Most of us suffer from lower back pain at some point in our lives; be it from a sedentary lifestyle, spending hours at the office desk or from strenuous physical exercises. In most cases, a little bit of rest does the trick. However, if the lower back pain persists for 3-6 weeks, physiotherapy is recommended.

How does physiotherapy help?

The main purpose behind physiotherapy is reducing lower back pain and increasing muscle and bone function, so that such instances are avoided in the future. Physiotherapy is the first line of defence against lower back pain. More drastic measures such as surgery are undertaken once physiotherapy fails to do is job.

Physiotherapy is often recommended when the back pain is caused due to lifestyle factors, a minor injury like a fall or other moderate factors. For more severe back injuries, doctors recommend surgery straight away when there is no scope of performing physiotherapy.

Low-intensity back pain can be cured using a combination of heat packs, ultrasound wave therapy and Iontophoresis (using a localized current source to introduce medical ionic compounds to the body).

A physical therapy program for back pain usually has two components:

Passive physical therapy to help reduce the patient's pain to a more manageable level

Active exercises

Passive Physical Therapy - Modalities

The physical therapist may focus on decreasing pain with passive physical therapy (modalities). These therapies are considered passive because they are done to the patient. Examples include:

Heat/ice packs

TENS units

Iontophoresis

Ultrasound

Active Physical Therapy - Back Pain Exercises

In addition to passive therapies, active physical therapy (exercise) is also necessary to rehabilitate the spine. Here are some of the common exercises for back pain:

Back Stretch: Put your hands underneath your head while lying back. Bend your knees but put your feet on the ground. Roll your legs to one side and hold them there for 10 seconds. Repeat three times for each side.

Deep Lunge: For this, you need to kneel on one knee with the other foot pointed towards the front. Lift the back knee up and hold it there for five seconds and then bring it down. Repeat this exercise three times for each side.

One Leg Stand: This is the simplest of exercises. Hold on to a wall for support while standing and face towards it. Then slowly hold one leg and bend it behind you. Hold in the same position for five seconds before bringing it down. Repeat the process three times for each leg in five second gaps.

Physiotherapy for Back Pain

In preparation for the possibility of conception, a woman's body undergoes the menstrual cycle every month which culminates into the periods. This is a normal process which all women of reproductive age go through every month. However, in certain cases, the periods can be really painful where you may suffer from menstrual cramps or could be generally in much pain. This condition is known as Dysmenorrhea.

What exactly is Dysmenorrhea
As mentioned above, Dysmenorrhea is a disorder that many women got through while having their periods where they may suffer from painful cramps. The pain usually occurs in the pelvis area along with the lower abdomen and it may also be accompanied by other symptoms.

Some symptoms of Dysmenorrhea
Some of the symptoms of Dysmenorrhea could be any combination of the following factors
I. Very painful menstrual cramps accompanied by lower back pain
II. Diarrhea and nausea along with the cramps
III. Pain in the inner thighs, lower back and hips
IV. Being hypersensitive to light, loud sounds, specific smells and touch
V. Being fatigued all the time, even causing you to faint

Causes of Dysmenorrhea
Dysmenorrhea is usually caused by the contraction of the Uterus. While the uterus does contract a little even in normal periods, during Dysmenorrhea the contractions tend to be a little too much. Due to this the uterus presses against the blood vessels and organs within the vicinity causing oxygen loss to them. This causes elevated levels of pain and discomfort.

Some of the underlying causes which may result in Dysmenorrhea are:
1. Narrowing of the cervix - Also known as stenosis, the lower part of the uterus which is the cervix may become narrow due to scarring and cause Dysmenorrhea.
2. Endometriosis - This is where the uterine lining is found outside the uterus, especially in the pelvic cavity and thus may cause painful cramps.
3. Inflammatory pelvic diseases - This is when a bacterial infection in the pelvic area can spread to multiple organs, including the uterus and thus may cause painful menstrual cramps.
4. Tumors - Tumors or fibroids which are unwanted growths on the inside of the uterus may also trigger Dysmenorrhea.

