Bones and muscles, together known as the musculoskeletal system, are responsible for all bodily movements. The bones and muscles move in unison, as they are connected by what are known as tendons, which are thin fibrous tissue. These tendons are prone to damage and inflammation known as tendinitis (this can cause inflammation in any organ). It can occur in any bone/joint but most common in areas which are prone for repetitive use including the wrists, arms, elbows, shoulder, knees, and ankles. 

Read on to understand how it happens and how it can be managed.

Causes: Depending on the onset, tendinitis can be acute or chronic. Though it can occur in any individual, the risk increases with age, as bones lose their elasticity and can tear.

Acute is caused by a sudden injury like a fall or accident or infections
Chronic is caused by repetitive movements, poor posture, poor stretching, overuse, etc. Some common movements include carpentry, painting, golfing, tennis, gardening, lawn mowing, badminton, etc.
Symptoms: As with any inflammation, the symptoms of tendinitis would include swelling, pain, redness, and warmth. There is also a reduced range of motion of the affected joint, producing what is known as adhesive capsulitis.

Prevention: Tendinitis is preventable to some extent by avoiding repetitive work and overuse of the joint. Those who are used to a lazy week and an active weekend should definitely watch out. Sudden, excessive stress can cause tendinitis. The tendons should be subjected to limited stress and activity. With any kind of activity, if there is even a slight hint of pain or any issue, get it checked with the doctor. Continuing to do the same activity will only make it worse. Symptoms to watch for include fever, swollen and painful joints, and limited movement of the affected joint.

Management: If identified and arrested in the early stages, tendinitis can be managed conservatively. Progressive measures of treatment would include the following.

As soon as there is discomfort identified, rest the joint and stop any activity, which you think could have caused the problem. Usually, this should help the condition to subside on its own. Ice and heat therapy can also help.
If it is the ankle or the knee, keep it elevated.
Pain killers may be taken if the pain cannot be tolerated or is affecting daily routine.
After the initial week, mild exercises to strengthen the tendon can be started.
Steroid injections may be required in cases where the joint pain and swelling is significant.
As a last resort, if the above measures do not work, surgery may be recommended. This will again be followed by rest, medications, and physical therapy.

Tendinitis - Ways It Can Be Managed!

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!

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?

Your knees are one of the most vulnerable parts of your bodies. In case of strenuous or vigorous activities, knees are more prone to damage and injury than the other parts. Several of the knee tissues are fairly delicate and often are easily impaired. Among the other knee tissue injuries, meniscus tears are perhaps the most frequent. Meniscus is essentially a cartilage that protects and stabilizes the knee joints. However, an untoward twist or a strain can lead to a tear in the meniscus. Meniscus tears are a common phenomenon among athletes and sportsmen. They have been noted to be more recurrent in older individuals. 

Some of the early symptoms that indicate the onset of a meniscus tear are swelling and difficulty in bending or straightening of the leg. Sometimes a" locking sensation" in the knees also forebodes a torn meniscus. The inflammation potentially causes a lot of pain and irritation. While, it is fairly easy to ignore a meniscus tear for a normal knee injury, prolonged overlooking may only aggravate the pain and worsen the condition. The process of diagnosing a meniscus tear usually involves an mri scan and an x-ray examination, over and above a detailed evaluation of the wound.

Treating meniscus tears vary according to the extent of the injury. Depending upon the location and the depth of the tear, various cures can be tried. The healing process, however, depends upon other allied factors such as age, level of physical activities and one's medical history. An external and minor injury is easily mendable. Whereas, graver injuries are resolved through surgical means. The other non-operative means include certain prescribed medicines and specific exercises. Some of the recommended ways of battling a meniscus tear can be enlisted as:

1. Resting the knee by limiting the activities that involve excessive use of the legs or they may potentially strain the leg muscles.
2. Applying ice pack can significantly bring relief to the swelling and the pain in the injured knee. Doctors advice regular use for a duration of at least 15 days.
3. Compressing the knee using an elastic bandage or neoprene sleeve reduces the swelling in the knee.
4. Prescribed medicines in the likes of non-steroidal anti-inflammatory drugs can be effective remedies for a meniscus tear. However, one must mandatorily consult a doctor before consuming such medicines.

All About Torn Meniscus

Fibromyalgia is a medical condition that is known to affect the soft tissues and muscles of the body. As a result, there is a muscular pain and fatigue experienced throughout the body, often interfering with daily activities of the affected individual. Though the condition can affect both men and women, females are more prone to Fibromyalgia than their male counterparts.

