Sarcopenia refers to the loss of muscle mass caused by the natural process of ageing. Over time, the loss of muscle mass may reduce a person s strength and affect his or her balance and the ability to walk. Sarcopenia can make it difficult for one to carry on with their routine activities, such as walking, lifting objects, or climbing stairs.

The reduction in muscle mass involves both a decrease in their size and the loss of muscle fibres. Sarcopenia becomes noticeable by age 40   and the loss of muscle tissues progress more rapidly by the time you reach the 60s or 70s. Doctors believe that certain hormonal changes due to ageing are the main reason for this condition. 

Apart from that, poor nutrition and a sedentary lifestyle also contribute to muscle loss. Health experts and doctors suggest that following a proper, nutritious diet can help treat or delay sarcopenia.

Diet recommended for sarcopenia patients 

If you are diagnosed with sarcopenia, your dietician or healthcare provider will likely recommend a diet that has an abundance of proteins, omega-3 fatty acids, and vitamins to prevent further muscle loss and boost their growth.

Here is a close look at the nutrients  

Proteins

The protein in your diet signals the muscle tissues to strengthen and build. As your muscles become more resistant to this signal with age, it is important that you consume more protein to increase muscle growth. A study found that people over age 70, who consumed a wholesome meal containing 35gms of protein, saw significant growth in the muscle mass. Leucine, an amino acid, is especially essential for regulating muscle growth. Some of the best sources of leucine include meat, eggs, fish, soy, and whey protein. 

Research has shown that the optimal intake of dietary protein should be somewhere between 0.6-0.9g/pound/d of protein in older adults with chronic or acute diseases. Besides eating more protein with meals, health experts recommend adding other protein-rich foods to their daily diet, including peanuts, almonds, edamame, and chickpeas. 

Vitamin D

Vitamin D is important for maintaining and building healthy bones. This is because the main component responsible for bone health, calcium can be absorbed only when your body has sufficient vitamin D. Milk, soymilk, cheese and other dairy products, egg yolks, and fatty fish like salmon, tuna, and mackerel are some of the foods offering sufficient amounts of vital vitamin D. While natural food sources are the best way to get your daily dose of vitamin D, you can also opt for supplements to increase muscle endurance and lower the risk of falling. However, be sure to discuss with your doctor before taking vitamin supplements. 

Omega-3 fatty acids

Fish oil extracted from fatty fish contains high amounts of omega-3 fatty acids, DHA, and EPA. Due to its anti-inflammatory properties, fish oil is known to boost muscle sensitivity to resistance training and protein, allowing for growth in strength, size, and muscle mass as you age. A study conducted over 16 weeks revealed taking omega-3 supplements regularly witnessed a significant increase in muscle growth. 

Sarcopenia becomes more apparent with age and may affect your quality of life. Eating high-quality protein and enough calories can delay the rate of muscle loss. Consult a dietician and ask for a diet plan comprising these nutrients to improve muscle strength and deter sarcopenia.

What Type Of Diet Should Be Taken In Sarcopenia?

Bone cancer is a rare form of cancer in the cancer family. It affects one of the bones of your body and spreads to other bones. But, more often, it has the tendency to affect the long bone in the legs and the arms. There are many types of bone cancers. While some of them can affect children, the others typically affect the adults. This type of cancer is different than those cancers which get initiated from other parts of the body and spread to the bones.

What are the symptoms of bone cancer?
The typical signs and symptoms of bone cancer include acute pain in the bone, tenderness in the affected area, swelling of certain bones, a tendency of bone breakage, fatigue with little or no effort, unexplained weight loss, shortness of breath etc.

What are the causes of bone cancer?
There is no particular reason for bone cancer. Studies have shown that an error in the structure of the DNA leads to bone cancer. This error leads the bone to grow and divide in an uncontrolled manner leading to non-extinction of cells. These cells keep growing and form a mass invade to other parts of the body, leading to cancer.

