Knee pain is one of the most common and painful ailments that can limit mobility. Injuries can result in cartilage or meniscal tears or sprains too. Obesity is another reason because of which knee pain is on the rise. Also, regular wear and tear of ligaments and tendons around the knees due to old age is another cause. These days, with reduced physical activities and sedentary lifestyles, the rate at which knees are wearing out has also become accelerated. Whatever the reason, a correct diagnosis followed by prompt treatment can help. Over the years, physiotherapy has been playing an important role in treating knee injuries. Whether to supplement the various drugs to reduce pain and inflammation or to avoid surgery, physiotherapy has helped many and its popularity is growing every day. Here are some ways that physiotherapy can help reduce pain.

Improve flexibility of tendons: The knee cap is an area where there are lot of tendons and ligaments, coordinating to enable movement. Careful exercising can ensure that the flexibility of tendons and ligaments is improved, thereby making your knee movement easier and less painful.
Improves blood supply: As we all know, proper movement requires good blood supply. Exercising with special focus on the knee ensures that blood supply is improved, and thereby the supporting ligaments and tendons function optimally.
Enhances the knee cap function: The knee cap is that portion which joins your thigh bone to your calf bones. This is prone to slip out of place, especially with arthritis and injuries. This can be painful and limit movement to a great degree. Focused exercises aimed at improving knee cap function will ensure that the knee cap has a wider range of function, and does not slip out of its socket easily.
Reduce rigidity: Once you start physiotherapy, you will feel your knees getting more flexible. The rigidity that had set in as a result of injuries and/or old age will also reduce over a period of time.
Slow down the wear and tear: When you start physiotherapy after knee damage, continuing the exercise routine, of course with expert guidance, can reduce the pace at which further damage might happen. A word of caution though. Be sure to consult an experienced physiotherapist before you begin. Exercising in a bad manner can do equal or more harm than the original injury or old age itself.

Knee Pain and Physiotherapy

The trapezius muscle is a triangular muscle which extends from the neck, down to the middle of the upper back and across the shoulder. It is one of the largest muscles in the body. It helps in stabilizing and moving the scapula. When you rotate your neck, move your arms, or even shrug your shoulders, you are able to do it because of the trapezius muscle. Over use of the muscle can cause it to strain.

Trapezius strain can be quite annoying and uncomfortable as you will have difficulty in moving your shoulders. It also causes any upper shoulder movement very difficult as it gives out an excruciating pain whenever you try to move your head or rotate your neck. It generally happens when you repetitively put stress on the muscle.

Causes:
1. Poor posture while sitting, standing or lying down
2. If you sleep in a wrong or uncomfortable position
3. If you bend over a desk for hours(This is more relevant to office workers)
4. If you have to carry heavy weights on your shoulders(This is relevant to school and college students who have to carry heavy bags every day)
5. If you over work your trapezius during work outs
6. If you suddenly twist your neck
7. If you met with a fall or accident which injured your back.

Symptoms:
The symptom that characterizes a trapezius strain is the searing pain in the muscles which is scattered around from the shoulders to the neck. The pain might interfere in your daily activities such as moving your arms when you push or pull. It might also cause discomfort while trying to sleep. A trapezious strain might even cause a bit of swelling in the muscle. Sometimes, due to the neck pain, you might even get headaches.

Treatment:
1. Resting: Rest as much as possible. Any strain or swelling can be easily cured with proper rest.
2. Ice packs: Ice packs help to reduce the swelling and get some relief from the pain.
3. Exercise: Stretchingthe muscle will help loosen it.
4. Blood flow stimulation therapy: After the inflammation is reduced, you should take up this therapy as an increase in the blood flow in the affected area will help cure the strain.
5. Care for the scar tissue: The scar tissue will take longer to heal than the muscle. Hence you have to follow your doctor's instruction very carefully to get a speedy recovery.

All About Trapezius Strain!

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!

Tennis elbow is a condition which is characterized by a sharp pain on the outer portion of the elbow. This condition is also called  lateral epicondylitis  and it occurs when the muscles of the elbow are overused. The symptoms of pain tend to occur near the forearm when you bend your elbow or try to grip an object.

Causes
The elbow joint comprises of muscles which facilitate movement of the wrist, elbows and the fingers. There are tendons present in the elbow which join the muscles and bones, thus regulating the forearm muscles. When the muscles of the elbow are overused, then it can lead to inflammation and tears in the muscles.

This condition is so called as it is usually caused by playing certain sports, primarily tennis. It may also be caused by activities that put repetitive stress on the elbow. If the same pain occurs around the inner portion of the elbow, it is called a  golfer s elbow .

Prevention
The best treatment method to prevent tennis elbow is to strengthen your elbow muscles. You need to follow a regulated strength and stretching program directed at strengthening the muscles of the body, including the elbows.

