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

Breaking a bone can be counted among one of the most painful experiences that one can possibly suffer from. Inflicted usually by external injuries, fractured bones generally require surgeries for recuperation. In the occasion of minor fractures however, plasters often facilitate recovery. Although these are the primary treatments that are meted out, recovering from fractured bones entail much more. For some, the time to restore normalcy takes longer than others. In such cases, one tends to opt for palliatives to ease out the pain.

Homeopathic medicines not only offer respite to the pain but also provide a holistic cure for the emotional anxiety one goes through in such times. Many therefore seek out homeopathic remedies for treating bone fractures. Some of the most effective antidotes in this regard have been enlisted below.

1. Arnica: Arnica is extremely helpful at curbing swelling and as a consequence, reducing pain. Prolonged use of Arnica can potentially minimize the swelling to absolute normalcy.
2. Hypericum: This soothes the fracture induced pains, especially when the fractures affect the nerves. This is a beneficial remedy for fractures in fingers, toes and the spinal regions.
3. Bryonia: Bryonia is known to bring relief in cases of the jarring pain that surfaces post trauma. Sometimes, even the slightest movement in the affected area can lead to a lot of distress. This is an ideal cure for such cases.
4. Calcarea Phosphorica: This speeds up the healing process following a bone fracture. Consumption of Calcarea Phosphorica accords a calming effect on the moods of the patient and helps to deal better with the pain, anxiety and irritability in the due course.
5. Eupatorium Perfoliatum: This helps in mitigating deep wounds and the consequent aches. The healing powers of Eupatorium Perfoliatum are extremely pervasive and results in quicker recovery.
6. Ruta Graveolens: This re-nourishes the damaged body fibers and soothes the bruised areas. It is also known to reduce restlessness.
7. Symphytum: It is extremely helpful in the rejoining of bones. It enables the body to heal faster and effectively cures joint pains.

5 Best Homeopathic Medicine for Bone Fracture Treatment

Tennis elbow is a type of tendinitis. It is usually the swelling of certain ligaments. It causes pain in the elbow as well as the arm. These ligaments are bands of strong and stretchable tissues that connect the muscles of your lower arm to your elbow. In spite of its name, you can in any case get tennis elbow regardless of the possibility that you have never been close to a tennis court. This is merely a name for the condition and has little to do with the sport. It can affect anyone who indulges in a swinging motion.

Any repetitive exercises that require a tight grip, particularly in cases where the thumb and the initial two fingers are used frequently, may cause tennis elbow. Tennis elbow is the most common reason for patients to see their doctors for elbow torment. It can occur in individuals of all ages; however, it is most common and normal at about the age of forty.

This condition is usually caused when there are repeated contractions of the lower arm muscles that you use to raise your hand and wrist as well as to straighten it. The repetitive movements and pressure to the tissue may bring about a series of little tears in the ligaments that connect the lower arm muscles to the hard surface on the outside of the elbow.

Tennis elbow ordinarily occurs after some time. Dull movements such as holding a racket during a swing can strain the muscles and put a lot of weight on the ligaments. That consistent pulling can cause a small amount of tears in the tissue. Tennis elbow may be caused because of the following reasons:

Playing tennis
Playing racquetball
Playing squash
Fencing
Weight lifting or any other stressful exercises involving the muscles
In tennis, the following moves can lead to tennis elbow:

One-handed backstroke with a poor stance or lose hand
A late forehand swing bringing a bend in the wrist altogether
Snapping and turning the wrist while hitting with full power
As the name suggests, playing tennis, particularly repeated use of the backhand stroke with poor strategy, is a conceivable reason for tennis elbow.
However, a number of other basic arm movements can also cause tennis elbow. It can also affect individuals with particular occupations or while performing leisure activities that require heavy arm movements or gripping, for example, the following:

Carpentry
Excessive writing
Painting
Raking
Weaving or knitting
Utilising plumbing devices
Driving screws
Chopping cooking ingredients or vegetables, especially meat
Repetitive computer mouse utilisation
Lifting heavy materials or even grocery bags
There are a number of ways to treat a tennis elbow. These include certain over-the-counter (OTC) medicines. If those do not work, seek the help of a specialist or physiotherapist. He or she can recommend you the right kind of medicines as well as exercises needed for the recovery.

