Knee replacement can be extremely painful. Previously, opioids or narcotics were administered for pain relief. But excessive addition of opioids is not exactly effective for controlling pain. 

Multimodal pain management has become an important part of the perioperative care of patients undergoing total joint replacement. The principle of multimodal therapy is to use interventions that target several different steps of the pain pathway, allowing more effective pain control with fewer side effects. Many different protocols have shown clinical benefit. The goal of this review is to provide a concise overview of the principles and results of multimodal pain management regimens as a practical guide for the management of joint arthroplasty patients.

Multimodal denotes administering two or more than two types of medications that work with different mechanisms. The following are the techniques used:

Pre-operative Femoral Nerve Block: Prior to the surgery, a catheter is placed beside the femoral nerve for blocking it. This nerve is located in the upper thigh. Medication is delivered through the catheter for the nerve to be numbed for 24 hours. Thus, pain signals to the brain are blocked. This method reduces the use of narcotics and the consequent side effects.

Patient Controlled Analgesia (PCA): This method is also known as  Pain Pump . An intravenous pump is used to administer pain relief medications, such as oxymorphone or morphine, after the surgery. The control button of the machine could be pressed, by the patient for 6 to 10 times per hour. The machine is used for two post-operative days.

Oral Medications: The oral medications include Non-Steroidal Anti-Inflammatory drugs or NSAID; such as Celebrex which is similar to aspirin, structurally. Alternatively, acetaminophen, such as Tylenol or its equivalent composition, can also be used.

Acetaminophen: It acts on the Central Prostaglandin Synthesis and relieves the patient of pain through multiple mechanisms.

Epidural Analgesia: It produces lower pain scores and involves less time for achieving physical therapy goals. However, this is subject to side effects such as dizziness, urinary retention and itchiness.

Gabapentinoids: These medications include membrane stabilizers such as Gabapentin and Pregabalin.

The objective of multimodal treatments is to provide quick relief to the patient and immediately so. Earlier the rehabilitation, more successful will be the knee replacement surgery.

Multimodal Pain Relief After Total Knee Replacement

Spondylitis, or cervical spondylitis, is a common condition that affects a large section of the adult population. This most common disorder of the cervical spine is a degenerative condition. There are soft disks between the vertebral bones which shrink with age and gets stiff. This leads to formation of small bone spurs. This reduces the space available for the disk to move, causing nerve pinching.

Causes:

Ageing is the most common cause for spondylitis. Injury, incorrect sleeping posture, and heavy weight-lifting can also cause spondylitis. While earlier it was common in people who were 60-plus, with more people spending more time at their computers and workstations, the onset happens much earlier in 30s and sometimes even in 20s.

Symptoms:

Most symptoms related to spondylitis are centered on the neck and shoulder regions. There is pain and stiffness in the neck that can extend to the shoulders, nape of the neck, arms, and sometimes even the fingers. In rare cases, the pain can extend into the forehead and back of the head too. Associated symptoms include numbness, weakness, and a pricking sensation in the hands, arms, and sometimes fingers.

Homeopathy in cervical spondylitis:

Homeopathy treats the root of the issue after taking into account all symptoms. Listed below are some common homeopathic remedies for spondylitis.

Conium: there is neck pain along with vertigo when lying down or turning in bed. There is constant mild pain in the back of the head and a tight sensation in the forehead region.
Rhus tox: when the neck pain is worse in the morning and with rest, rhus is a good option. Moving the neck helps relieve this pain, which is often as a result of some injury.
Kalmia latifolia: when there is pain extending from the neck to the arm and hand and fingers, kalmia works wonders. There may also be pain from the nape of the neck to the shoulder blades. The pain is increased with leaning forwards or looking down. The patient may also have nausea with the pain.
Gelsemium: when there is pain extending from the neck to the back of the head, centering in the occipital region. The patient also feels weak, dull, and dizzy. The pain is triggered by emotional excitement.
Silicea: when there is pain extending from the neck to the eyes and forehead, silicea provides good relief. The patient will have intolerance to cold and feels chilly. The pain is improved by heat pads and lying down.
Calcarea phos: if the radiographs show bony changes in the cervical spine with the spondylitis, this is very useful. The bony spurs that form can be painful and cause nerve pinching leading to vertigo.