Here are some tips to prevent tennis elbow:

Try to stay in good shape physically.
Use proper technique when you are carrying out any activity that involves the elbow.
Avoid overstressing the elbow joint with repetitive movements as it can cause injury to the tendon.
The muscles of the shoulder, arm and the upper back should be strengthened to prevent tennis elbow.
For movements that require you to twist your arm or grasp things, you can use a counter force brace to protect your elbow. This brace is worn on the forearm which redistributes pressure on the muscle. A counter force brace is recommended for people who are at an increased risk of tennis elbow.

Tennis Elbow - Tips To Help You Prevent It!

Fibromyalgia is a musculoskeletal disorder that is more prevalent among women (in the age group between 25 - 60 years) than men. The condition often results in muscular and joint pain along with extreme tiredness. Further, there may be severe headaches, body stiffness, insomnia or sleeping disorders, high sensitivity to extreme temperatures, abdominal pain, Irritable bowel syndrome and also Fibro Fog ( a condition triggered by Fibromyalgia, whereby an individual is unable to concentrate on anything). In some, the condition can trigger severe anxiety, stress, and depression.

While discussing Fibromyalgia, it is important to mention about the Tender Points or Trigger Points. These are delicate points and areas located throughout the body where even a gentle tap or pressure is enough to cause pain. Some of these trigger points in Fibromyalgia include:

upper chest.
back of the head.
knees.
top of shoulders.
outer elbows.
hips
Some of the common factors that play a significant role in triggering Fibromyalgia are

Stress and Trauma: Fibromyalgia may be an outcome of extreme physical, mental and emotional turmoil (which often creates a hormonal imbalance) or Post-Traumatic Stress Disorder.
Fibromyalgia may be linked to genetics and hereditary. People with a family history of Fibromyalgia are more susceptible to the painful condition.
In some individuals, an autoimmune disorder such as Lupus or Rheumatoid Arthritis can also be a contributing factor resulting in Fibromyalgia.
Acupressure to treat Fibromyalgia

People often opt for Alternative Therapy to treat Fibromyalgia. Individuals with Fibromyalgia benefit immensely from Acupressure. Acupressure is a popular alternative therapy that finds its origin in China. It channelizes upon the use of pressure at certain points in the body to ease the pain. Some of the acupressure points that are often used to relieve the pain, especially related to the Post-Traumatic Stress Disorder, in Fibromyalgia include:

Stomach 36 (ST 36): ST 36 holds great significance in providing a soothing and calming effect in people with extreme stress and anxiety (one of the critical symptoms associated with Fibromyalgia). ST 36 is located in the depression of the tibia (lateral side), at a distance of about four fingers downwards from the patella or the knee. Gently and slowly massaging the point for 3-4 minutes is said to provide great relief.
Ren 17: Another acupressure point that goes a long way to lower the anxiety and physical stress is Ren 17 or the chest center. This acupressure point is the middle of the chest (anterior midline), at the fourth intercostal space from the second rib downwards.
Ear Shen Men: The Ear Shen Men is an important acupressure point in the triangular fossa, at the upper region of the ear. People with physical and emotional stress benefit from this acupressure point.
Pericardium 6: The Pericardium 6 is in the mid arm region (lower and inner part of the arm) between the two tendons at a distance of four fingers from the wrist crease. In addition to a great soothing effect, Pericardium 6 is beneficial for people with nausea.
Yintang: Nothing works more like the Yintang to relieve stress and anxiety. The acupressure point in between the eyes at the eyebrow level.

Role Of Acupressure In Treating Fibromyalgia

Pain in the joints continues to bug mankind till this very day. There are different types of joint pains, which might occur all of a sudden, with no signs of receding. The most common of them all are arthritis, tennis elbow, frozen shoulder, back pain and repetitive muscular strain. These joint pains are sometimes impossible to diagnose properly by the regular modes of diagnosis. In those cases, resorting to the homeopathic mode of medication might be a good idea as it is a medication based on treating the actual cause of the disease and sustained use might result in complete remission of the pain.

Some commonly used homeopathic medications for pain in the joints are as follows:
1. Rhus Tox: This is the most commonly used in homeopathic preparation for severe joint pains, the symptoms of which include severe pain after relaxation, pain triggered by slightly wet weather and pain after walking or running for a long time.

2. Arnica Montana: When the symptoms are pain in every joint of the body resulting in body aches and pertaining injuries due to accidents, Arnica Montana serves as the perfect medication.

3. Actea Spicata: This medicine is primarily used as a remedy for pains in the small joints of the hands. The symptoms for which the medication can be implemented are rheumatoid arthritis in the joints of the finger and swollen wrists after usage of the hand.

4. Colchium: This medicine can be used in case of Rheumatoid Arthritis (inflammatory and chronic form of arthritis).

5. Bryonia Alba: This medication can work wonders if the symptoms include severe pain in the knee joints while walking, severe swollen joints and osteoarthritis (affects the flexible tissues present at the bone ends).

However, it is always advisable to take medication as prescribed by your doctor, as the potency and frequency can only be decided by your doctor.

Homeopathic Treatment for Pain in the Joints

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