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!

Most of the arthritic conditions don t have any cures. Ankylosing Spondylitis is also a type of arthritis that does not have a cure. It is a kind of arthritis of the spine; it affects the vertebrae. It primarily affects the spine, but it may also affect other areas such as shoulders, hills, hips, ribs, small joints of the feet and hands etc. In very advanced stages, it may also affect eyes, lungs and heart. 

However, what really makes it scary is Ankylosis. When Ankylosis takes place, there is formation of new bony structures in the spine. These structures cause some sections of the spine to fuse and make the spine immobile. 

Symptoms of Ankylosing Spondylitis 

  Pain and Stiffness 

One may feel a constant pain coupled with stiffness in areas like buttocks, lower back, hips etc. These symptoms may go on for months. It often starts at the sacroiliac joint. 

  Bony Fusion 

The formation of bony structures in the spine in advanced stages may affect movement of the back, neck, hips etc., and may also impair the ability to perform daily activities. The formation of bony structures may go to the extent of fusing the ribs in the rib cage to the breastbone or spine. This may limit the ability to expand the chest while taking deep breaths. 

  Pain in Ligaments and Tendons 

Ankylosing Spondylitis may also affect the tendons and ligaments that attach the muscles to the bones. This may precipitate pain and stiffness beneath or behind the heels. 

Cause of Ankylosing Spondylitis 

The cause of this disorder is not yet known, yet a genetic link cannot be ruled out. It has been observed that most of the people affected with Ankylosing Spondylitis carry a specific gene in them. People carrying this gene are susceptible to spondylitis. However, there are about 10% people who carry this gene, but don t have any sign of Ankylosing Spondylitis. So, a sure determinant of cause of this disease is not completely known. 

Diagnosis of Ankylosing Spondylitis 

To diagnosis Ankylosing Spondylitis, the physician has to look at several factors. 

These include: 

  Symptoms exhibited by the patient 

  Physical Findings 

  X-Rays of pelvis and back regions 

  Taking chest measurements while taking deep breaths 

  Laboratory tests Based upon the complete diagnosis, physician can positively determine if the condition is indeed Ankylosing Spondylitis. 

Treatment 

While a cure for Ankylosing Spondylitis is still not on the horizon, there are some treatments which can reduce pain and discomfort and thereby improve daily activities. Goals of treatment Since the disease can t be cured, the goal is to reduce pain and stiffness, prevent deformity, maintain a good posture, and help perform daily activities. In fact, if treatment is proper, the patient may lead to a semblance of a normal life. However, it calls for a team approach. The team must include a physical therapist and an occupational therapist, apart from a rheumatologist. If the patient is suffering from bony growth, the doctor may go for an osteotomy.

Ankylosing Spondylitis - How To Handle It?

Damaged hips can cause great distress in carrying out daily activities, such as walking, getting dressed and many more. If you have damaged one or both of your hips, and it causes you great pain, you may require a hip replacement. It is a common form of surgery in which a damaged hip joint gets replaced with an artificial one. This is known as prosthesis.

Conditions which lead to hip replacement

Osteoporosis where the cartilage inside a hip joint gets worn out, and the bones rub with each other as a result
Rheumatoid arthritis, which is caused when the immune system attacks the hip joint lining by mistake
If the hip joint gets damaged severely during an accident or fall
The purpose of a replaced hip joint is to provide pain relief, improve the hip s function, improve your ability to carry out day-to-day activities and improve your overall quality of life.

Procedure
A hip replacement is usually carried out under general anesthesia. An incision is made in the hip by the surgeon and the damaged hip joint is removed through it. It is replaced with an artificial metal alloy or a ceramic joint. The surgery takes approximately 60 to 90 minutes for completion.

Recovery
After the surgery, a walking aid such as crutches is required for up to four to six weeks. You may enroll for an exercise program, which aims at regaining and improving the new hip joint functions. Regular activities can be restored within two to three months. A year is required for utilizing the new hip joint normally.

Risks of hip replacement
There may be several complications as a result of a hip replacement. They include:

Dislocation of the hips
Infection at the surgery wound
Injury to nerves and blood vessels
Difference between the lengths of two legs
Fractures
Alternative
Hip replacement surgery has an alternative type of surgery, which is called hip resurfacing. During this surgery, the damaged surfaces of the bones within the hip joint are removed and replaced with a metal surface. Less bone is removed in this surgery. However, the metal surface may cause complications and health hazards.

Hip replacement is being improved upon with the advent of technology. Stronger and newer materials are being developed for prosthetics, which will allow enhanced joint mobility and a longer wear. New cement-less implants are also being developed. Also surgery assisted by computer is being used for generating an image of the hip joint.

 Hip Replacement - An Overview!

The bones are the bits and pieces which form the framework of the body. Each bone is placed in the correct position to give your body the structure it has. It is of utmost importance for you to have healthy bones so that the structure or frame of your body is maintained. A lot of times, due to the stress of your daily life, you tend to neglect the health of your bones. But remember that if you want to have a fit body, you will have to keep your skeletal system fit as well. Here are a few tips on how to keep your bones healthy:

1. Family history: Having a knowledge of your family history is extremely important as there may be cases where you might suffer from a particular disease which is hereditary. If your family has a history of osteoporosis, there is a high chance of you suffering from it. 

2. Increase your regular calcium and vitamin D intake: Calcium is extremely essential for your bone health. If you want your bones to be healthy and strong, you need to take a regular calcium dose in order to achieve that. But there is a catch to this. Although you might have food containing calcium every day or take calcium tablets, it won't be helpful until you also get a supply of Vitamin D. Vitamin D helps the bones to absorb the calcium.

