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

Acupressure can prove to be extremely effective if you are looking for non-medicinal solutions to treat musculoskeletal problems, such as back pain, sports injuries, arthritis, etc. Acupressure is the application of putting firm pressure on the areas on the body which are swollen, agitated or tense by massaging the acupoints (specific points in the body). Acupressure believes that relieving these areas of pressure reduces the pain.

Here are some musculoskeletal problems that can be healed by acupressure:

    Arthritis: Those who seek acupressure as an alternative treatment for pain are mostly suffering from arthritis (a disease characterised by chronic joint inflammation and cartilage degeneration). Acupressure applies pressure on the inflamed joints.
    Back pain: Back pain is a common problem that can affect anyone irrespective of his or her age. Acupressure acts to relieve the points where the muscles are too tense and helps to tone or support the muscles which have become weak with disuse.
    Chronic pain: Unrelenting pain can stem from many causes. Acupressure focuses on the pain and the pain signals when treating chronic pain. The acupoint of the pain and the nerves are gently massaged to relieve the pain.
    Fibromyalgia: Traumatic injury to the soft tissue, emotional trauma or severe illness can cause fibromyalgia. It is non-inflammatory in nature and often leads to Chronic Fatigue Syndrome (a troublesome disorder with symptoms of deep fatigue, sleeping problems, pain, etc.). Acupressure can greatly improve the fatigue and sleeplessness that fibromyalgia causes.
    Tendonitis: The tendon connects the tissue to the bone, and tendonitis is the condition when the tendon is inflamed. Acupressure helps in reducing the inflammation and easing mobility restrictions.
    Sciatica: The sciatic nerve is the longest nerve in the body, stretching from the lower spine to the back of the foot. So when this nerve is agitated, pain radiates from the lower back to the foot. This condition is called sciatica. The acupoints in sciatica are the lower back and the hip. Acupressure effectively loosens the muscles in these regions and reduces inflammation.
    Sports injuries: Strains and sprains are common sports injuries, which mostly affect athletes. Acupressure has anti-inflammatory benefits that can help heal severely injured tendons, ligaments or muscle. Acupressure also plays a huge role in restoring and retraining the body, especially if you are an athlete and play high-demand sports.
    Carpel Tunnel Syndrome: Carpal tunnel syndrome is a condition in which the pressure increases on the median nerve as it goes through the carpal tunnel, and this causes wrist pain. Acupressure involves the use of directed pressure to specific acupuncture points on the surface of the body.
    Insomnia: Insomnia is a sleep disorder. The Acupressure Points between your heel and anklebones (on both sides) have traditionally been used to relieve and prevent insomnia.
    Migraines: Acupuncture is used to effectively treat primary headaches, namely tension and migraine, which are the most common.

Acupressure: The Non Medicinal Solution to Musculoskeletal Problems

Arthritis is a disease usually associated with elderly people, but it can also affect children. When arthritis affects children, it is known as juvenile rheumatoid arthritis. This disorder affects the musculoskeletal structure of a child and can cause pain, stiffness and swelling in the muscles, joints, ligaments and bones. In some cases, it can also affect the internal organs. With medication and therapy, the symptoms of this disorder can be managed and the quality of the child s life can be improved.

Hence, it is important to recognise the signs and symptoms of this disease. Some of the symptoms to look out for are:

Pain: Complaints of pain in the joints or muscles on waking up from bed can be a sign of juvenile arthritis. This may affect a child s jaw, neck, hands, knees and feet. For most children, moving around helps relieve some of the pain. Unlike the pain triggered by an injury, this kind of pain develops slowly and affects both symmetrical joints.

Joint stiffness: Children affected by this disorder may complain of stiff joints which hamper normal movement and activities. As with pain, this stiffness is usually worst in the morning and improves with movement.

Swelling: Redness and inflammation of painful joints is another symptom of this disorder. The joint may also feel warm to touch. This swelling may come and go or persist for several days. The joints of the hands, feet and knees are most susceptible to swelling.

 Fever: Frequent fever accompanied by fatigue can indicate juvenile arthritis. These fevers usually come on suddenly and are relieved after a short time. Also, they do not exhibit any signs of respiratory or stomach infections.

Rashes: Rashes that are symptomatic of this disorder appear commonly over the knuckles, nose bridge or on the trunk, arms and legs. This often takes the form of a faint, pink rash that persists for weeks but unlike other rashes, it does not itch or ooze.

