?

Epidural Steroid Injection is a proven, safe and an effective treatment that works on the concept of Interventional pain management - to provide relief from persistent and chronic pain of Sciatica. Generally, a single injection is sufficient to relieve patients of the pain. The procedure can be repeated for a maximum 3 times in a year, depending on the patient's response. With effective pain relief, surgery is negated.

Non-Surgical Treatment For Sciatica

Sciatica nerve is the longest nerve of our body, which starts from the spinal cord, passes through the lower back and into the lower leg. Sciatica is a symptom of pain in the sciatic nerve which occurs if it is being compressed by any mass, irritated or overgrowth along its course.

Symptoms
Patients with sciatica experience severe pain along their back as well as may suffer from additional symptoms including numbness and weakness, a feeling of tingling and pins and needles on the foot or toes. In severe cases, some people may also suffer from loss of bladder and bowel control.

Causes
One of the most common reasons is the pinching of the nerve due to a slipped disc in the lower back. Other conditions which cause sciatica are trauma to the spine, spondylolisthesis, spinal tumors and lumbar vertebral canal stenosis.

Prevention
One of the easiest ways to prevent sciatica is by protecting your lower spine. You can follow these easy tips that can be really helpful in maintaining your health and remaining pain free.

    Exercising regularly: By exercising regularly, patients can strengthen their back and abdominal muscles and prevent damage to their vertebral column.
    Good posture: By maintaining a good posture while sitting and working in an ergonomically designed chair that properly supports your hips and back and does not compress the back of your thighs and knees while sitting is essential to maintain a healthy back.

Treatment
Homeopathy offers natural medicines that can cure and reduce sciatica pain. One of the biggest advantages that homoeopathy offers for treating sciatica is that it can treat the disease effectively, by rectifying the compression or irritation on the sciatic nerve.

Homeopathy practitioners use Colocynth for treatment caused in right sided sciatica pain. Homeopathic medicine Gnaphlium is used to treat numbness associated with the paint, while Rhus tox is usually helpful in treating all sciatica symptoms and is the most preferred medicine by homeopathic practitioners.

Homeopathy also offers additional benefits as it not only helps in rectifying sciatica pain it also help in strengthening a patient s constitution so that the disease is cured from its roots and there are no further recurrences. Homeopathic medicine is very fast and effective and is totally natural, free from any side effects. It is one of the most widely accepted forms of medicine which causes no side effects and can be taken easily by both men and women. 

7 Homeopathic Remedies for Sciatic Nerve Compression Pain

When other treatments fail to provide relief, the last resort to treat spine problems is the spine surgery. Spine surgery is conventionally referred to as open surgery which indicates that the area that needs to be operated is opened with a long incision so that the surgeon is able to view and have access to the anatomy.

In the recent times, advances in the field of medical science have made it possible to treat back and neck conditions through minimally invasive surgical techniques that don t involve an elaborate incision. Let us understand more about it.

How is minimally invasive spine surgery carried out?
Minimally invasive spine surgery fusions and decompression processes are performed by exploiting different approaches. The most commonly utilized technique involves the use of the tubular retractor. In this process, the surgeon makes a small incision and then inserts the retractor through the skin right into the spinal column. It leads to a tunnel to the accurate area where the problem persists in the spine. The functionality of tubular retractor lies in the fact that it helps in holding the muscle open throughout the procedure.

A number of particular processes have been designated for the minimally invasive spine surgery. Some of the most common options include spinal decompression, discectomy, and transforaminal lumbar interbody fusion. Each of these processes is different and only an expert in this arena can determine what s suitable for you.

Minimally invasive spine surgery is also called less invasive spine surgery where surgeons make use of special instruments. One of the most compelling drawbacks of open surgery is that the pulling of the muscle can lead to damage to both the muscle and the tissues in close vicinity. On the other hand, minimally invasive spine surgery allows the surgeon to see the precise location of the affected area. Besides, it also leads to smaller incisions, reduced bleeding and short stay in the healthcare facility.

Consulting an expert about the surgery:
It is very important on part of the patients to discuss the suitability of minimally invasive spine surgery with their doctors since it is not a good option for all patients. It is generally suggested for patients having spinal tumours, spinal instability, spinal infections, vertebral compression fractures, lumbar spinal stenosis and spinal deformities like scoliosis.