3. Maintain a healthy bone density: To do this you need to eat food which will supply you with vitamin K. Vitamin K boosts bone density by enabling the body to make proteins required for healthy bones. Vitamin K also helps the bones absorb calcium just like vitamin D although this function is not predominant for vitamin K.

4. Exercise: The secret to healthy bones is exercise. The more you exercise regularly, the fitter your bones and muscles will be. Regular exercise helps to keep bone problems at bay. Leading a sedentary lifestyle heightens the risk of suffering from osteoporosis. It can also mess with your bone density and weaken your bones. Hence, exercise regularly for healthy bones.

5. Cut down on your caffeine intake: Too much of caffeine can mess up the calcium absorbing power of your bones. If you have more than two cups of coffee every day, your bones will gradually become weak.

So, if you want to remain as fit as a fiddle, then try these tips out, and you will not complain.

Tips And Tricks To Keep Your Bones Healthy!

Whether you're old or young, male or female, having a backache can be a real pain! A number of factors ranging from osteoarthritis to muscle strains can be attributed to back pains. No matter what the cause of a backache, a combination of core strengthening exercises, activity, and physical therapy can help lessen the pain.

A backache can be caused by something as simple as bending the wrong way. Hence, the first step towards dealing with a backache is to pay attention to daily movements. If you have to lift something heavy off the floor, bend your knees and let the weight of your load fall on your legs instead of it falling on your back. Here is more on how you can fight back pain with a bit of effort:

Light exercises
Simple, light exercises are the most effective ways of dealing with back pain. The key to exercising your back is moderation and knowing your limits.

Brisk walk and yoga
Regular brisk walks and yoga exercises that strengthen and stretch back muscles are effective ways to reduce and prevent back pain.

Right posture
Exercise can also help reduce excess weight that in turn helps reduce back aches. Slouching not only causes a hunch back but also aggravates back aches. Hence, maintain a right posture to take the pressure off nerves and lower back pain.

Proper posture while sleeping
A good night's sleep can also help soothe inflamed back joints and repair strained muscles. Pay attention to your mattress and ensure that your back is flat when you lie on it. Sleeping on your side can also help deal with the back pain. Consider resting your neck on a pillow, to keep your spine aligned while you sleep.

Hot & cold therapy
Experiment with hot and cold therapy before picking one of them to deal with your back pain. While applying ice packs on your back can help reduce inflammations, hot packs work better to reduce cramps and muscle spasms. Whether you use a hot pack or a cold pack, do not leave it on for more than 20 minutes.

Natural supplements
Natural supplements such as flaxseed oil, calcium, magnesium and vitamin c are helpful when dealing with back pains.

For short-term relief, you could also try over the counter pain relievers. However, do not let this become a long-term habit, as your body could get dependent on it. Other potential side effects could include stomach and liver problems. Hence, if your back ache does not subside on its own, it is best to consult a doctor before treating it yourself.

How to Deal with Back Pain

About 80 percent of people all across the globe experience lower back pain at some stage in their lives. It is one of the most common reasons why people miss their work and appoint a physiotherapist. But lower back pain is an ailment that can be avoided with proper knowledge and some back exercises. In case your lower back pain is not under control and you have been neglecting it, you are susceptible to acute pain, sciatica, nerve pain and pain in other regions caused from a pinched nerve. Long-term pain in the back portion can lead to permanent ailments like degenerative disc disease or spinal stenosis.

Probable causes of lower back pain
Severe pain in the lower back region can be caused due to a herniated disc, back muscle pain, ligament strain or any other non-specific pain. An individual may also suffer from lower back pain due to systemic conditions like rheumatoid arthritis, fibromyalgia or ankylosing spondylitis. Though these causes are very common in most people suffering from lower-back pain, the diagnosis varies from person to person and to ensure the best care to alleviate the pain, you must consult a responsive musculoskeletal physiotherapist.

Stages for assessing and treating lower back pain
Managing the back pain is the primary objective of physiotherapy. In reality, back pain is the final symptom that is developed and the first thing that must be addressed.

Stage I
Back pain relief: The physiotherapist is going to use different types of tools and items to help the pain subside along with the inflammation. These include electrotherapy, acupuncture, ice application, soft-tissue massage and deloading taping techniques. Sometimes the physiotherapist may also recommend an anti-inflammatory drug if the pain is intolerable.

Stage II
Restoring normal strength: With the settling of pain and inflammation, you are more susceptible to injury because though your pain has subsided, your ligaments and muscles are weak. Your doctor will aim at restoring normal motion of lumbar spine, muscle endurance and strength, proprioception, balance and walking abilities.

Stage III
Restoring full body function: Depending on your daily chores and activity, your physiotherapist will aim at restoring the function of your back portion to keep you safe while performing the chosen activities. For some, it may be taking a slow walk around the park while for others it may mean taking part in some sports activity.

Stage IV
Preventing recurrence: Your physiotherapist will rehabilitate you to prevent further occurrence of this excruciating pain by suggesting proper postures, exercise and core muscle workout.

Each of these stages are important to help you get rid of severe back pain and with daily exercise, you can regulate your body and spare yourself from recurrence of this lower back pain.

Treating Chronic Lower Back Pain

Don't wait any longer, manage your Homecare Physiotherapist online with a Lybrate doctor today

Consult for Homecare Physiotherapist - Online and Easy!

FilterClear All

COMMON SPECIALITIES

COMMON ISSUES