The pain (can be acute or chronic) associated with fibromyalgia is often an outcome of a condition whereby the receptors in the brain that perceive the pain signal undergoes modification, becoming oversensitive to the pain stimuli.

The body has 18 tender points spread throughout the body. These tender points are highly sensitive and can be quite painful when pressed. Research suggests that individuals with fibromyalgia experience pain in at least 11 of these pressure points when pressed (often used in the diagnosis of fibromyalgia).

Causes of Fibromyalgia
While it may be difficult to decipher the exact trigger that results in Fibromyalgia, the condition may be an outcome of

Physical or emotional trauma, stress, anxiety, and depression
Genetic predisposition. The incidence of fibromyalgia is higher in individuals with a family history of the condition
Indulging in too much of a sedentary lifestyle (lack of physical activities and exercise) can play a pivotal role in triggering fibromyalgia
Certain health conditions and infections such as Arthritis can also give to fibromyalgia

Symptoms
While muscular and joint weakness and pain are synonymous to fibromyalgia, a person may also complain of

Sleeping disorders
There is a weakness, headache (often associated with a migraine), and fatigue (in spite of having a sound sleep and proper rest)
A person may experience Fibro Fog (a condition resulting from fibromyalgia whereby a person finds it difficult to memorize or concentrate on anything)
There may be morning stiffness along with numbness or a tingling sensation in the legs, hands, feet
Some women with fibromyalgia may experience menstrual cramps which are often painful
One may also suffer from IBS (Irritable Bowel Syndrome), Temporomandibular joint disorders

Treating Fibromyalgia with Ayurveda
According to Ayurveda, Fibromyalgia is an outcome of the vitiation of all the three doshas - Vata, Kapha, Pitta. This affects the digestion process (it weakens or slows down) with the buildup of toxins or Ama in the body. Thus, for an effective treatment, the balance between the three doshas should be restored along with the elimination of the toxins out of the body (detoxification).

The treatment often involves a concoction of herbal and Ayurvedic oil massages and oil baths, lifestyle changes, dietary modifications, meditation and yogas or pranayamas
Avoid non-vegetarian (can have lean meat though), spicy and greasy foods. Instead, supplement the diet with fresh fruits, vegetables, healthy or good fats (poly or monounsaturated fats), whole grains
Drink at least 6-8 glasses of water daily
Follow a healthy sleep routine. Mediation and Yoga will act as a catalyst, enhancing the overall treatment
Drinking alcohol or smoking tobacco or drug abuse should be avoided
A Warm Ayurvedic oil application with gentle pressure is very effective in this if done on regular basis
Stay happy and stress-free 

Fibromyalgia - Ayurvedic Ways That Can Help Resolve It!

4 exercises to strengthen your knees

Knee pains and pains in the joints are not restricted to a certain age group anymore. Younger people of today face this problem too. To stay active all your life and escape the severe aches associated with weakening of muscles, joint pains or arthritis, you must start now. The only way to keep your knees fine and working is to exercise. 
4 moves that help you strengthen your knees.
1. Leg lifts (inner thigh) - lie on any one side, lay your head on the arm of the side below you. Make sure this hand is straight above your head, touching the ground. Keep your legs straight, one above the other. Lift the leg on top a few inches above, hold for few seconds and bring it back. Do this for 10 times and then with the other leg, on the other side. This exercise strengthens your inner thighs, eventually strengthening the knees.
2. Hip raises: lie flat on your back, your shoulders touching the ground. Bend your legs comfortable, your feet resting firmly on the ground. Raise your hips and thighs so that from your head to feet, you form an angle. Wait in this position for about 10 seconds, lower your hip until it touches the ground. Repeat for ten counts.
3. Lunges: stand straight. Take a step ahead with your right leg. Left leg remains in its place. With your back straight, bend your knees so that both are at 90 degrees. Go back to standing position; take your right leg back to where it was. Do the same step with your left leg. Repeat both sides ten times.
4. Bent leg extensions: this is pretty easy and all that you need to do it sit on a chair comfortably, with your back straight first. Your feet firmly flat on the ground in front of you, lift the right leg straight extending to the front. Make sure your thighs stay on the chair. Bring your leg back to the original position, firmly planted on the ground. Do the same with your left leg. Repeat 10 times on both sides.
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The Only 4 Moves That Strengthen Your KNEES

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