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!

The backbone (spine) has smooth movement with smooth intervertebral disks. However, this fluid movement can be limited due to arthritis, which can happen due to many reasons   genetic to age to injury to infection to tumors. The lower back has two sets of spinal disks   sacral and iliac. This sacroiliac region has an elastic vertebral tissue. This could be gradually replaced with hard bone, which can cause fusion between the disks. Such a condition is known as ankylosing spondylitis (fusing disk spaces), which is a type of arthritis.

The typical symptoms of ankylosing spondylitis (AS) are morning pain and stiffness in the low back and upper buttocks, which gradually decrease as the day goes by. The symptoms usually start and continue to gradually worsen over a period of 3 to 6 months. In severe cases, there could be spinal fractures, but in most cases, pain, stiffness and reduced movement are the main complaints.

Why homeopathy for AS (Ankylosing spondylitis)?

Major benefits of homeopathy could be summarized as under:

It addresses altered immune system, treating the roots of this autoimmune disease.

It helps in pain control without side effects.

It aims at disease control.

It is absolutely safe even if used for a long time.

Homeopathic medicines are prescribed on the basis of individual case evaluation by taking into account patient s genetic, immunological and psychological parameters. It is safe and effective as a long-term therapy. It reduces pain, improves mobility and most importantly, controls the disease. It has no adverse effects.

Homeopathy helps AS patients by acting on the immune system, which is usually overactive in these people. Depending on the presenting symptoms, the doctor will prescribe a customized regimen for the patient.

Rhus Tox: This is the first medicine of choice when the patient experiences sacral/lumbar area pain that is worse at rest, with sitting, or after a period of inactivity. The pain radiates down the legs to the foot. Walking or any other activity/motion provides relief from the pain.

Aesculus: This is indicated in patients who have extremely painful and stiff low back and hips. The pain is a constant ache and there is discomfort with trying to rise from a seat, stooping, and walking, where greater effort is required. There is a feeling that the legs would give way, adding to resistance while walking.

Kalmia: This is used in patients where the back pain and stiffness are accompanied by a warm, numb, and prickly sensation. Low back pain and neck pain is associated with a burning sensation. The pain appears in sudden bursts in the early parts of the night and travels down the arm or up into the scapula.

Kali Carb: This is indicated where there is extreme weakness along with AS symptoms of pain and stiffness in the lumbosacral back area. The patient feels like he is going through a paralytic attack and must lie down to rest. This is a feeling similar to a broken back, and can extend up into the neck or down to the legs. The symptoms are more severe in the early morning hours. Changing positions in the bed worsens the pain.

If you or someone else is suffering from AS symptoms, give homeopathy a try.

Homeopathy Treatment For Ankylosing Spondylitis

When we speak of bone health, calcium is usually the hero of the story. However, by itself, calcium is not enough for healthy bones. Vitamin D is equally important for healthy bones and the prevention of orthopedic conditions.

What does Vitamin D do?
Vitamin D helps the body absorb calcium from the food being eaten. It also controls the calcium and phosphate levels in the body. This is critical for the growth and development of new bones. Vitamin D also controls how much calcium and phosphates are being expelled by the body. In this way, vitamin D helps strengthen the bones and improve overall bone health.

Vitamin D Deficiency
Vitamin D is not commonly found in food. It is present only in certain types of oily fishes, egg yolks and mushrooms. Most of the vitamin D we eat comes from fortified cereals, breads and dairy products. The sun is an important source of vitamin D but exposing yourself to too much sunlight could cause various skin problems. Thus, vitamin D deficiency is very common. When it comes to bone health, vitamin D deficiency can cause low-density bones. This, in turn, can cause rickets and osteoporosis. People with vitamin D deficiency are likely to suffer frequent fractures. Vitamin D deficiency can also cause skeletal deformities such as bow legs and a stooped spine.

Vitamin D and Osteoporosis
Osteoporosis is a musculoskeletal condition that is marked by low bone density. Studies have shown that people with osteoporosis have lower levels of vitamin D as compared to others. Some studies also suggest that fractures are more common in winter as compared to summer. The winter sun is often hazy and many days can go by without strong sunlight. Thus it can be inferred that people do not get their required quota of vitamin D from the sunlight in winters leading to a deficiency and aggravated osteoporosis-related fractures.

Who is most susceptible to bone conditions caused by vitamin D deficiency?
Vitamin D deficiency is a very common condition across the globe. Some surveys have claimed that approximately 30% of the global population suffers from vitamin D deficiency. People with dark skin, women and elderly people are most susceptible to this deficiency. People suffering from kidney diseases may also be affected by vitamin D deficiency. Vitamin D supplements are usually very helpful in combatting this deficiency. These can be taken by young children as well as adults.

Relation Between Vitamin D Deficiency And Bone Problems!

Pain causes a lot of discomfort in the body no matter whether the pain is in the back, legs or in the head. Almost all people experience lower-back pain at some point in their lives, which can be extremely painful and can cause considerable annoyance. The first medical specialty that comes to mind for relief of lower-back pain is Orthopedics. The other two specialists that play a vital role in treating lower-back pain are the neurosurgeons and the physiatrists.

Pain in the Back
It is very difficult for the body to source the pain when it is deep and this pain could be due to infection, disease or injuries in the back, stomach and heart. It is even possible that the pain radiates to different places in the body. Often back pain is accompanied by body changes like redness, fever, neurological problems, heat, and changes in body functions and for that diagnosis of the back pain may be very severe. Patients suffering from lower-back pain and with symptoms that comprise of weakness in the foot or other symptoms of a neurologic insufficiency must definitely see a neurosurgeon.

