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!

A broken nose is any crack or fracture in the bony portion of the nose. This is usually a result of external trauma.


Nasal fractures are often cited as the most common type of facial fracture, accounting for approximately half of all facial fractures in several studies.


Broken Nose Causes:


Common sources of trauma include the following:


Sports injuries
Personal fights
Motor vehicle accidents
Falls
In children, nasal fractures are most commonly due to falls.




Broken Nose Symptoms:


Tenderness when touching the nose
Swelling of the nose or face
Bruised nose
Bruising under the eyes (black eye)
Deformity of the nose (crooked nose)
Nosebleed
Pain and difficulty breathing out of the nostrils 


Broken Nose - 7 Signs You are Suffering from it

The Hijama or Cupping Therapy is an ancient form of Alternative medicine that has long been practiced in Egypt, China, and few Middle Eastern countries. The cupping therapy work wonders to deal with problems ranging from body pain, skin lesions to inflammation. It also plays a significant role in improving the circulation and blood flow. But what is the Cupping Therapy and how does it work? In this article, we will discuss some important points related to the cupping therapy along with its merits.

What is a cupping therapy?
A Cupping Therapy is a non-invasive procedure that involves the use specially designed cups (made of silicone, bamboo, glass, or earthenware) placed on the target skin area to create a vacuum or a suction to help treat a particular health condition.

What happens in a cupping therapy?
The cupping therapy can be Dry or Wet

In both the types, before using the cup, the cupping therapist uses a flammable substance such as herbs or alcohol (placed inside the cup) and sets it on fire. With the fire slowly going off, the therapist carefully puts the hot cup in the target area of the skin in an inverted (upside down) position (for around 3 minutes). This is done to create a suction inside the cup triggering an expansion of the blood vessels. Alternatively, a rubber pump can also be used to create a suction.
In Wet cupping therapy, the steps involved in creating the first suction (generally a mild one) is identical to those used in Dry Cupping. However, in wet cupping, following the first suction, small incisions or scratches are made in the target skin area. During the second section, it is through these cuts that the elimination of the toxic or impure blood takes place.
Soon after the therapy, the cuts are well bandaged along with the application of medicated creams or lotions to ensure a fast healing sans any complications.
For better lubrication and movement of the cups, the therapist may apply a herbal or medicated oil to the skin.
Some people may also opt for Needle Cupping. As indicative of the name, needle cupping involves the use of Acupuncture needles (inserted into the skin over which the cups are then placed to carry out the suction and the subsequent therapy).
Merits of a cupping therapy

The cupping therapy is a nonsurgical therapy that can be used to treat many health complications such as high blood pressure, varicose veins, gynecological problems (including infertility), anemia, dermatological conditions (such as eczema and acne), fibromyalgia, migraines, arthritis, hemophilia, to name a few.
The cupping therapy ensures a better pain management.
It works wonders in the case of stress and anxiety.
The cupping therapy goes a long way to restore the balance between the three Doshas.
It comes with negligible side effects (light bruises, mild burns, or minor skin infections).

Cupping Therapy - Know How It Works!

Aches and pains are typical signs of fatigue, but sometimes these aches are constant and can affect your day to day life. Fibromyalgia is not a disease, but a syndrome that affects the muscles and soft tissues of the body leading to chronic pain, tiredness and insomnia among other symptoms. Though this syndrome cannot be cured, it is not life-threatening and can be managed without causing permanent damage. One of the ways to manage fibromyalgia is through massage therapy.

Massage therapy is one of the oldest forms of healthcare. It aims to improve circulation thereby, improving the flow of nutrients through the body and aiding in the elimination of waste material. When it comes to fibromyalgia patients, a massage not only calms tired muscles but also reduces heart rate, improves the range of motions possible in joints and increases the body s production of natural painkillers.
Most fibromyalgia patients benefit from deep tissue massages. During the treatment, a therapist may use his or her elbows, forearms and feet along with their palms and fingers. He or she will typically use long strokes while kneading the muscles in deep circular patterns. Your therapist will also be able to address specific tender points and ease muscle knots.
Massage therapy can be customised as per your requirements and sensitivity. Fibromyalgia patients are very sensitive to touch and hence, to benefit from a massage, it is essential, to be honest with your therapist and tell him or her the level of pressure you can handle.
Massage therapy not only helps deal with fibromyalgia-related pain, but can also help treat insomnia that accompanies it. After a massage, you are more likely to have a restful sleep that does not make you wake up feeling tired. Having a good night s sleep is important for fibromyalgia patients as it is during this time that the body restores and rebuilds itself.
Massage therapy can also help manage the stress and anxiety that results from fibromyalgia pain. As the therapist addresses the various pressure points on the body, stress, anxiety and depression are relieved. Some theories also suggest that a massage blocks pain signals from reaching the brain while others suggest that a massage can stimulate the release of serotonin or endorphins.
Though a massage may feel like a simple procedure, the wrong massage can cause worsen your pain. Hence, it is important to work with a professional masseuse to treat your aches and pains. Following a regular massage schedule can also help manage your discomfort better.

