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!

Injuries are an inherent part of sports. All athletes have sustained some injury or another during the span of their careers. No matter which sport you play, be it football, hockey, tennis or cricket, whether you are representing your country or your college, you are likely to get hurt at some time. An injury has the potential to end careers and ruin dreams. That is because the injury takes a toll not just on the body but the mind as well. It instils confusion and hesitation and sometimes after an especially traumatic accident, athletes find it difficult to return to practice because they are crippled by a sense of fear.

That is why along with treatment or surgery, a sportsperson also needs to undergo rehabilitation therapy.

Why Psychological Rehabilitation is Important? 

After suffering a serious injury that almost jeopardized their career, athletes suffer a wide range of psychological and physical challenges, which makes them retreat from the outside world. These are problems they would not be able to cope with unless they opt for rehabilitation programmes.

  It helps them accept that getting back to the game will be a mammoth task 

  Inspires in them the confidence to keep trying 

  Deal with the pain 

  Go about their practice sessions with as little discomfort as possible 

  Overcome feelings of fear or despair 

  Cope with depression 

  Prevents the person from sinking into a state of self-pity which hinders recovery 

  Look at the injury not as something that might put an end to their career but as a mere impediment in the path to success 

Psychological rehabilitation adopts a wholesome and expansive approach to healing the athlete. It takes into account several factors in chalking out a course to recovery that is individualistic   

  The personality- the toughness, determination, will power of the athlete, ability to deal with anxiety

  Medical history- past injuries or illnesses 

  Resources of coping- the athletes  support system, a network of friends and family, management of stress, treatment and medicines etc 

Psychological rehabilitation also takes into account the individual s response to therapy to ensure that it is as effective as possible. These are   

  Cognitive appraisal - Monitors a person s growth or decline in self-esteem or worth as well as confidence. The aim of rehabilitation is to restore the person s faith in his/her capabilities 

  Behavioural response - This ensures that the individual s behaviour shows traces of denial or avoidance because negativity will only delay recovery 

  Emotional response - The profile of Mood States (POMS) is utilized to analyze or gauge the person s emotional reaction to therapy. It is supposed to uplift the athlete mood and deal alleviate feelings of despair or hopelessness. Medicines and physiotherapy become more successful in treating a sports injury when coupled with psychological rehabilitation. 

Athletic Injuries - How Effective Is Psychological Rehabilitation As A Line Of Treatment?

Arthritis, which is quite a common ailment among people aged above 40, is painful regardless where it affects a person, be it the hands or the toes. However, the Ayurvedic field of medicine has come up with historic ways of treating the issue. Over the course of time, these methods have proved to be quite effective, and especially popular as they have no side effects. A person only needs to spend a little time to get to know how to go about using Ayurveda to cure the arthritic aches and pains, which plague daily life!


One of the best things about Ayurveda is the fact that the solutions are generally made using ingredients that are very easy to source. For example, there is a solution for arthritis, which involves mixing a cup of mustard oil with about 10 grams of camphor and then heating the combination. This oil mixture then needs to be massaged on the affected areas. Now, isn t that simple?


The common potato, long considered to be a vegetable of the masses, also finds its use in Ayurveda when it comes to treating arthritis. If you soak a few unpeeled slices of potato in a glass of water overnight and drink this water the following morning, you are sure to find an improvement in your condition quite soon. 


Additionally, there are a few other food items that are recommended in the Ayurvedic treatment. These include bitter gourd, which is not only low in calorie content, but also very high on vitamins and ginger which improves metabolism. Consuming garlic and buttermilk is also considered advantageous. 


Moreover, you may also need to make some changes to the lifestyle habits, which have been deeply ingrained. For instance, sleeping as per a regular schedule and not going to sleep very late at night has a positive impact.


As you have probably be discerned, when it comes to health, the devil is in the eating! If a person who has arthritis makes an effort to conform to a good and healthy diet, which does not contain fried or sugary food, or even those which have spices in excess, he or she will not only find the pain symptoms of arthritis reducing, but also gain a general sense of health.


As long as a person has the patience to follow the way of treating arthritis set out by Ayurveda, the benefits will truly be bountiful!

Arthritis - How Ayurveda Can Help Treat it?

Bone Fractures: Causes and Symptoms

'Fracture' is a medical term for a broken bone. According to an estimate, an average person has two fractures within their lifetime. When a force exerted is stronger than the bone itself, it can lead to a fracture. The risk and chance of fracture depend on your age. With age, bones tend to become brittle and, hence, a fall that would have been potentially harmless years ago can lead to a broken bone at a later age.