Back pain that occurs due to reversible problems is known to vanish in a few hours or in a day. However, if it continues longer and is accompanied by body changes, then there are chances that the condition can become worse. Visiting a doctor becomes a must for back pain if any of such characteristics are witnessed. It is always better to get evaluated by a physician.

When to Consult a Doctor Immediately

    Back pain that is followed by a shock like a car accident.
    The pain in the back worsens and is constant
    Back pain continues for more than 4-6 weeks
    The pain does not improve even after taking typical remedies such as taking pain relievers or after resting.
    Severe pain in the back in the night and that is alleviated by rest
    The back pain is accompanied by abdominal pain
    Numbness in the upper thighs, buttocks, groin or in the genital area
    Weakness or tingling sensation in the arm or legs

Role of a Neurosurgeon
The neurosurgeon provides non-surgical as well surgical care depending upon the nature of the illness or the injury, and he does not just operate. The neurosurgeons are experts and offer treatment to patients suffering from any injury or disease in the spine, brain or peripheral nerves that deal with arms, hands, feet and legs. But there are many other neurosurgeons that confine their practice to treating back pain.

Lower Back Pain - 8 Signs When You Must Visit Your Doctor

Muscle cramps often occur in the calf muscle of the back of the lower leg. It is often characterized by a momentary sharp pain along with a muscle lump beneath the skin. Just like its sudden appearance, muscle cramp disappears the same way without any botheration. However, a doctor should be consulted if you see any of the following symptoms:

    The pain keeps coming back
    The cramps result in weakening of the muscles
    It causes frequent discomfort
    It results in changed skin color, redness or swelling of the skin
    The condition doesn t improve with normal care
    Cramps are not associated with obvious causes such as playing, exercising and jogging

What causes muscle cramps?
Any strain on muscle, dehydration, muscle overuse or simply standing for a prolonged time can lead to muscle cramps. The exact cause of muscle cramps is not known in a lot of cases. There could be the following medical conditions that could lead to such muscle cramps:

    Blood supply: At times when the arteries narrow down resulting in an inadequate blood supply in the leg, a sharp pain can be felt followed by muscle cramps. This can happen while exercising or playing. It disappears as soon as one rests their legs.
    Mineral depletion: Shortage of magnesium, potassium and calcium in the body can lead to muscle cramps. Even medication for high blood pressure can lead to cramps in the legs.
    Nerve compression: Nerve compression of the spine can produce sharp pain on the leg muscles. The pain worsens with longer durations of walk. The symptoms, however, can be delayed a bit if the walking posture is changed, like the way one walks while carrying a shopping cart.

What are the risk factors associated to muscle cramps?

    Dehydration: Muscle cramps often happen among athletes when they get dehydrated and fatigued while performing in hot temperature.
    Age: People over the age of 60 often lose mass in the muscle. The remaining mass gets stressed out soon, resulting in muscle cramps.
    Pregnancy: Pregnant women face frequent muscle cramps due to the sudden increase of body weight and restricted movements in the pregnancy period.
    Medical conditions: Certain medical conditions such as nerve disorder, thyroid problems, liver failure, diabetes etc. greatly increase the chance of muscle cramps.

Some common ways to treat muscle cramps:

    A brisk walk followed by stretching relaxes the muscles and greatly helps in staying away from cramps.
    A diet consisting of magnesium on a regular basis gives relief from muscle cramps.
    A wet cloth soaked in hot water often shows magical results and gives instant relief from muscle cramps.
    Being hydrated throughout the day helps with muscle cramps. It is necessary to consume enough amount of electrolytes so that muscle contraction does not happen.

Why You Get Muscle Cramps?

How Homeopathy Can Cure Muscle and Joint Pain?

Joint and muscle pain arises when excess pressure is exerted on a particular joint or due to the wear and tear of a particular muscle. This is one area where many people face chronic pain, with symptoms such as deformity of the joints, swelling, immobility of the joints and severe joint pain. There are a lot of topical as well as oral medicines for chronic pain within conventional medicine, but it may not always be effective for all types of patients.

Homeopathy has been known to provide effective cures for many types of muscle and joint related ailments.

Let's first look at the common causes for muscle and joint pain related problems:
- Sports related injuries
- Vehicular accidents such as a car or bike accidents
- Bad postures or habits
- Other underlying physical or medical conditions

So what are the ways in which homeopathy can cure certain conditions and alleviate pain in patients?

- Arthritis: One of the most common problems that many people report is that of arthritis and rheumatoid arthritis, which causes a lot of pain in many people. In many cases, the use of Natrum Muriaticum and Bryonia has been known to allay the pain.
- Moving and shifting joint or muscle pains: Many patients have this problem where they face joint or muscle pain but instead of it being constant in one area, it moves around the body. Pulsatilla is known to effectively reduce the symptoms in these cases.
- Tennis elbow or tendon related problems: This is a common ailment, which in many cases is caused by strenuous activities, such as sports. Rhus tox has been known to be effective in such cases.
- Muscular conditions: There are many muscle-related conditions such as fibromyalgia and fibrositis among others have also been reduced after the usage of Rhus tox.

Homeopathic medicines like Medorrhinum, Ruta, Formica Rufa, Arnica, Symphytum and a few others are useful for treating such conditions, depending upon the exact symptoms and causes.

If you would like to consult with me privately, please click on 'Consult'.

How Homeopathy Can Cure Muscle and Joint Pain?

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