Spondylitis - Causes and Symptoms

Today  working  usually implies sitting at a desk from morning to evening. While this may seem more comfortable than working in the fields, sitting at a desk can trigger a host of back problems. This is because sitting in the same position all day makes the spine bend forward and lowers the efficiency of the back muscles. Working at a desk not only strains your back, but also restricts your movements to typing on a keyboard and moving a mouse. 

Once a back problem begins, it usually lasts a lifetime hence; here are a few tips to save your back.

Get yourself a good chair: Your chair is crucial to your back s health. Avoid the hard backed plastic chairs and pick a more flexible mesh backed office chair if you sit at the table for a long span of time. Ergonomic chairs may seem expensive, but are worth the expense in the long run.
Stretch your muscles: Sitting in the same position all day, puts the muscles under stress and with time can constrict the muscles. Make it appoint to stand up every 30 minutes and stretch your back and sides. Also try rotating your hips and shoulders form time to time.
Take a break: No matter how much work you have in front of you, take a break at the end of each hour. Taking even 2 minutes off out of 60 every hour can have a huge impact on your health. If you still feel guilty skip using the phone to connect with your colleague and walk over to their desks instead.
Get a pedometer: Keeping a pedometer will help you track the number of steps taken in a day. Ideally, a person should take 10,000 steps a day to stay healthy. If you sit at a desk for majority of the day, take every opportunity you can to up the count on your pedometer. Go for a walk around your office after lunch or park your car a little way off from the office to create opportunities to walk.
Take the stairs: As far as possible avoid escalators and elevators. Instead climb stairs for a quick workout. If your office is on the 20th floor, walking up may not be feasible, but you could get off the elevator on the 18th floor and walk up the remaining two floors.
Eat healthy: Lastly, pay attention to what you eat. Avoid eating at the office canteen or picking up a bite at the coffee shop and carry lunch from home. This ensures that you eat a balanced meal.

World Spine Day-6 Back Saving Tips for People Who Sit at a Desk All Day

One of the most common complaints of men and women is that of a back ache with lower back aches being the most common. Apart from an improper posture, this may be caused by old age, lifting heavy weights or an injury to the back. A consistent back ache can affect your daily life and make performing regular tasks uncomfortable. Luckily, it can be managed quite well with simple ayurvedic remedies.
According to Ayurveda, backaches are triggered by an excess of Vata dosha. Thus, the Ayurvedic remedies for a back ache aim at reducing the Vata dosha. Ayurvedic remedies are natural and have negligible side effects. 

For this reason, they can be prescribed to both children and adults. Some such remedies are:

Cut down on spices: One of the main characteristics of the Vata dosha is dryness. This can be caused by pungent spices such as wasabi and green or red chillies. The internal dryness caused by these spices can lead to constipation which in turn can be one of the causes of low back aches. Hence, if you suffer from a chronic backache that may or may not be accompanied by constipation, cut back on the spices and try eating food that is slightly blander.
Eat food before it gets cold: Eating cold food or cold drinks can also increase the Vata dosha levels in our body. Coldness creates congestion and constricts the internal organs while warm food allows the digestive and stool carrying channels to stay open. This allows for the easy expulsion of waste and reduces toxins in the body. Hence, opt for warm drinks like tea or coffee instead of soft drinks and juices and try to eat your food while it is hot.
Padahastasana or the standing forward fold pose: This yoga asana is very effective when it comes to treating back pain as it allows the Vata dosha to flow easily through the body. In doing this it opens up the digestive channels that may have been causing constipation and back pain. It also relieves problems associated with sciatica. To practise this asana begin by standing upright with your feet beside each other. While inhaling, lift your arms over your head till they touch your ears. Bend forward from your hips while exhaling and try to keep the back and your legs straight. Touch the floor or wrap your hands around your calves. Bring your head as close to the knees as possible and hold for 5   10 seconds. Inhale and the slowly roll your body upright again.

Back Pain - Ayurvedic Remedies for Managing it!

The carpal tunnel is the passageway for the median nerve to pass through on the inner side of your hand, when your palms are facing down. For example, while typing, there is a lot of movement of the fingers and this puts a lot of pressure on this tunnel. In fact, people who are involved in a lot of typing are one of the most prone people for carpal tunnel syndrome (CTS). Other causes would include trauma, fractures, etc., where the tunnel is injured.