What to do if you are suffering from Dysmenorrhea
Below are some of the basic steps which you can take to ease pain from Dysmenorrhea
1. Avoid smoking and abstain from alcohol
2. Ample rest during periods
3. Keep the body dehydrated
4. Don't consume foods high in salt
5. Don't drink coffee or any caffeine rich foods
6. Lower back massages and hot water bag treatments to relieve pain
If severe pain still persists for long or if dysmenorrhea occurs repeatedly, then you should consult a doctor first rather than trying to resolve the problem yourself.


All about Dysmenorrhea

Shoulder pain can be a persistent dull and nagging sensation in the upper arm or shoulder area. It can be easily differentiated from neck pain as it is related to the movement of shoulders i.e. it will increase and decrease with shoulder movements, especially overhead activities. The other signs to identify shoulder pain is if your shoulder movements are reduced.

If you find it difficult to scratch / wash your back, comb your hair or reach your back pocket, it clearly shows you are suffering from shoulder pain. Shoulder pain can happen due to various reasons, it varies from person to person depending on the activities he/she is involved in, for e.g. sports, manual job etc. It can be a single major injury or multiple small injuries due to repetitive usage patterns. Also, degenerative changes in various parts of the shoulder can lead to shoulder pain.

In case of middle to old age, injuries that can cause shoulder pain are:

    Biceps Tendonitis
    Acromio-clavicular Joint arthritis
    Scapular Dyskinesia
    Trapezitis
    Suprascapular nerve entrapment In young age, injury due to sports or gym activity can cause shoulder pain
    Superior labral anterior/posterior (SLAP tear)lesion

Also, traumatic or repeated dislocations of shoulder can cause shoulder pain due to:

    Bankart lesion

Diagnose Shoulder Pain

Shoulder pain can be diagnosed only after thorough history taking and clinical examination. However, some imaging studies can be very helpful like:

    X-rays: Through an x-ray one can view the shoulder in many different views.
    Ultrasound: With an ultrasound, you can also check the damaged caused to the tendons and muscles of the shoulder but the quality of reporting depends upon the expertise of the doctor.
    MRI: MRI gives a clear picture of the shoulder as it shows everything related to a shoulder joint that is joints, vessels, tendons and muscles that too from different angles.
    Diagnostic Arthroscopy: A surgical procedure often used by orthopaedic surgeons to diagnose and treat issues inside a joint. Arthroscopy has the big advantage that one can use it to diagnose as well as treat at the same time.

Treatment for Various Types of Shoulder Pain

    For Shoulder Impingement or Rotator Cuff tear: Give rest to the shoulder for a few days only Dedicated Physiotherapy Protocol Bursal injections If these fail then, (Surgery)Arthroscopic sub-acromial decompression If Cuff tear is found, then one can go for Arthroscopic/Mini-open repair
    Labral Lesions: For anterior Labral lesions (Bankart's) following anterior shoulder dislocation then surgery in the form of Arthroscopic Bankart's repair is the only option to reduce risk of recurrence and degeneration.

SLAP Lesions

    Pain relief and physiotherapy as first step If this fails then following surgical options are available
    Arthroscopic debridement or repair of labrum
    Biceps tenotomy or tenodesis

Arthritis

In this case, the joint is already destroyed and has to be resurfaced for pain relief and to maintain ROM. If Rotator cuff muscles are working, then Shoulder resurfacing hemiarthroplasty (preferred in young people), that has a life of 10 to 15 years, Total shoulder replacement (preferred in middle aged to old people) has a life of 10 to 15 years. But, if rotator cuff muscle are not working then Reverse Geometry Shoulder replacement is recommended, that has a life of 10 years.

It is always advisable to get yourself diagnosed properly in case of shoulder pain as management changes depending on clinical situations. Neglecting shoulder conditions can lead to bigger problems later on.

Always remember 'a stitch in time saves nine'

Shoulder Pain: Causes, Diagnoses & Treatment

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

Pain is unpleasant suffering caused by injury or illness. Back pain may be sudden/constant, dull, severe or not responding to short rest and medication. Constant pain in back in any region of spine for more than few days to weeks needs intervention.

Pain which is intense especially at night requires urgent visit to a specialist.

Sudden onset of pain in back with or without injury needs urgent attention.