Weight loss: Drastic weight loss and an unexplained loss of appetite can also signal this disorder. In such cases, the child may also appear fatigued and showcase symptoms of associated malnutrition disorders.

 Eye problems: Persistent troubles with eyesight such as pain, blurred vision and redness of the eye can be a sign of juvenile arthritis. In some cases, this disorder also causes the iris and uveitis as well as the middle layer of the eye to appear inflamed. If you wish to discuss about any specific problem, you can consult a rheumatologist.

Juvenile Rheumatoid Arthritis - 7 Signs Your Child Is Suffering from It!

Does you back hurt only when you wake up in the morning or is it a chronic problem? If yes, then you need to take immediate steps to treat it. Back pain, being the common physical anomaly for people primarily in the age range of 35-50, is one of the top causes for office absenteeism and mid-life lethargy and fatigue. Usually back pain indicates an underlying problem that involves the nerves, bones and muscles.

Here are some risk factors for back pain:

Pregnancy
Stress related to work
Leading a sedentary lifestyle
Anxiety and depression
Being overweight
Over exercising
Strenuous physical work outs
Smoking
There are varied reasons as to why back pain may occur. Discussing the causes of back pain is beyond the purview of this article; the focus is now going to be on some of the stretches one can practice to get relief from back pain: 

Downward dog: A classic yoga pose, the downward dog stretches the entire back, hamstrings and the whole of the leg. Begin the process in a classic push up pose with the palms and toes on the floor. Keeping your back straight, lift your tailbone up and straighten your legs. Push the heels to the floor and breathe to get the most out of this stretch.
Child s pose: A simple stretch, it begins with you sitting back on your buttocks and then stretching the arms in front of you. Keep your forehead on the floor and breathe slowly.
Cat cow pose: If your common complaint is that of a sore and painful back, then this is one of the best stretches for you. A very simple pose, you begin by sitting on all fours, then transitioning into the cat pose by pushing your spine upwards. Hold the pose for one breath and then go to the cow pose wherein you lift your buttocks and the head while scooping your spine.

Back Pain - 3 Stretch Exercises You Must Follow!

Gridhrasi is what Sciatica is known as in Ayurveda. It is the disorder that causes mild to agonizing pain in the sciatic nerve or neuralgia. These nerves, emerging from the pelvis, run along the hamstring and may cause intense pain in one or both the legs when a person suffers from Sciatica. Sciatic pains fill your life with misery as the simplest of daily activities cause sudden and excruciating pain. There are two types of sciatica i.e. true sciatica and pseudo sciatica. Sciatica may be caused due to bulging disc or herniated disc, degenerative disc disease, piriformis syndrome, pregnancy or trauma etc. 

According to Ayurveda, Sciatica is caused due to impairment in Vata i.e. the dosha responsible for the functional ability and movement of the body and also in some cases due to impairment in the Kapha i.e. the dosha that is responsible for body fluids and lubrication. Ayurvedic herbs that improve the symptoms of Sciatica are:

1. Babunah is also known as Bitter Chamomile. Not only is it used to relieve and reduce the pain faced by a sciatica patient, but it is also used for treating problems such as rheumatism due to the advancement of age. Compressed bitter chamomile flowers are prescribed for sciatica.
2. Guggul is also known as Indian Bdellium. Since guggulu is well known for its anti-inflammatory properties, it relaxes the sciatic nerves.
3. Rasna is also known as Vanda Orchid. Intense or agonizing pain due to the sciatic nerve issues can be reduced by this ayurvedic herb due to its anti-inflammatory properties. 
4. Juniper oil is extremely helpful when massaged onto the thigh muscles with firm strokes or pressure. It is used extensively in massage therapy for treating sciatica since the extent of reduction in sciatic nerve pain is tremendous. 
5. Jaiphal is also known as Nutmeg. After being mixed with sesame seeds oil, nutmeg is coarsely powdered and then fried till it turns brown. This is then applied to those areas where the sciatic pain is intense for instant relief.
6. Kumari is also known as Indian Aloe. Properties of Indian Aloe are extremely helpful in treating lower back ailments such as sciatica and lumbago.
7. Shallaki is also known as Boswellia or Frankincense. Containing anti-inflammatory properties, shallaki is applied externally to get relief from sciatic nerve pain. 

Ayurvedic preparations such as yogaraja guggulu, Vataganjakusha, Saindhavadi taila are also very useful in treating Sciatica.

Ayurvedic Treatment of Sciatica

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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