Conventional measures to treat CTS included a combination of exercise and pain killers in mild to moderate cases. In moderate (sometimes) to severe cases, surgery was also done. However, with advancements in medical technology, endoscopic surgical procedure is gaining popularity.

What is done?
In endoscopic surgery, a small incision is made in the wrist or one each in the palm and the wrist. Through this, a flexible tube with a camera and minute cutting tools are inserted into the wrist. Another ligament known as transverse carpal ligament is cut. This reduces the pressure on the median nerve, which provides relief from the CTS symptoms.

What to expect as benefits?
The intention behind the surgery remains the same in both traditional and endoscopic procedures. The pressure on the median nerve is released, restoring movement and reducing pain in the joints. In addition, the endoscopic procedure has the following benefits.

Less invasive: Needless to say, there are only one or two small incisions done for this procedure, so less surrounding tissue is damaged.
Same day surgery: No hospitalization is required, and unless required, the patient can return home on the same day of surgery.
Reduced recovery time: The recovery period is usually substantially less compared to the traditional surgical approach.
Back to work: Depending on which is your dominant hand, you would be able to return to your regular work earlier than with regular surgery. If your non-dominant hand is involved, a day or two of rest is required. If your dominant hand was involved, give it up to four weeks for complete recovery.
Reduced chances of nerve injury: The area of operation has many nerves and blood vessels, and endoscopic surgery reduces the chances of damaging adjacent nerves.
Anesthesia: This is done under local anesthesia. Therefore, complications arising out of general anesthesia are completely avoided.
Indications
While these sound promising, your doctor will decide if you are a candidate for endoscopic procedure depending on the following:

Nonsurgical treatment including exercise and pain killers have not provided relief, even after several months.
Severe symptoms including those of nerve damage, like loss of sensation, altered coordination, etc., is affecting your normal daily routine.
Person requiring bilateral surgery like severe trauma, wheelchair dependent, etc.

Carpal Tunnel - How Endoscopic Surgery is Beneficial?

Tennis Elbow is involved with the muscles and tendons of one s forearm. It leads to inflammation of the tendons which join the forearm muscles on the outside of the elbow. Physiotherapy treatment can be of great help. The primary goal of this treatment is to improve the strength as well as the flexibility of one's forearm muscles. Now, before we take a look at the tips regarding physiotherapy treatment, let us briefly discuss its symptoms and causes.

Symptoms

If a person suffers from the problem of tennis elbow, then it s sure to cause pain and tenderness on the outside of one s elbow. The pain is at its peak when the elbow is kept still, while there might be variations in the pain when it is in use. There are other symptoms, which include:

Trying to lift the arm can cause discomfort as it results in pain.
One can also feel the pain while writing or even when anyone tries to grip small objects.
People can even encounter stiffness accompanied by pain when they try to extend his or her arm at full length.

Causes

There are a number of causes behind the occurrence of Tennis Elbow. They include:

Incorrect movements of the arm on a repeated basis, which can result in the tendons getting torn.
Those who play sports like badminton, tennis and squash that require excessive movement of racquets.
Any manual work that requires regular lifting of the wrist.
Sports activities that involve an extensive amount of throwing.

Tips Regarding Physiotherapy Treatment For Tennis Elbow

Consult a physiotherapist to undergo physiotherapy treatment for tennis elbow, the therapist would help to provide strength and flexibility of forearm muscles. The following are some of the tips regarding Physiotherapy treatment to treat tennis elbow:

A physiotherapist can offer the modern technique of dry needling the wrist extensions in order to improve the range of motion among patients.
Modern physiotherapy treatment for tennis elbow also includes the use of Kinesiology Tape, which can relieve pressure, relax associated muscles and also increase blood circulation.
Cupping is another mode of physiotherapy treatment, which can help increase blood flow to the affected tissue and improve the length to rest muscles
Physiotherapy can include a patient wearing an elbow strap, which wraps around his or her upper forearm in such a way that the pressure gets relieved on the tendon attachment.
A physical therapist might even apply ice and electrical stimulation to ease out the pain and improve the healing process of the tendon.
Physical Therapy sessions can also include iontophoresis, which makes use of mild electric current to insert anti-inflammatory medicine.
Once the pain subsides, a physical therapist provides inputs on different exercises like Elbow Bend, Wrist Turn, Wrist Lift and Palm Up, Towel Twist etc.

Physiotherapy Treatment In Tennis Elbow!

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