What are the different types of bone cancer?
The type of the bone cancer can be distinguished from where cancer originates from. Some of the common bone cancer type includes the following:

Osteosarcoma: This is the form of cancer that originates from the bone cells and is often witnessed in young adults and children. They often attack the arm and the leg.
Chondrosarcoma: This form of cancer begins from the cartilage cells. The exact place of damage appearance includes legs, arm, and pelvis. This is typically observed in middle-aged persons in older adults.
Ewing's sarcoma: Though researchers are yet to find out the location this form of bone cancer originates from, it is mostly considered to affect the legs, arms, and legs of young children.
What are the risk factors?
While doctors are yet to researching for the exact reason of bone cancer, there are certain risk factors which have been associated with the bone cancers.

Inherited genetic syndromes: Certain genetic condition such as the hereditary retinoblastoma and Li-Fraumeni syndrome which are passed on from generations are a prime culprit of bone cancer.
Paget's disease: This is a bone-related disorder that affects the bone and increases the chance of bone cancer.
Radiation: Exposure to a huge amount of radiation increases the chances of bone cancer and other associated cancers.
How is bone cancer detected?
Imaging tests such as the bone scan, x-ray, MRI, PET scan and the CT scan can diagnose bone cancer. Apart from these, oncologists might order a biopsy that includes removing a part of the tissue and test the same in a laboratory can also help to detect bone cancer.

Bone Cancer - Risk Factors Associated With It!

The core muscles, mainly concentrated around the abdomen, hips, lower back, trunk, and glutes, are indeed a powerhouse that gets you going. The stronger the core muscles, the fitter you stay. Without a proper core strength, a lot of the day to day activities including lifting or bending gets affected. Certain health conditions can weaken the core muscles. But how to know if the core muscles are weak? There are many signs and symptoms associated with weak core muscles. 

Mentioned below are some important signs that may be an indication of weak core muscles.

For your posture to be correct, the spine and pelvis need to be stable: The muscles of the lower back and the abdomen does exactly that, ensuring a steady and correct posture. However, when the core muscles weaken, they are unable to provide stability to the spine and the pelvis resulting in a poor posture. Left unattended, poor posture, in turn, can trigger a myriad of complications and discomfort.
The body loses its balance: As already mentioned, the core muscles go a long way in stabilizing the body and helping you to maintain the body balance. You can perform a small test to know if your balance is affected. Close your eyes and stand on one foot. Repeat the procedure with the other foot as well. If you have a developed core, you will be able to hold the position for at least 10 seconds, if not more (both the legs).
A pain concentrated to the lower back: Do not ignore a lower back pain. It could be an indication of your core muscles not being strong enough, especially the ones adjacent to the spine. The weak muscles fail to provide the necessary support to the discs and the vertebrae resulting in pain (mild to severe depending on the severity of the condition) and discomfort. Timely medical intervention may help improve the condition.
Weakness throughout the body: The strong core muscles are an indication of a healthy and fit body. When the muscles start to lose its strength, the entire body gets affected. A person finds it difficult to even lift things. Doing even a small and regular work leaves a person weak and tired.
You can also perform the Hollowing Test to check your core strength: Sit in a comfortable position. Starting breathing in and out. As you breathe out or exhale, try to pull your stomach inwards towards the spine for at least 10 seconds. Unable to pass this test (can't hold the position for 10 seconds) indicates weak core muscles.
You can also try the plank test: Get yourself in a push-up position with the entire body resting on your elbows, arms, and toes. The hip should be level and steady. Failing to stay in this position for 50 seconds is indicative of weak core muscles

Core Muscles - How To Know If They Are Strong Or Weak?


The neck and back are closely related, and pain in one area can easily affect the other. Both neck and back pain have become lifestyle problems, due to prolonged sitting and incorrect working postures. Treating one area can help in subtly treating the other and also reduce the onset of pain. 