Fibromyalgia Pain - Can Massage Therapy Reduce It?

Broken bone is commonly known as bone fracture a d it occurs when an exorbitant amount of force is applied causing the bone to split or shatter. While some minor fractures lead to cracks and crannies, others may lead to complete breakage of the bones. Despite being hard, bones are formed in such a way that they can absorb pressure to only a certain extent, beyond which they break. Statistically, the incidence of broken bones are most common in children and in old age people.

Causes of Bone Fracture
Bone fracture can be caused due to a number of reasons; both intentional and accidental. Some of them include:
1. Accidents and injuries: Sports injuries, being hit by a car and tripping and falling are some of the typical episodes.
2. Old age: Diseases such as osteoporosis and brittle bone disease are common in aged people. As bones tend to become more fragile among the aged, they are at a greater chance of bone fractures.

Type of bone fractures
Primarily bone fractures are of four types, based on the way the bone splits. They are:

Complete fracture: This type of fracture refers to a complete breakage of the bone wherein the fracture may occur at various parts of the bone.
Incomplete fracture: In this type of fracture, the bone partially breaks instead of splitting entirely.
Compound fractures: This is a type of a fracture wherein the bone breaks past the skin. It is also known as an open fracture.
Simple fracture: In this type of a fracture, the bone breaks without causing an open wound on the skin.
Treatment of bone fractures
In case of a broken bone, the immediate course of action would be to reach for the first aid box. This can be done to stabilize the bone prior to hospitalization. Icing the injury, elevating the injured area to prevent further swelling and covering the wound with bandages are common measures. In many cases, people also make household splints (made of newspapers) to keep the bone stabilized. Hospitalization and especially surgery, can be also opted for in case of severe fractures.

Bone Fracture - Understanding the Types + Causes

Ayurveda is a very old system of medicine, which originated in India. Using herbs found in nature to cure various illnesses, knee pain can also be permanently cured with this method indigenous to India. It reduces knee pain caused by various illnesses including arthritis, inflammation of the cartilage and wearing of the patella among others. Here are some common Ayurvedic remedies, which help reduce knee pain:

1. Alfalfa: Alfalfa is medically known as Medicago Sativa. Alfalfa is excellent for making sure that your joint pain reduces, when taken in liquid form four times a day.

2. Ashwagandha: Ashwagandha is medically known as Withania Somnifera. In the West, Ashwagandha is popularly known as Winter Cherry. Also, it has a lot of therapeutic properties, which include reducing joint pains. 

3. Banyan: The Banyan tree's medical name is Ficus Benghalensis. It has a sap very similar to the form of rubber known as latex is derived from the Banyan tree. The Banyan tree's sap is externally applied over the joints and the pain usually disappears after a few regular applications. 

4. Bishop's weed: The medical name for Bishop's weed is Trachyspermum Ammi. The oil extracted from this herb is usually applied to the knees to reduce the intensity of such knee pains.

5. Celery: The medical name for celery is Apium Graveolens. Celery is not only an effective treatment for rheumatoid arthritis and associated pains in the knees, but it is also helpful in treating gout. It is usually agreed upon that this particular treatment is usually long lasting because of its alkaline nature.

6. Dandelion: Dandelion's biological name is Taraxacum Officinale. It is rich in magnesium and is crucial for the correct mineralization of the bones. This mineralization allows the bones to become stronger and also prevents knee pain.

7.  Garlic: The medical name for garlic is allium sativum. Five to six cloves eaten everyday has proved to reduce knee pains.

8. Ginger: Ginger is biologically called Zingiber Officinale. These can be easily included in your diet and go a long way in curbing knee pain.

Ayurveda and Knee Pain

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