Osteoporosis is a disease of the bones. It occurs when the mesh-like structures present inside the bones becomes thin. This is a condition in which the bones become extremely fragile and have a tendency of breaking easily. The broken bones cause extreme pain. There are artificial medicines available in the markets for treating this condition. However, treatment of osteoporosis can be best done by the naturally produced Parathyroid hormone (PTH). 

It is secreted by the parathyroid glands in our body. It is an 84-amino acid polypeptide. The most interesting thing about PTH treatment is that it actually builds new bones. Other medications for osteoporosis only reduce the rate of loss of bones. PTH helps in increasing the amount of calcium in body. It also prevents bone loss due to osteoporosis. It is often considered to be an anabolic agent. If an osteoporosis patient is given low doses of PTH, his or her bones get strengthened. It also helps in increasing the bone mass.

Why a doctor recommends PTH for osteoporosis? Is it better than other drugs?
Traditionally, bisphosphonates were used to treat osteoporosis. However, it has been observed in a number of cases that bisphosphonates only help in slowing down the loss of bone density. However, PTH increases bone mineral density. Therefore, it is a better option for the treatment of osteoporosis. It is usually given to patients who have extremely low bone mass. It has been found effective in cases where other medications failed to show results. Moreover, it also works for postmenopausal women. 

Doctors believe that it can also be used for treating men with osteoporosis who are at high risk for fracture. It improves the microarchitecture of the bone and can do wonders in altering the bone size. Moreover, it has lesser side-effects on the health of the patient. It is known to cause dizziness and nausea and no major discomfort. It has also been noticed that patients who are being treated with PTH develop less back pain. These are also cost-effective for the long term treatment of osteoporosis.

Parathyroid Hormones - Is It a Better Treatment For Osteoporosis?

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!

10-minute easy exercises to relieve back pain

Most of us lead sedentary lifestyles these days which have led us to experience severe problems with our spine. Irrespective of your age, a majority of people today suffer from back pains as a result of sitting for long periods. The most effective way to counter back pain is to strengthen your spine to make it capable of dealing with these aches in a better manner.

These 3 exercises will help you counter back pain quickly.

1. Leg lifts - a lot of us have weak abdominal muscles as compared to other regions and this leads to an imbalance in the muscle strength of different groups. Leg lifts help restore that balance. You have to lie on your back and choose a firm and rigid surface. Start by lifting your legs slowly and avoid any bending. Keep lifting them to bring them at an angle of 90 degrees with your upper body and then return to the starting position. Around 15-20 repetitions of this exercise on a daily basis are bound to give you much relief from recurring back pain.

2. Cycling - this exercise is perfect for building coordination among all the abdominal muscles of your body. Set your body in a sit-up position with your back on the floor and knees bent. Next, move your legs in a pedalling position, as you would do in case of riding an actual bicycle. Continue the movement for about 20 seconds in each direction.

3. Plank positions - in a plank position, you are required to hold your body in a particular position for a specified time period. For example, you can perform a plank position by holding your body in a position that it would acquire during a push-up. Do not rest on your palms and instead bend them at your elbow, so that your weight now rests on the forearms. Breathe deeply and hold the position for a minimum of 30 seconds.


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10-Minute Easy Exercises To Relieve Back Pain

What is spinal stenosis: The narrowing of the gaps in the spine or the backbone is called as spinal stenosis. This leads to pressure on the nerves and the spinal cord. 5% of cases of spinal stenosis are seen in the low back of the lumbar spine. In some cases the narrowing of the spine leads to the compressing of the nerve root, which leads to pain in the leg.

Causes of spinal stenosis: It can be caused by aging, arthritis, trauma to the spine, spondylolisthesis and tumor of the spine

Symptoms of spinal stenosis: There is constant pain in the back and legs as stenosis pinches the nerve responsible for sensation and muscle power. Other symptoms are numbness and tingling in the legs, frequent falling and pain while walking.

Treatment of spinal stenosis:
-  A routine program with exercises and physical therapy are the best treatment for spinal stenosis. The exercises are not a complete cure but they are beneficial in keeping the patient active. A physical therapy can be supervised and once the period of the same is over people easily transition to the exercise program. The key for exercise is starting slowly in order to build strength.

-  Generally, the patients are counseled not to perform strenuous activities as that might worsen the symptoms of spinal stenosis. In case of lumbar stenosis, patients find it comfortable when they are flexed forward. The doctor might recommend walking while being bent over and leaning when using a walker if not walking upright; sitting in recliners is also recommended instead of straight back chairs.

