The most common cause of neck pain can be cervical disc disease. It is generally caused by the abnormality of the disc that is the cushion present between the vertebrae. The disc can get damaged because of arthritis or any unknown cause. When damaged, it usually leads to inflammation or spasm of the muscles leading to neck pain. There are a number of pain medications, traction exercises, and physical therapy for minimizing the neck pain. However, these home based remedies help in relieving pain along with a speedy recovery:

*  Take it easy: If you have a busy and hectic life, then take it easy. Living with cervical disc diseases can lead to an increase in the neck pain; thus cutting down on activities helps. A comfortable position should be observed while resting. If need be then a pillow can be placed under the neck.

*   Apply Cold/Heat Pack: There is always a confusion regarding whether a cold or a hot pack is to be used. The recommendation is to use ice or cold pack for the first 24 to 48 hours of the injury, so that the swelling subsides. This should then be followed by hot fermentation in order to improve the muscle stiffness and also loosen them. But in case of a cervical disc disease neither cold nor heat penetrates the tissue to relieve inflammation, so it is best to use the one which feels better. Whichever, pack is chosen it should only be used for 20 minutes and then left for 40 minutes. Take care and do not use ice or heat directly against the skin. 

*  Stretch: Stretching exercises should be done in order to improve the flexibility and relieve pain in the neck. Exercises can be performed after warming up of the muscles by a warm towel or bath. Here are a few simple stretches for cervical disc disease that you can do at home:

* Move the neck: As per the study by the American Medical Association, women who had neck pain got relief when they did exercises using light weight and resistance bands. This increased their endurance and strength of the neck muscles. Also, 30 minutes of exercise in the form of biking, walking, swimming, and biking is recommended to improve the blood flow.

*  Maintain the posture of the neck: A bad posture can cause a neck pain. Every time while standing, sitting, walking, lifting the posture should be kept in mind. The head and neck should be kept straight and the back should be supported in order to avoid neck pains.

Neck Pain and How To Deal With It

Pain related sleep disruption has affected a large number of people around the globe. Statistics has it that, in India, about 25% of the population suffers from pain-related sleep deprivation. Studies call it  the vicious cycle of pain and sleep  as pain affects your ability to sleep and lack of sleep makes the pain even worse.

Back pain and arthritis are examples of some common pain-related medical disorders. People with these types of chronic pains have reported persistent sleeplessness or have had immense trouble falling asleep.

The following are the primary sleep disorders associated with chronic pain:

Insomnia: It is a medical condition that is characterized by an inability to fall asleep no matter how physically exhausted you are. Insomnia can be acute (lasting for one night to a week) or chronic (that lasts for more than 3 weeks).
Hypersomnia: It is a condition wherein you tend to sleep excessively; in this condition, you will have trouble being awake throughout the day or can fall asleep at any point of time.
Sleep Apnoea: This is a sleep disorder wherein breathing pauses and resumes repeatedly. Risk factors include obesity, age and gender; it is more commonly observed in men. This condition can be chronic with symptoms such as snoring loudly or feeling very tired even after one has had a night s sleep.
Restless leg syndrome: It is a sleep disorder wherein you continuously move your legs while sleeping. However, this condition can also cause you to move your legs even if you aren t sleeping.
Some of the causes of sleep disorders due to chronic pain are:

Pain
Worry and anxiety
Sweating at night
Depression and other mental disorders
Treatment

A pain and sleep disorder should be simultaneous as both the components of it, pain and sleep, are interrelated. Some of the ways people with chronic pain can still have a good night s sleep are:

Limiting caffeine intake
Abstaining from alcohol and smoking, as these disrupt the sleep cycles, thus aggravating the existing pain.
Practicing meditation and other relaxation techniques
Pain killers or sleeping pills can be administered, but only with the doctor s advice.
Hot water fomentation over painful area during night, for better sleep.

Back Pain and Bad Sleep

Juvenile arthritis also known as juvenile rheumatoid arthritis and is a chronic, systematic and inflammatory disease, which causes damage to joints or damages of connective tissues. Symptoms include fever, rashes and hepato-spleenomegaly. This disease is persistent and inflammatory in nature and occurs before the age of sixteen. Homeopathy is widely used to cure juvenile arthritis. Here is a list of the best homeopathic medicines used to treat juvenile arthritis along with the symptoms based on which they are prescribed.

 Abrotanum: this homeopathic medicine is used when a child is suffering from juvenile arthritis and is unable to move. Symptoms include soreness and paleness and the condition worsens in the morning. Gouts may occur in the wrists or ankles. Inflammatory rheumatism is indicated before the start of swelling. Marasmus of children may occur signified by marked emaciation, especially in the leg. The skin tends to hang loose and gets flabby. Constipation and diarrhea occur.
 Aconite: aconite is a homeopathic remedy, which is used in arthritis where there is tearing pain in the limbs. Violent pulls in the joints and bones are experienced. Contraction of the tendons and feeling stiff in the flexor muscles are other symptoms. Cramps affect several limbs. Aconite is used in early stages of juvenile arthritis. Atmospheric changes affect the patient, and dark hair, and eyes are developed. The muscle fibres becomes rigid.
 Apis: apis is used in oedematous swellings and synovitis. The knee gets swollen, sensitive, sore and shiny along with stinging pain. The feet also swell and feel extra large. There is a rheumatic pain in the backside and in the limbs. The fingertips and hands become numb, and the patient is tired. Glands are enlarged or indurated.
 Arsenicum album: this homeopathic medicine is used in juvenile arthritis where the patient experiences acute pain in the arms and hands. The pain begins from the elbow and extends to the armpits. There is an acute, pulling and shooting sensation in the wrists. The fingers swell as well along with pain in the finger bones. Cramps occur in the legs and swelling is felt in the palms at night. The hips experience acute pain as well, which extends to the thighs, groins and ankle bones. 
 Belladona: belladona is used for joint and bone pains. The pains generally increase at night and during the afternoon. Any kind of movement or touch leads to aggravation in the pain. Palpitations in muscles are caused. Cramps, spasms and movements which are convulsive are indicated.