Back pain with difficulty in walking, pain while getting up from position of comfort, pain during change of posture or pain after prolonged sitting (for work) can lead to serious permanent damage, if left untreated.

Pain which travels to one or both legs may be due to pressure on the nerve/s and if left untreated for long can lead to permanent weakness or damage.

Pain associated with numbness, tingling or weakness in legs, especially below the knees, commonly called Sciatica, needs to be investigated. Various spinal ailments can lead to weakness in one or two limbs or all four limbs. There may be associated or isolated numbness (loss of sensation to touch, pain or temperature) without back pain.

Numbness, tingling or weakness may be the only symptoms without any complaint or without history of back pain.

Problems related to bladder control which may be difficulty to control, hesitancy in passing or dribbling of urine. There may be associated constipation. Loss of bowel/bladder control is caused by pressure on spinal cord &/or nerves which may be due to injury, infection, disc prolapse or tumor.

Sudden swelling and redness in back usually happens after an injury or accident but sometimes are signs of underlying severe illness.

Loss of normal shape/curvatures of spine can present with or without pain. It can lead to forward, sideways or rarely backward bending.

Unintentional weight loss, loss of appetite, evening rise of fever or disturbed sleep with associated back pain/weakness/numbness needs visit to a specialist.

When Should You See Your Doctor in Back Pain?

Lower back pain is one of the most common ailments among adults all across the world. You may wake up in the morning with an energising drink before going out to work. After you arrive at work, you may have to sit there till lunch, which involves further sitting and you are required to sit for more hours for completing the remaining work. Then you come back home by sitting in the car and have the night s meal while again sitting. Did you know sitting through the day is the major culprit behind your back pain? Thankfully, yoga has effective ways of treating back pain to a considerable degree.

You can choose to do the following yoga poses for alleviating your back ache:

Supine hamstring stretch: You will have to lie back on your back and bend the right knee to the chest. Then you will have to place a rolled-up towel around the football and straighten the leg towards the ceiling and press both the heels. In case your lower back feels strained, you can bend your left knee and place the foot right on the ground. Hold the position for about 3 to 5 minutes and practice regularly for soothing back pain.
Two knee twist: You will have to bend your knees to the chest while lying on the back and try to bring out the arms forming a T-shape. Then try to exhale and lower down the knees on the ground towards your right side. Keep both the shoulders pressed down firmly and hold this position for about 2 minutes for best results.
Sphinx: You will have to prop yourself on the forearms while lying on the stomach. You will then have to align the elbows right under the shoulders and press through the tops and palms of the feet. You are likely to feel terrific sensations down your lower back, but it is advised to bear through it as it allows the flow of blood to that region which is required for healing. Practice the position regularly and hold it for at least one minute.
Thread the needle: This is quite an easier pose where you will have to lie flat on your back by bending both the knees with your feet flat on the ground. You will now have to bend the right knee by placing the outer left ankle through the right thigh. You will have to thread the right hand between the leg and interlace the hands behind the left thigh.
These positions would help in soothing your lower back pain, but it is recommended to consult a doctor if the pain still persists. Ayurvedic Tiktaksheer basti, massage therapy and certain oral medicines can help a lot in speedy recovery from spine/back related problems.

Ayurved has a very unique way of drug administration called Basti in which various medicines are given through the anus ( Rectal route)...For Lumbosacral / spine disorders a very specialised form of enema Tiktaksheer Basti (Medicated Bitter Milk enema) is given which shows amazing results. Kindly consult a specialized Ayurvedic practitioner for additional details.

Kati Basti (Vasti) is a traditional Ayurvedic treatment used for lower backache and disorders of lumbosacral region, including slip disc, lumbar spondylosis, sciatica, spinal problems etc. Kati Vasti is a part of external oleation (Snehana) therapy in Ayurveda. It is very safe, non-invasive and green category procedure.

In this procedure, you will get instant relief from backache. After completing a course of 7 to 21 days, you may not need any kind of oral medicines. It is a complete therapy for back pain and lumbosacral disorders.

However, the results vary person to person, but in most of cases, people get quick relief after the procedure.

Lower Back Pain - 4 Yoga Asanas For Treating it

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