Tennis Elbow - Common Causes Behind It!

A sprain refers to a break or a tear in any of the ligaments of your body. A ligament is a band consisting of tissues that connect the bones at any given joint in our body.

A strain on the other hand refers to a tear or a break in the entire muscle itself or a tendon (the band of tissues that connect the muscle to the bones).

Occurrence
Sprains usually take place due to unforeseen incidents like falls, accidents, and such other things that forces the body part to go out of its normal position. The most common types of sprains that people suffer from are ankle sprains which affect about 25,000 people every day on a worldwide basis.

Strains usually happen when you twist a whole muscle or a tendon. This condition most commonly occurs in cases of sportspersons who are engaged in contact sports like hockey, football, rugby, and such others.

Symptoms
The identification signs of sprains and strains are mostly very similar, which are listed below:
1. Pain and discomfort in the joints
2. Visible swelling or inflammation seen on the joints
3. Bruising of the affected area
4. Tenderness and softness of the affected joint

The overall intensity of the above mentioned symptoms might differ basis on the severity of the condition that is directly proportional to the nature of injury that you have faced. Some pains are so light that it may not affect your daily routine at all, whereas some pains are so intense, that you might not be able to move your affected joint at all.

Treatment
Some of the common methods to cure a sprain or a strain are listed below:
1. Rest the area which is affected
2. Apply ice bags or cold compress to soothe the pain
3. Compress the affected joint using a compression tape
4. Place the affected joint on an elevated area to speed up the healing process

Sprain Versus Strain

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

Physiotherapy plays a pivotal role in helping a person recover after a hip replacement surgery. It brings back the old flexibility and prevents blood clots in the area where the procedure has taken place. After the surgery team gives its green signal, a physiotherapist starts working with a patient for a full recovery. 

Here is a list of some common exercises that a physiotherapist suggests after a hip replacement surgery:

Walking: It is important to use the crutches for a time period of 4-5 weeks post the procedure. Until the surgeon or the physiotherapist advises against using the crutches, it makes sense to use it while walking. It makes sense to retain the normal walking posture by using the crutches rather than limping without it. A physiotherapist reviews the pressure exerted by the arm while holding a crutch, before advising the patient to get rid of the crutches.
Increasing hip flexibility: This is a basic form of exercise where an individual lies on one side of the body with knees and hips bent. A pillow is placed in between the knees. While doing this, it should be ensured that both the feet is kept together and the back muscle is not twisted. The top knee should be slowly raised like an opening of the calm shell. This position should be maintained for 4-5 seconds.
Strengthening the hips: The body should rest on the stomach. The buttocks should be tightened and one leg should be slowly lifted. This position should be maintained for a stretch of 3-5 seconds. The same should be repeated for both the legs.
Strengthening the hip and the stomach muscle: The body should rest on the back with a leg bent. The stomach muscle should be tightened and the bent leg should be lifted carefully while ensuring that the bend does not supersede more than 90 degrees. While keeping the stomach muscle tight, the lifted leg should slowly come down to touch the surface. This act should be repeated for 5-6 times.
Strengthening the thigh muscle: While sitting in a steady chair, an elastic loop should be wrapped around the ankles. The elastic loop should be stretched with one leg while keeping the other foot firmly rooted to the ground. The lifted foot should slowly come down to the normal position. The same act should be repeated for 4-5 times.
Improving balance: An elastic loop should be tied to one leg of a table and the other end of the loop should be tied to one ankle. The table should be held on for maintaining balance. Maintaining an erect position, the tied up ankle should be stretched sideways. The position should be maintained for 3-5 seconds to return back to normal standing position.

How Physiotherapy Can Improve Recovery After Hip Replacement Surgery?

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