Hip replacement is a surgery in which a specialist doctor surgically removes an agonizing hip joint afflicted with arthritis and replaces it with a man-made joint usually produced using metal and plastic elements. It is usually done when all other treatment choices have been tried and have proven unsuccessful in providing satisfactory pain alleviation. The technique is to mitigate the pain in ahip joint, in order to make walking and other physical exercises easier.

The surgical procedure is as follows:

Hip replacement surgery can be performed generally or by utilizing what is called a non-obtrusive method. The primary difference between the two methodologies is the number of entry points needed for the surgery.
During standard hip replacement surgery, you are given general anesthesia to relax your muscles; this will keep you from feeling any pain during the surgery or being awake during the surgery. A spinal sedative might be given to counteract pain as an add-on option.
The specialist will then make a cut at the edge of the hip and move the muscles connected to the highest point of the thighbone to uncover the hip joint.
Next, the ball part of the joint is taken out by cutting the thighbone with a saw. At this point a fake joint is attached to the thighbone using a material that allows them to stay intact.
The specialist then readies the surface of the hipbone - evacuating any harmed ligament - and joins the substituting attachment to the hipbone.
The new ball part of the thighbone is then embedded into the new joint part of the hip. The specialist then reattaches the muscles and shuts the entry point.
There are some things you need to keep in mind and be attentive about, post the surgery. These are as follows:

You will probably remain in the healing facility for four to six days and may need to remain in bed with a pad between your legs to keep the new hip joint set up.
A seepage tube will be set in your bladder to help you urinate without having to walk to the bathroom.
Non-intrusive treatment usually starts the day after surgery and within the days you can go around with a walker or a walking stick.
You will continue with the non-intrusive treatment for quite a long time which could be a number of months post the surgery.
For anywhere in the range of six to twelve months after hip replacement surgery, rotating or putting pressure on the operated leg needs to be limited to a great extent. You need to likewise not cross the operated leg past the midline of the body nor turn it inwards.
You cannot twist the hip past ninety degrees. This includes both twisting forward at the abdomen and crouching.
Your physical advisor will tell you the methods and equipment that will help you comply with the above rules and precautionary measures while performing every day exercises.

Hip Replacement - Things You Must Keep In Mind!

Joint pain is considered to be one of the first few signs of aging. According to the science of Ayurveda, joint pain is triggered mainly by an accumulation of toxins in the body. These toxins can create an imbalance in the doshas which in turn can cause pain and inflammation on the joints. Along with joint pain, a person is likely to experience a loss of flexibility, weakness, tenderness and enlargement of the joints.

Unlike some popular forms of medication that focus on relieving the pain, Ayurveda addresses the root cause of the issue. Panchkarma aims at cleansing the body of toxins and clearing blockages in the body s digestive and circulatory system. This helps the vatta dosha flow easily through the body and reduces pain associated with arthritis etc. Panchkarma can be defined as a collection of five ayurvedic techniques. These are:

Vasti or Medicated Enema: Vasti aims at removing toxins and waste products from the body through the colon. In doing this, it cleanses the digestive channels and improves circulation of air or the vatta dosha in the body. With better circulation, joint pain is effectively reduced. An enema also nourishes the body and gives it the strength to rebuild tissues while boosting the immune system.
Abhyanga or Full Body Massage: This technique helps I the removal of toxins from deep tissues within the body. It pacifies the vatta and nourishes the body while simultaneously reducing stress and enabling better quality sleep. A full body massage also helps calm the body both physically and mentally.
Potli or Poultice Massage: As the name suggests, a potli involves massaging the body with medicated herbs tied together in a tiny bundle that has been warmed with medicated oils. This potli is then used to massage the entire body. This technique helps relax the muscles of the body and soothes the aggravated vatta dosha. It is very effective when it comes to providing relief from joint pains caused by arthritis, spondylitis, muscle cramps etc.
Pizhichil or Rich Oil Massage: A rich oil massage involves subjecting the body to streams of lukewarm oil that has medicinal properties while simultaneously softly massaging the body. This type of massage helps relieve tension and stress and is a very effective remedy against joint pains. It is highly recommended in the case of rheumatic diseases.
Svedana or Steam Bath: A steam bath helps cleanse the body both physically and mentally by aiding in the removal of toxins through sweat and calming the mind. It also helps soften the muscles and tissues and dilates the channels in the body.

Joint Pain - How Panchkarma Therapies Can Help You?

Tennis elbow is a type of tendinitis. It is usually the swelling of certain ligaments. It causes pain in the elbow as well as the arm. These ligaments are bands of strong and stretchable tissues that connect the muscles of your lower arm to your elbow. In spite of its name, you can in any case get tennis elbow regardless of the possibility that you have never been close to a tennis court. This is merely a name for the condition and has little to do with the sport. It can affect anyone who indulges in a swinging motion.

Any repetitive exercises that require a tight grip, particularly in cases where the thumb and the initial two fingers are used frequently, may cause tennis elbow. Tennis elbow is the most common reason for patients to see their doctors for elbow torment. It can occur in individuals of all ages; however, it is most common and normal at about the age of forty.

This condition is usually caused when there are repeated contractions of the lower arm muscles that you use to raise your hand and wrist as well as to straighten it. The repetitive movements and pressure to the tissue may bring about a series of little tears in the ligaments that connect the lower arm muscles to the hard surface on the outside of the elbow.

