When we speak of bone health, calcium is usually the hero of the story. However, by itself, calcium is not enough for healthy bones. Vitamin D is equally important for healthy bones and the prevention of orthopedic conditions.

What does Vitamin D do?
Vitamin D helps the body absorb calcium from the food being eaten. It also controls the calcium and phosphate levels in the body. This is critical for the growth and development of new bones. Vitamin D also controls how much calcium and phosphates are being expelled by the body. In this way, vitamin D helps strengthen the bones and improve overall bone health.

Vitamin D Deficiency
Vitamin D is not commonly found in food. It is present only in certain types of oily fishes, egg yolks and mushrooms. Most of the vitamin D we eat comes from fortified cereals, breads and dairy products. The sun is an important source of vitamin D but exposing yourself to too much sunlight could cause various skin problems. Thus, vitamin D deficiency is very common. When it comes to bone health, vitamin D deficiency can cause low-density bones. This, in turn, can cause rickets and osteoporosis. People with vitamin D deficiency are likely to suffer frequent fractures. Vitamin D deficiency can also cause skeletal deformities such as bow legs and a stooped spine.

Vitamin D and Osteoporosis
Osteoporosis is a musculoskeletal condition that is marked by low bone density. Studies have shown that people with osteoporosis have lower levels of vitamin D as compared to others. Some studies also suggest that fractures are more common in winter as compared to summer. The winter sun is often hazy and many days can go by without strong sunlight. Thus it can be inferred that people do not get their required quota of vitamin D from the sunlight in winters leading to a deficiency and aggravated osteoporosis-related fractures.

Who is most susceptible to bone conditions caused by vitamin D deficiency?
Vitamin D deficiency is a very common condition across the globe. Some surveys have claimed that approximately 30% of the global population suffers from vitamin D deficiency. People with dark skin, women and elderly people are most susceptible to this deficiency. People suffering from kidney diseases may also be affected by vitamin D deficiency. Vitamin D supplements are usually very helpful in combatting this deficiency. These can be taken by young children as well as adults.

Relation Between Vitamin D Deficiency And Bone Problems!

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?

Runner s knee is a very common problem with athletes. It is definitely not something one needs to worry about. In fact, with certain exercises, it can be prevented and if you do develop a runner s knee, it can be treated with some exercises as well. There are special sports medical practitioners who prescribe not only regular physiotherapy, but also specific exercises to deal with specific sports injuries. To fight with runner s knee pain, there are a few exercises. 

But the four most important ones are described in detail below.

Quads: For performing proper quads, all you need is a back wall for additional support. You need to hold yourself against the wall and keep your legs apart from each other. The legs should be folded in the knees. In this position, you have to move up till the knee position with a minimum of one minute hold time in the knee position. You can repeat this exercise 10 times at a stretch before moving on to the next exercise.
Hamstring: This is a fairly easier exercise than the previous one. You have to stand straight with your legs apart. Bend downwards from your hips. Relax your neck and back. Ease your head downwards as well. Keep your hands behind. Join both your hands and give it a stretch. If you think that this position is straining your neck or back a little too much, then you can simply stretch your hands without joining them.
Calves: Calves is a standard exercise that is prescribed by medical practitioners and physiotherapists for easing out the pain caused by runner s knee. You have to stand with your hand against the wall. Put your left leg forward and bend it at the knees. Stand on your right heel. Hold yourself in this position for 20 to 30 seconds before changing the legs and doing the same.
Lateral: Lateral is also one of the easiest and common forms of exercises. You have to stand with your legs directly below your hips. Then stretch your right leg apart. Without bending your knees, try to touch the toes of your right leg with the fingers of your left hand. Hold this position for 20 to 30 seconds before changing the position and performing the lateral with your left leg.
Thus, these are some of the very fundamental exercises that one should follow in order to get quick relief from the pains of a runner s knee. These exercises are very easy and help in reducing pain.

Runner's Knee - 4 Most Important Exercises for it

Our bones and joints make us functional on a day to day basis. It is, therefore, imperative that we should take good care of them at all times. There are many conditions that can affect our skeletal system and one of them is, Gout. While the link between the two may not be that obvious, gout happens to be a condition, which is sometimes related to arthritis. Therefore, it is sometimes known by the name 'gouty arthritis'.

While the issue may be severely painful, it does not mean that it cannot be reduced. And of course, when a person has the option and cutting the pain caused by gout drastically, his or her natural response is likely to be 'why not?'

Why Does It Happen?

The main reason for the occurrence of gout is too much uric acid being present in the body. The limbs of the body swell up, especially the extremities and this is known to be very painful. In many cases of gout, the swelling is especially evident in the big toe. Flare ups can last hours on end and may even get longer.

The people who wish to get the gout that is putting him or her through so much pain treated, there are quite a few options at their disposal. There are pain relievers that can be consumed under the advice of a medically qualified professional. While these pain relievers do not treat gout, but can reduces the intensity of the symptoms. Daily doses can be recommended as per the requirement and severity of the situation.

How to Get Rid of Gout?

While some anti-inflammatory drugs may have their effect, but no matter how bad the pain, aspirin is a drug that needs to be avoided. Intake of aspirin can make the problem even worse, which is the last thing a person would want!

The severe problems of gout can be dealt with the chemicals known as corticosteroids. Now, while these can provide some very effective pain relief, using them can be tricky due to certain side effects. One of these side effects is that since these chemicals are injected into the joints, they can significantly weaken them. The other side effect is that they slow the healing process of the wound. Both of these side effects are highly undesirable for any patients. These chemicals are usually prescribed by the doctors after a thorough analysis of patient's condition and history.

A person who drinks alcohol and suffers from severe condition of gout should look to scale back the amount which is consumed by him or her. This is because alcohol increases the amount of uric acid which is present in the blood.

Gout and Its Treatments

Stress is sometimes good for you. When you stretch yourself beyond your capacity, your body accepts challenge and increase the capacity to cope up with challenge. To a certain extent, it is good for body. But when the stress crosses the limits, it starts hurting you. That's the bad stress for you. Moderate stress for too long a time also is bad for you. Most of the hormonal diseases like diabetes, thyroid etc. Occur because of long standing underlying moderate stress. 

Stress can be physical or mental. Physical stress is due to long and continuous physical activities like walking, jogging, travelling, cycling. Mental stress is mainly because of financial tension or relationship distress. Both types of stress cause similar damages to body. Stress is the main underlying cause behind diseases like high blood pressure, heart disease, thyroid, diabetes, kidney disease, peptic ulcer, bleeding disorders, cancer, recurrent infections etc. 

Finding out the reason of stress and removal of cause of stress should be the main line of treatment of such diseases.

Stress - Good and Bad

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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