There are many types of bone fractures, but the main types are:

Closed fracture: A fracture in which the bone breaks but does not tear through the skin

Open fracture: Where the broken bone punctures through the skin and protrudes out. There's a greater chance of bone infection in an open fracture

Displaced fracture: In this type of fracture the bone snaps into more than two parts

Nondisplaced fracture: The bone cracks partly or wholly but it does continue to move

Some of the common signs and symptoms of a fracture are:

- Bruising and swelling of the bones
- Open fractures marked by protruding bones from the skin
- Loss of locomotive and functional ability of the injured area
- Deformity of the injured area
- Pain in the event of movement of the injured area

A fracture can be caused by a number of reasons, and they are:

- Injuries and accidents
- Falls and slips
- Wear and tear through overuse
- Sport injuries
- Fist fights and brawls
- Osteoporosis (a disease which causes bones to weaken in adults)
- Osteomalacia ( a disease caused due to softening of your bones, which is caused by a vitamin D deficiency.) Soft bones are more likely to bow and fracture than are harder, healthy bones.

Note:

Osteomalacia is not the same as osteoporosis. Osteomalacia occurs due to a defect in the bone-building process while osteoporosis develops due to a weakening of existing bones.



Bone Fractures: Causes and Symptoms

A spinal cord injury is a damage to the spinal cord. It s an extremely serious type of physical trauma that s likely to have a lasting and significant impact on most aspects of daily life.

The spinal cord is responsible for sending messages from the brain to all parts of the body. It also sends messages from the body to the brain. We are able to perceive pain and move our limbs because of messages sent through the spinal cord.

If the spinal cord sustains an injury, some or all of these impulses may not be able to  get through . The result is a complete or total loss of sensation and mobility below the injury. A spinal cord injury closer to the neck will typically cause paralysis throughout a larger part of the body than one in the lower back area.

Causes-

A spinal cord injury is often the result of an unpredictable accident or violent event. The following can all result in damage to the spinal cord:

a violent attack such as a stabbing or a gunshot
diving into water that s too shallow and hitting the bottom
trauma during a car accident (specifically, trauma to the face, head and neck region, back, or chest area)
falling from a significant height
head or spinal injuries during sporting events
electrical accidents
severe twisting of the middle portion of the torso
Symptoms-

Some symptoms of a spinal cord injury include:

problems walking
loss of control of the bladder or bowels
inability to move the arms or legs
feelings of spreading numbness or tingling in the extremities
unconsciousness
headache
pain, pressure, stiffness in the back or neck area
signs of shock
unnatural positioning of the head
If you suspect that someone has a back or neck injury:

Don t move the injured person   permanent paralysis and other serious complications may result
Call 911 or your local emergency medical assistance number
Keep the person still
Place heavy towels on both sides of the neck or hold the head and neck to prevent them from moving until emergency care arrives
Provide basic first aid, such as stopping any bleeding and making the person comfortable, without moving the head or neck
Prevention-

Because spinal cord injuries are often due to unpredictable events, the best you can do is reduce your risk.

 Some risk-reducing measures include:

always wearing a seatbelt while in a car
wearing proper protective gear while playing sports
never diving into water unless you ve examined it first to make sure it s deep enough and free of rocks

Spinal Cord Injury - Signs, Causes & Prevention

When you experience any kind of bone and joint pain, you may be wondering what the best remedy might be to get relief. Some people ignore the pain, and it worsens, while others take over-the-counter medicines. However, the best remedy for bone and joint pain is to visit a pain management specialist. The field of pain management has evolved over the last twenty years. Nowadays, there are dedicated pain management specialists who are experts in treating bone and joint pain.

Here are 3 reasons to consult a pain management specialist for bone and joint pain:
1. Pain management specialists are trained especially for understanding any kind of bone or joint pain. They undergo special training based on bone and joint pain management and thus know how best to recognize and treat such pains.

2. Pain management specialists have a multidisciplinary approach towards treating bone and joint pain. The aim of pain management is to provide overall treatment and pain management specialists know about the best ways to take care of joint and bone pains. Pain management involves interventional procedures, psychological therapies, medication management and physical therapies. Pain management specialists also provide you with lifestyle modification remedies and assign you exercise schedules and diet plans. Alternative medicines like acupuncture and massage therapies are also provided by pain management specialists.

3. Pain management specialists cooperate with you and come up with the best solution for your bone and joint pain. Pain is such an aspect, which has no fixed cure and the remedy varies from person to person and depends on the nature and severity of the pain. Thus everyone should receive a personalized treatment, which is most suitable to cure the pain that has occurred to them. Pain management specialists work with patients, discuss a lot and come up with the best treatment procedure, which would complement the patient. For example, a neurostimulation device can be prescribed to a patient who suffers from complex regional pain syndrome and did not have success with other treatment procedures. In many patients with a shattered spinal disc, pain management specialists prescribe injections, which work effectively to give relief and treat the condition.

A pain management specialist can make the best assessments on bone and joint pain. Being trained especially in bone and joint pain management, you can bank upon pain management specialists to receive the best treatment for your bone or joint pain.

3 Reasons to See a Pain Management Specialist for Bone and Joint Pain

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