Tennis elbow ordinarily occurs after some time. Dull movements such as holding a racket during a swing can strain the muscles and put a lot of weight on the ligaments. That consistent pulling can cause a small amount of tears in the tissue. Tennis elbow may be caused because of the following reasons:

Playing tennis
Playing racquetball
Playing squash
Fencing
Weight lifting or any other stressful exercises involving the muscles
In tennis, the following moves can lead to tennis elbow:

One-handed backstroke with a poor stance or lose hand
A late forehand swing bringing a bend in the wrist altogether
Snapping and turning the wrist while hitting with full power
As the name suggests, playing tennis, particularly repeated use of the backhand stroke with poor strategy, is a conceivable reason for tennis elbow.
However, a number of other basic arm movements can also cause tennis elbow. It can also affect individuals with particular occupations or while performing leisure activities that require heavy arm movements or gripping, for example, the following:

Carpentry
Excessive writing
Painting
Raking
Weaving or knitting
Utilising plumbing devices
Driving screws
Chopping cooking ingredients or vegetables, especially meat
Repetitive computer mouse utilisation
Lifting heavy materials or even grocery bags
There are a number of ways to treat a tennis elbow. These include certain over-the-counter (OTC) medicines. If those do not work, seek the help of a specialist or physiotherapist. He or she can recommend you the right kind of medicines as well as exercises needed for the recovery.

Tennis Elbow - Common Causes Behind It!

Sciatica is a very common neuropathic pain that is caused by damage to the sciatic nerve, a large nerve that runs from the lower back region down the end of each leg. It is the largest single nerve in the body.
This condition affects around 4 out of 10 people at some point of their lives. The nature of the pain varies from a mild ache to a sharp stinging sensation and may cause feelings of numbness and extreme weakness.

Causes of sciatica
The causes for the onset of sciatica are numerous. Some of them are as follows:
-slipped lumbar disc
-muscle inflammation
-internal bleeding
-pregnancy
-obesity
-awkward sleeping position
-uncomfortable footwear
-spinal injury

How can physical therapy help?
There are many ways of treating sciatica, such as medication, acupuncture and surgery, which can provide relief. The most common and easy treatment method however is physical therapy. A progressive and controlled exercise routine that is specifically tailored to the nature of the condition in consultation with a physical therapist acts as an effective remedy in treating the problem. It alleviates pain and also eliminates the chances of relapse.

Physical therapy exercises used to treat sciatica are of many types. They are a combination of core strengthening, muscular stretching and aerobic conditioning routines, which aim at correcting the root of the problem.

The different types of exercises employed to treat sciatica include the following:
Strengthening exercises
These aim at strengthening the spinal column and the pelvic region, which includes the hips and buttocks. They help in making the muscles and ligaments in this region more robust and allow for improved flexibility and support. Lunges and squats are some of the examples.

Stretching exercises
These provide pain relief through improved agility and flexibility. The most important aspect of these routines is stretching and exercising the hamstring. Hamstring, stretches, calf stretches and tricep stretches are a part of stretching exercises.

Aerobic conditioning
These are cardiovascular exercises of low intensity, which provide pain relief through the release of endorphins and the facilitation of fluid and nutrient exchange. Examples of these are swimming and brisk walking.

Reduce Sciatica Pain With Physical Therapy

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!

At some point in life most people experience acute pain in their lower back which is extremely painful. Pain in the spine causes a lot of discomfort and disruption in the life of an individual and hence, it is always better to get it checked on time. There are patients who even wonder when they should consult a neurosurgeon or a spine surgeon for their back pain. It is advisable that a physical examination is done by a primary care physician for low back pain before consulting a spine surgeon.

Why consult a Physical care Physician First?
The main reason to consult a primary care physician at first is that he would prescribe medications for severe lower back pain. The medications could include non-narcotic pain medications such as Ultram or non-steroidal anti-inflammatory drugs such as Motrin. The physician can even refer you to a chiropractor or for physical therapy to get relief from the back pain. Mechanical means are made use of by a chiropractor mainly to alleviate the back pain of the patient.

If the patient feels better with the physical therapy or the medications prescribed by the family doctor and is able to resume normal activities, then there is no need to see a spine surgeon. It is often recommended to take good care of the back and to exercise. A combination of ergonomics, regular stretching and improved everyday posture is beneficial as it reduces the chance of causing pain in the lower back. Exercise plays a very important role and it provides the possibility of reducing the pain.

Conservative Care for Treating Lower back Pain
It is best for patients to consult a conservative care specialist if after consulting a chiropractor they do not find any reduction in their pain and they do not want to undergo spine surgery. The conservative care specialists are well-trained in rehabilitation of musculoskeletal disorders and specialize in spine care. The role of the conservative care specialist is similar to a cardiologist who specializes in treating neurological disorders.

The specialist for spine care works along with the surgeon in a spine center to treat the lower back pain. The specialist is trained in diagnostic techniques and is capable of making use of a combination of diagnostic tests as well as injection techniques such as epidural steroid injections to diagnose the source of the lower back pain in a patient. They can even advise patients whether it is appropriate to consult a spine surgeon for surgery. Surgery is done to correct the anatomical conditions and it is performed only when non-surgical treatments are not successful in alleviating the pain of the patient.

When Is The Right Time To See A Spine Surgeon?

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