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

If your kid is affected by Duchenne muscular dystrophy (DMD), it is important for you to know about the best ways of dealing with the condition. Muscular dystrophy consists of group of diseases, which result in the weakening of muscles along with reduced flexibility. DMD accounts for being the most common type of muscular dystrophy. It occurs because of flaws in the gene, which controls how your body keeps the muscles healthy. This disease affects boys and the symptoms start appearing from early childhood.

Treatment
There is no specific treatment for DMD. However, there are several ways, including medicines and therapy, to deal with the symptoms and to protect the muscles.

Several steroids such as prednisone help in slowing down muscle damage. Children taking this medicine are able to walk for two to five years longer than they would usually do. Lung and heart functions are also improved.
DMD leads to heart problems and hence, you should take your child to a heart doctor for regular checkups until the age of 10.
In some cases, a surgery may be required to fix their shortened muscles, for straightening the spine, or for treating a heart or lung problem.
Taking care of your child
If your child has DMD, it does not mean that he will have to refrain from activities such as school, sports and spending time with friends. By sticking to the right treatment plan, you will be able to make your child active.

Stand and walk: Being in an upright position will keep your child s bones strong and the spine straight. You can get your child braces or standing walkers, which will help him in terms of balance and mobility.
Eat right: Although there is no special diet for DMD, several food items should be taken for preventing problems related to weight. Your child should eat the proper amount of food with a proper balance of nutrients and calories regularly.
Stay active: You should ensure that your child exercises regularly. Regular stretching exercises help in keeping the muscles and joints limber, which makes him feel better. You can avail the help of a physical therapist for an exercise schedule.
You can look for and join local support groups associated with DMD, as other families living with DMD can be a source of good advice and understanding about life with DMD.

Muscular Dystrophy -  How To Deal With It?

If you are suffering from arthritis, it is important for you to know about how it affects your knee and other joints. Arthritis is a chronic, systematic inflammatory disease which damages your joints and connective tissues. Your knee is commonly affected by arthritis and there are three primary types of arthritis that occur in the knees. They include osteoarthritis, rheumatoid arthritis and post-traumatic arthritis.

Types of arthritis 
The different types of arthritis affecting the knees occur due to different reasons. Osteoarthritis is a progressive condition, which wears away the joint cartilage over time. Rheumatoid arthritis is an inflammatory condition, which may occur at any age. Post-traumatic arthritis occurs after an injury is inflicted to the knee and may occur several years after a ligament injury or knee fracture.

Major symptoms

Arthritis pain may occur all of a sudden, but commonly develops slowly. In the early stages, the pain is observed in the morning after you have been inactive over the night. Pain is likely when you want to move around. Pain may be experienced even when immobile.
Periodic inflammation is a common symptom of arthritis of the knee. This happens because of the formation of bone spurs or excess fluids in your knee. The swelling gets pronounced after being inactive for a long period. The skin on your knee may look red and feel warm while you touch it. This may lead to chronic inflammation, which is very difficult to manage.
Treatment
There are several ways of treating knee arthritis. The mode of treatment depends on the severity and cause of knee arthritis. NSAIDS or nonsteroidal anti-inflammatory drugs are commonly prescribed for dealing with arthritis pain temporarily. Other medicines used for knee arthritis treatment are as follows:

Analgesics, which help in pain reduction act as good alternatives to NSAIDS.
Corticosteroids are used for reducing inflammation.
Certain DMARDs or disease-modifying antirheumatic drugs are used.
Certain injections that are used for helping with knee arthritis. They include:

Hyaluronic acid supplements, which ease the pain and inflammation by lubricating your knee joints.
Corticosteroid injections also soothe inflammation and pain.
You may also require a surgery for dealing with knee arthritis when other modes of treatment fail. The most common surgeries are as follows:

Total joint replacement, where your knee is replaced with a prosthetic made of metal, plastic or ceramic.
Osteotomy, where the knee bones are modified for controlling pressure and damage in the knees.
Arthroscopy, where an incision is made in the knee for removing damaged parts.
It is recommended for you to consult a doctor, if you experience any symptom of knee arthritis. Early treatment will prevent the condition from worsening.

Knee Pain - It May be a Sign of Arthritis?

Injuries are very common, especially head injuries are one of the leading causes of death and disability in adults. As per surveys conducted, 1.7 million people suffer from head injuries every year and this estimation is increasing day by day.

Head Injury is any trauma to head other than superficial injuries to face. It results in high morbidity & mortality. Head injuries are an important cause of loss of young people at their productive age.

Causes of Head Injury-

A head injury can occur due to many reasons. Some common causes of these head injuries are:

Vehicle accidents

Street fights

Fall from height

Child abuse

Symptoms of Head Injury-

A head injury is followed by various symptoms depending upon the intensity of the injury. Here is a list of the possible symptoms of brain injuries:  

Nausea and vomiting, fatigue or sleepiness, severe headache, confusion, amnesia,  loss of consciousness, seizures, loss of muscle control or paralysis in the part of the body controlled by the part of the brain that is affected, coma, dilation of the pupils and disturbance of vision, Cerebrospinal fluids might come out of the ears and nose, sometimes accompanied by blood, difficulty in breathing, low pulse rate, increase in blood pressure, difficulty in swallowing, loss of hearing, problems in cognitive functions.