Pain in neck and back can be due to strained muscles, wrong posture, injury or stress due to knots in muscles and can be easily treated with a number of ways such as physical therapy, muscle relaxants and trigger point injection. Also, facet joint arthritis occurs due to degeneration of joints in elderly, excessive strain in some type of jobs or injury. Physical therapy along with injection in the nerves that carry a message from these joints to the brain along with medications that can numb sensation and Radiofrequency Rhizotomy for long-term relief is performed by pain specialists. Disc prolapse of neck/ lumbar vertebrae can also cause back pain.

Read on to know the best ways to manage back and neck pain, as the following techniques work for both.

Ice and heat therapy: Alternating heat and ice therapy can help reduce pain. It helps by reducing the sensation of pain and improving blood flow, thereby providing relief.
Physical therapy: Exercising and stretching, whether as a preventive measure or as a part of therapy, can work wonders. It improves the agility of the bones and tendons, improves movement, reduces stiffness, and relieves pain. A program should be drawn up based on the patient s overall health condition and symptoms. Patients should be monitored for any improvements or changes in symptoms.
Pain medication: When nothing else works, then pain medications become the next course of action. These can be taken for immediate relief, but cannot treat the pain permanenetly.
Steroids: Injecting corticosteroids into the bone and joint spaces can help with acute pain management.
Collar or brace: A neck collar or brace is used to keep the neck in place to reduce movement and provide support, thereby, it helps in reducing pain.
Acupuncture: Each area has associated pressure points in the body. These pressure points are identified and needles are applied to provide relief from pain.
Massage: The Massage can help by stimulating tissues, improve blood flow and also to relax muscles. The herbal oils that are used provide added benefit too, and so periodic massages are being widely used for pain management of neck and back.
Chiropractic therapy: This involves manipulation of the spinal cord with the belief that the spinal cord could be incorrectly settled. The cord is manipulated to get it to the correct location, thereby relieving pain and stiffness and improving movement
TENS (transcutaneous electrical nerve stimulation): The nerve in the affected area is stimulated by electrical impulses, thereby providing pain relief. This needs to be repeated at frequent intervals and is often reserved for acute cases.
Surgery: Often, used as a last resort, where all other measures have failed. Whether it is a herniated disk or a pinched nerve, the cause is identified and then surgery planned.


Back & Neck Pain - Different Ways Pain Can Be Managed!

One of the most common diseases that afflict a large section of the population is arthritis. It is common among people who are above 40 years of age. Acute joint pain, difficulties in movement and weakened bones are among the most common symptoms of arthritis. Given the fact that it is a condition that has permeated into modern life so deeply is what makes arthritis one of the most feared illnesses of this time. Although there are multiple forms of arthritis, there are primarily two types, which are:

Osteoarthritis: This is characterized by a breakdown of the cartilage between the bones. It is mostly known to affect a person s joints.
Rheumatoid Arthritis: This is a form of auto immune disease that severely affects the lining within the joints of bones.
Causes
The causes of arthritis might vary from person to person. Some of them are discussed below:

Diet and nutrition habits: Some food items, especially red meat and products derived from animals can cause a rise in the level of uric acid thus, increasing the risks of arthritis as well as gout. Smoking also has been known to worsen this condition.
Genetic predisposition: Some people are more prone to develop arthritis as they are genetically predisposed to it.
Problem in the immune system: Rheumatoid arthritis is one condition which is caused by the attack of immune system on the lining of the joints within the body.
Risk factors for arthritis include:

Obesity: The joints are subject to excess stress because of the excess weight. This results in a higher risk of arthritis in obese people.
Age: The risk of arthritis increases with age.
Family history: It is possible for you to be vulnerable to this disorder if arthritis runs in the family.
Previous injury: People who have had a previous joint injury are more susceptible to arthritis.
Typical symptoms of both forms of arthritis are:

Redness in the affected areas
Stiffness in the joints
Pain in the joints of the body
Swelling in particular joints or most joints of the body
Decreased mobility either due to pain or stiffness

Can Poor Diet and Nutrition be a Cause of Arthritis?

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!

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