Homeopathy is an ideal remedy for treatment of juvenile arthritis. Homeopathy being purely natural has no side effects and puts a check on all underlying causes of juvenile arthritis.

Is Homeopathy a Cure for Juvenile Arthritis?

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!

Arthritis is inflammation of one or more of your joints. Pain, swelling, and stiffness are the primary symptoms of arthritis. Any joint in the body may be affected by the disease, but it is particularly common in the knee.

Knee arthritis can make it hard to do many everyday activities, such as walking or climbing stairs. It is a major cause of lost work time and a serious disability for many people. There are 2 types of arthritis the knee joint in the human body can get afflicted with. They are:

Osteoarthritis: The form of arthritis which, with increasing pain, slowly wears down the joint cartilages is called osteoarthritis. This form of arthritis usually affects people after the age 40. The symptoms of osteoarthritis include:

severe pain in the knee joints

pain after walking up the stairs and it subsiding once you are on rest

severe pain after the movement of joints for a long time

pain that becomes worse in rainy days

joints becoming stiff after waking up in the morning but they improve in the latter part of the day

pain which also occurs in the thighs and the genital regions coupled with joints swelling and joints getting stiff after rest.

Rheumatoid Arthritis: Rheumatoid arthritis is a chronic form of arthritis caused because of the knee joint inflammations. This form of arthritis can occur at any age. Being an auto-immune disease, its symptoms include, but are not limited to:

severe pain in the morning

mild fever accompanying the pain

joints suddenly becoming swollen, red and warm causing, immense pain

sudden stiffness of the joints

pain that increases in cold weather

mild fever, extreme tiredness and weakening of the muscles

Doctors are still doubtful about what exactly causes the disease; but the deformation of the immune system might cause the damage of the joints, causing people who are already suffering from obesity, smokers, and women, in general, more prone to this disease.

When the knee pain is diagnosed as a form of arthritis, the following treatments are suggested:

If you are overweight or obese, losing some of those extra pounds can go a long way in reducing the pain.

Muscle-stretching exercises are effective in keeping the knee joints flexible.

Acupuncture and devices such as knee braces and knee caps can relieve the pain.

Prescribed dosage of anti-inflammatory drugs such as Tylenol, Motrin, and Advil or injections of hyaluronic acid might relieve your pain.

If regular treatments do not work, you might opt for knee-replacement surgery and osteotomy (the process of cutting a bone with the help of surgery) which might better the alignment of the knee by transforming the bone shapes.
Physiotherapy For Knee Arthritis-

Physiotherapy treatment is aimed at improving the symptoms of the disease (i.e. knee pain, swelling, stiffness), and you should begin to notice a positive difference within one or a few physiotherapy sessions.

The main goals of physiotherapy for your knee arthritis are:

Reduce your knee pain and inflammation.
Normalise your knee joint range of motion.
Strengthen your knee: esp quadriceps (esp VMO) and hamstrings.
Strengthen your lower limb: calves, hip and pelvis muscles.
Improve your patellofemoral (knee cap) alignment and function.
Normalise your muscle lengths.
Improve your proprioception, agility and balance.
Improve your technique and function eg walking, squatting.

Arthritis - How Physiotherapy is Beneficial for it?

A small piece of bone is known as a fragment and it is very common that an avulsion fracture also tends to damage the protrusions of bone to which the tendons attach. This basically means that the tendon or ligament will come away from the bone and it will take a small piece of bone with it. It is sometimes very hard to find out what type of injury you have and this is why knowing the causes and symptoms of an avulsion fracture are very helpful in determining exactly how severe the injury is. 
Here are the causes of an avulsion fracture.
Causes:
Explosive Landing: Athletes who tend to jump or land with great impact tend to get these most commonly. Therefore, it is crucial for your health that if you participate in such sports, you do follow the correct method of jumping.
Explosive Extension: Similar to how an athlete landing ferociously can get an avulsion fracture, someone who is extending the legs very violently and explosively during an exercise can also get an avulsion fracture. This is because the bone getting extended could very well damage the protrusions to which the tendons are attached. 
Symptoms:
These are the two main causes of an avulsion fracture. There are not many symptoms of an avulsion fracture. This is because an avulsion fracture can only be determined by an MRI or by an X-ray scan. Therefore it is nearly impossible to diagnose that you have an avulsion fracture without looking at the results of the tests performed on the part of your body. However, the way you got the fracture and especially the details of it are very good indications of whether you have an avulsion fracture or not.


Causes and Symptoms of Avulsion Fracture

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