Brain damage is a process, not an event. 80% are minor head injuries, 10% are moderate head injuries and 10% are major head injuries.

Management of Head Injury-

Diagnosis of a brain injury has to be detailed and very quick at the same time. It always comes under emergency cases. Some of the steps involved are:

Glasgow Coma Scale

Pupillary reaction to light

Brain stem reflex tests

Head to toe examination

CT scan of head is the initial study of choice. MRI Brain is helpful in cases of non-haemorrhagic contusions, diffuse axonal injury and deep lesions.

Surgical Indications

Head injuries with intracranial hematomas causing significant mass effect

Massive cerebral edema

Hydrocephalus

Infection

Precautions for Head Injury

Use Helmets- both riders

Use Seat Belts

Keep vehicle speed under control

Follow traffic rules

Take adequate precautions during trekking, diving

Take Away-

No head injury is minor enough to be neglected nor severe enough to be given up.

Head injuries take time to heal, but medical treatment along with neurosurgery can aid the process of recovery and also help a person to lead a healthy life in the future. Most young patients recover fully, while some older patients or patients with preexisting neurological conditions live with a degree of disability.



Head Injuries - All You Must Know!

Facial paralysis is a loss of facial movement because of nerve damage. Your facial muscles may seem to hang or may become distinctly weak. It can happen on one or both sides of the face. Usual reasons for facial paralysis include:

Infection or swelling of the facial nerve
Head injury
Head or neck tumor
Stroke
Facial paralysis can increase all of a sudden or happen slowly over a span of months (mostly if one has a head or neck tumor). Based upon the cause, the loss of movement may keep going for a short or a long period of time. However, physiotherapy can prove to be very beneficial. Here is how:

1. Electrical stimulation: A few specialists suggest utilizing electrical stimulation and biofeedback as technique for physiotherapy for facial paralysis, yet different specialists believe that it does help in recovery. Talk with your specialist or advisor about whether electrical stimulation is ideal for you. Electrical stimulation uses little amounts of electricity to relieve the muscles in your face. This causes your muscles to jerk as though electrical signals from your brain reacted to them. During this time, your face is most incapacitated, which might be the main cause for you to enact these facial muscles.

2. Manual massage: Face rub can be performed in conjunction with other treatment choices. It is possible to enhance mental relief. Massage methods on the face include:

Effleurage
Finger or thumb massage
Tapping
Stroking
3. Kabat rehabilitation: Kabat recovery is a sort of engine control restoration procedure. During Kabat, specialists increase the compression of the weakened muscle by applying a global stretch and then massaging the solid segment. They encourage movement by verbal info and manual contact. While performing Kabat, there are namely three phases - the upper (temple and eyes), intermediate (nose), and lower (mouth). Before Kabat, ice compression needs to be performed to the particular regions, with a specific end goal to build its contractile power.

4. Icing: Ice helps in decreasing the aggravation surrounding the facial nerve, which might be in charge of the loss of nerve movement or conduction leading to facial paralysis. You can either use an ice pack or any cold compressor.

5. Facial exercises: These include doing essential activities with the distinctive muscle surrounding your face. In case you consult a specialist or physical advisor for your facial paralysis, he or she will suggest particular exercises for your level and stage of paralysis. If not, have a go at flexing the different muscles in your face through and through. Frown, raise your eyebrows, gradually flicker your eyes, and proceed down to your jaw.

Facial Paralysis - How Can Physiotherapy Help You Get Better?

As life expectancy is increasing so is the incidence of vertebral body (VB) fractures now being the commonest fracture of the body. PVP is an established interventional technique in which bone cement is injected under local anaesthesia via a needle into a fractured VB with imaging guidance providing instant pain relief, increased bone strength, stability, decreasing analgesic medicines, increased mobility with improved quality of life and early return to work in days.

In this era of minimally access surgery replacing open surgeries, PVP is a novel procedure & should be in the first line of management in place of conservatism or major spine surgery for painful uncomplicated compression fracture spine.

Morbidity & consequences of spinal fracture:

Traumatic VB is a painful condition requiring bed rest restricting daily activities markedly
Left untreated it can cause DVT, increase osteoporosis, loss of VB height, respiratory & GI disturbances, emotional & social problems secondary to unremitting pain, loss of independence with high cost of rehabilitation.
High risk of primary or consequential damage to neural, bony or disc element
Increased wedging, deformity & increase incidence of adjacent VB
Chronic pain of altered spine mechanics
Uncomfortable braces & sleep disturbance because of pain & discomfort with its sequels.
Cost of surgery and hospital treatment
Cost of implants
Phobia of surgery
Prolonged recovery period & Extensive rehabilitation
Changed spinal mechanics & transition syndrome
Major surgery & anesthesia with its own complications
Results / Outcome