When you know that you will have to undergo the surgery, it pays to gather information about the surgery and what you may expect from the recovery process. The most commendable benefits of minimally invasive spine surgery include better cosmetic results owing to lesser skin incisions and reduced dependence on the medications. Moreover, it is performed as an outpatient procedure and it makes use of local anaesthesia only. Thus, there is also a reduced chance of suffering from an adverse reaction to general anaesthesia.

So, depending on the pros and cons and depending on the individual condition, your doctor will decide on the course of action.

Everything You Need To Know About Minimally Invasive Spine Surgery!

The knee is the largest joint in the human body and is a complex structure formed of bone, muscle and cartilage. Development of pain in the knees can be caused by numerous factors such as aging, injuries, diseases, dietary deficiencies, etc.

Arthritis is the most common cause of knee pain and usually affects the elderly and aged. It occurs due to an inflammation of the joint and causes pain, swelling, redness and inflexibility of the knees.

What are the factors that determine treatment method?

Diagnosis for knee pain varies from patient to patient as each case is different and must be approached differently. Some of the factors that determine the treatment method are as follows:

- Cause of the problem
- Nature and intensity of pain
- Age of the patient
- Medical history of the patient
- Diet and lifestyle of the patient

There are a number of different types of arthritis which can affect the knees in different ways and, consequently, require different types of treatment methods.

What are the various treatment methods for knee pain?

1. Conventional Remedies - These are used in case of conditions that are not too severe or chronic. It includes keeping on bed rest, using an ice pack, taking a painkiller and anti-inflammatory medicines, wearing knee braces, etc.

2. Physical Therapy - There are many stretching and strengthening exercise routines that help alleviate knee pain and treat the condition. Recovery is achieved by making the muscles around the knees stronger and increasing stability and flexibility.

3. Injections to the Knees - A number of anti-inflammatory substances and supplements, as well as lubricants, can be injected into the knee joint which helps reduce pain and makes the joint more supple.

4. Stem Cell Therapy - This involves drawing platelets from the patient's blood and injecting it into the knee joint for repairing damage caused to ligaments, tendons or cartilage.

5. Surgery - Surgical procedures for treating knee pain include partial or complete knee replacements.



What kind of treatment does your knee pain require?

Facial paralysis can happen due to many factors. Sometimes inflammation develops around the facial nerve as it passes through the skull from the brain. This presses on the nerve and makes it stop functioning. As the nerve stops functioning, so does the muscle it controls.


This is what happens in Bell s palsy, the most common cause of facial paralysis.


Bell s palsy can happen to anyone and its cause is, hold your breath, a viral infection. Herpes zoster, Varicella zoster and HIV viruses can cause Bell s palsy.


Bell's palsy is a common cause of a facial paralysis but there are many others too that affect or damage facial nerve. These include head injury, sarcoidosis, lyme disease, growths in the ear, tumours in the parotid gland, brain tumours and stroke.


The weakness of the face usually one-sided is a symptom of Bell s palsy. The face may droop to one side, chewing food is also tough, drooling, dry eyes and difficulty wrinkling forehead and speech are other symptoms of Bell s palsy, the most common reason for facial paralysis.


Treatment:
The type of therapy you receive for facial paralysis will depend on its cause. It will also develop on how long you ve suffered from facial paralysis and the extent of damage to the facial nerve.


Your physiotherapist can help and so can speech and language therapists to deal with the issue.


In physiotherapy, a treatment called 'facial retraining' with facial exercises helps with facial palsy. It is important that you seek help from a therapist who specialises in facial rehabilitation only.


This is what you can expect from facial rehabilitation therapy-
Exercises for eye care
Exercises for dry mouth management
Exercises to make drinking and eating easier
Speech therapy
Your physiotherapist will educate you on how the facial nerve works and how it recovers. This is important to make you recover. A home therapy programme plays an important role too. It includes massages to keep face muscles mobile and healthy, stretches to lengthen muscles, exercises to help re-learn balanced facial movements and relaxation of your facial nerve and muscles.


The physiotherapist will work on your facial movement to make muscles fit. The basic idea is to slowly rewire the brain-to-nerve-to-muscle pathway. The physiotherapist s first step is to retrain you to do correct movements voluntarily, while mentally focusing on the movement.


Physiotherapy may take months but keep at it to recover completely, especially the home exercises.


Injections of botulinum toxin or Botox also help especially if you suffer from spasms in facial muscles. Surgery is also an option for chronic cases.


Remember that exercises should be done gently as well as daily to reap benefits. Always do these exercises with the help of a therapist only. Doing exercises by yourself can be counter- productive.


Facial Paralysis - How Can Physiotherapy Help You Get Better?

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