-  Injections of cortisone are usually given in the epidural space. This is believed to relieve the symptoms of spinal stenosis temporarily. Though there have been studies which question the use of these injections as they lead to the risk of osteoporosis related fractures. This is still being pondered over by the doctors as a suitable treatment option as it has its own benefits and risks.

-  Medications such as the anti inflammatory medicines like ibuprofen or aspirin are helpful in controlling the symptoms of spinal stenosis. Narcotic drugs might also prove to be helpful if used with care and for a short while. This is helpful for severe pain related to the nerves. Muscle relaxants like gabapentins might also be recommended. In some case antidepressants might also be given to provide relief from pain. 
Though side effects are a concern when using these medications and the patient should let the doctor knows about their allergies.

Treatment For Spinal Stenosis - 4 Things That Are Part Of It!

Lower back pain can be one of the most physically debilitating things that can affect you and limit your mobility. Even if the pain isn t that acute, it could still signal something deteriorating in your lower back. While oral medications, topical creams or sprays can help in reducing pain, there are other effective remedies you can try on your own. These will be handy when you have no medications at hand. One of these is the hot and cold therapy.

Heat therapy for lower back pain

Heat works well with lower back pain as it can dilate blood vessels and improve circulation within the tissue. This will help in circulation and also result in lowering the pain. Heat therapy will also loosen up other muscles in the area and help soothe sore areas which have been taking the burden along with the lower back muscles. Some of the techniques that can be applied are:

1. All day heat wraps: These are specially manufactured belts or wraps which wrap around your abdomen and keep tightness and pressure on your lower back as well as supplying heat.

2. Electric heating pads: These are mechanized heating pads which generate heat with electricity. You can place them under you back and then either sit or sleep with it positioned behind you. However, ensure that you don t keep these for too long as they could burn your skin.

3. Hot Compress with towels or hot water bags: Use a clean towel and heat it over a conductive surface and apply it on your lower back. You can also use hot water bags for the same purpose.

Cold therapy for lower back pain

Cold therapy uses the principle of constriction of blood vessels as well as slowing circulation. This will help numb the area and thus help relieve the pain. Some of the ways these can be administered are mentioned below.

1. Ice towel: In this method, soak a towel in ice cold water, wring it to dry it and then apply on your lower back. This will numb the pain without transferring the sting of the cold or damaging your skin.

2. Ice packs: Put about half a kg of ice in a plastic Ziploc bag and pour water over the ice to just about cover it. Push out the air out of the bag and then lock it. Use this ice pack with a towel to ensure that you back doesn't get wet.

3. Ice gel packs: These are ready made packs, which can be bought from medical stores and kept frozen to be used whenever you need it in order to relieve lower back pain.

Treating Lower Back Pain Using Hot and Cold Therapy

Plantar fasciitis is the inflammation of a tissue underneath the ankle bone, which causes intermittent pain and discomfort. It affects a whopping 10 million people in India every year. Those aged 40 and above are at a higher risk of being affected by the condition.

Causes Of Plantar Fasciitis-
Plantar fascia is the soft tissue under the ankle bone, which connects the ankle bone to the toes and facilitates movement. If the fascia gets inflamed, the condition is known as Plantar fasciitis. If the tissue undergoes too much pressure, small tears are likely to take place. With repeated stretching and tearing of the tissue, inflammation and pain may develop.

However, in most cases, the exact cause of the condition is not well understood. Although, it is possible that sprinters or sportsmen are more likely to develop the Plantar fasciitis. Furthermore, obese people have a tendency to develop the condition, as do pregnant women during the later stages of pregnancy.

Symptoms
Here are some common symptoms associated with the Plantar fasciitis-

Pain is the most common symptom related to the condition, although the exact location may vary. Some people experience discomfort on the heels, while others may experience pain at the bottom mid-foot area.
The intensity of the pain also differs, as some may experience a dull pain, while others undergo a sharp pain while moving.
The pain is common when you take your first steps in the morning after getting out of bed. It is also common for the pain to return when you get up after spending a prolonged period of time sitting down.
Treatment For The Condition
Treatment is broadly divided into home remedies and conventional medication. Home remedies involve the usage of ice packs on the heels, at least three to four times a day. Ample rest for your legs may also be enough to cure the condition. Additionally, the use of comfortable shoes along with stretching exercises may also cure the condition.

However, if none of the home remedies seems to work, over the counter nonsteroidal anti-inflammatory medications may be used. The doctor may even inject a steroidal medication into the affected region. In such cases, the medical treatments must be used in conjunction with physical therapy.

Plantar Fasciitis - What Are The Causes, Symptoms, And Treatment?

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