PVP is a novel procedure with high benefit to risk ratio, which is highly underutilized in relation to the high prevalence of the vertebral.
Different studies show an immediate pain relief in (85   90)% of patients with low complication rate ranging from (1-5)% depending upon the type of lesion.
PVP does augment height of VB but ideal would be kyphoplasty
Patient is either off medicine or on reduced doses.
Patient feels so well that he almost forgets if he had VB

Percutaneous Vertebroplasty (PVP) is an emerging interventional technique in which surgical polymethyl methacrylate bone cement is injected under local anaesthesia via a large bore needle into a vertebral body (VB) under imaging guidance providing increased bone strength, stability, pain relief, decreased analgesics, increased mobility with improved QOL and early return to work. Started in 1984 by Galibert PVP is done in host of indications.

Senile osteoporotic compression remains the commonest Indication. Other indications are Metastatic VB, Multiple myeloma VB, VB haemangioma, Vertebral osteonecrosis & for strengthening VB before major spinal surgery. The benefit has been extended to the traumatic stable uncomplicated VB compression (VCF) which is commoner in younger age group with active life profile and prime of their career where strict bed rest and acute or chronic pain are unacceptable and they are more demanding for proactive treatment approach so as to be back to work ASAP.

Discovering the fact that VB is the commonest of body, its incidence >the hip, it becomes imperative to take it more seriously. With increasing life-span there is more of aged osteoporotic population, more so due to sedentary indoor lifestyle and post menopausal osteoporosis. Diabetics, smokers & alcoholics are at higher risk of developing osteoporosis. I have seen such alcoholic patient developing six spine fractures in just three months time from a single fracture being on complete bed rest.

Quick fix of fracture spine makes patient walk back same day instead of bed rest of months together avoiding morbidity & mortality of prolonged bed rest, making bedridden patient walk, in a way bringing patient back to normal life.

In this era of MAS replacing open surgeries, PVP is a novel procedure & should be in the first line of management in place of conservatism or major spine surgery for painful uncomplicated compression.

Morbidity & consequenses of spinal 

Traumatic VB is a painful condition requiring bed rest restricting daily activities markedly.
Left untreated it can cause DVT, increase osteoporosis, loss of VB height, respiratory &
GI disturbances, emotional & social problems secondary to unremitting pain, loss of independence with high cost of rehabilitation.
High risk of primary or consequential damage to neural, bony or disc elements.
Increased wedging, deformity & increase incidence of adjacent VB
Chronic pain of altered spine mechanics.
Uncomfortable braces & sleep disturbance because of pain & discomfort with its sequels.
Morbidity and complication of spinal surgery 

Cost of surgery and hospital treatment
Cost of implants
Phobia of surgery
Prolonged recovery period & Extensive rehabilitation
Changed spinal mechanics & transition syndrome
Major surgery & anesthesia with its own complications
Preparation & Procedure:
X-ray spine in a/p & lat view. CT is more informative of bone & morphology. MRI is good for soft tissue injuries. Ask for pedicle size in all dimensions and construct a 3D image aiming needle placement and cement filling in scan room itself as rehearsal of PVP. This reduces operative time & gives better results. Conventionally PVP is done by hammering the vertebroplasty needle through the bone. Here we use light weight drill to bore through the vertebra. It is important to set the needle at exact entry site & side with right trajectory aiming the defects.

In lateral view needle should go through middle of the pedicle going up to anterior 1/3 of VB. In P/A view the needle can be in midline or paramedian depending upon & if uni/bipedicular approach is planned. Approach varies as per location of vertebra, anterolateral in cervical, costotransverse/parapedicular in thoracic & transpedicular in lumbar vertebra.

Do bone biopsy if there is any doubt about lession. Do dye test (vertebral venography). Make cement more radiopaque by adding barium /or tungsten. Inject cement with 1or2 ml luerlock syringes strictly under fluoroscope in lateral view & cross checking in P/A view. Stop injecting either there is adequate filling or at the first sight of ectopic cement leak. Keep sample cement to see for hardening. Remove needle with rotational movement before cement hardens.

Pain relief is by virtue of different mechanisms postulated :

Cementing of fragments.
Thermal neurolysis of VB nerve ending due to heat of polymerization.
Washing away of nociceptor chemicals.
Neurolytic action of liquid monomer.
By allowing early ambulation decreasing pains of immobility & bed rest.
Complications 

PVP is generally safe with low risk.
Ectopic cement leak is frequent but generally inconsequential.
Outcome 

PVP is a novel procedure with high benefit to risk ratio, which is highly underutilized in relation to the high prevalence of the vertebral
Different studies show an immediate pain relief in (85   90)% of patients with low complication rate ranging from (1-5)% depending upon the type of lesion.
PVP does augment height of VB but ideal would be kyphoplasty.
Patient is either off medicine or on reduced doses.
Patient feels so well that he almost forgets if he had VB

Vertebroplasty (PVP) / Kyphoplasty - Approach To Management Of Vertebral Body Fractures!

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