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Spinal Surgery Disorders
Treatment of Neurological Problems
Treatment of Nerve And Muscle Disorders
Treatment of Hip Disorders
Neuro Physiotherapy Treatment
Treatment of Knee Injury
Pregnancy Exercise Therapy
Treatment of Sports Injuries
Treatment of Splinting
Treatment of Spondylosis
Arthritis And Pain Management Treatment
Heat Therapy Treatment
Post Pregnancy Classes
Orthopedic Physical Therapy
Treatment of Shin Splints
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I am 26 old female. Before 5 month I had an accident. Now I am fine but my back is hurting when I get up my bed or lay down. What should I do?
Is it ok to donate blood if esr and crp is high? My current esr is 45 mm and crp is 39.2. My blood group is o negative and I have a spondylitis back problem.
I am 22yrs old man, I am smoker, I have terrible calf while sleeping. Any thing serious? facing this issue more than six months.
I have back pain during 1month my age is 18 when I was playing cricket, shuttle pain is coming very big what can I do for this?
Spondylitis includes swelling of the vertebra. It happens because of wear and tear of the ligament and bones found in your cervical spine, which is in your neck. While it is to a great extent because of age, it can be brought on by other reasons too. Side effects incorporate pain and stiffness starting from the neck to the lower back. The spine's bones (vertebrae) get fused, bringing about an unbending spine. These changes might be mellow or extreme, and may prompt a stooped-over posture. Some of the non-surgical methods to treat spondylitis are as follows-
Exercise based recovery/physiotherapy: your specialist may send you to a physiotherapist for treatment. Non-intrusive treatment helps you extend your neck and shoulder muscles. This makes them more grounded and at last, relieves pain. You may neck traction, which includes using weights to build the space between the cervical joints and decreasing pressure on the cervical disc and nerve roots.
- Medications: your specialist may prescribe you certain medicines if over-the-counter medications do not work. These include:
- Muscle relaxants, for example, cyclobenzaprine, to treat muscle fits
- Opiates, for example, hydrocodone, for pain relief
- Epileptic medications, for example, gabapentin, to ease pain created by nerve damage
- Steroid infusions, for example, prednisone, to decrease tissue irritation and diminish pain
- Home treatment: in case your condition is less severe, you can attempt a couple of things at home to treat it:
- Take an over-the-ounter pain reliever, for example, acetaminophen or a calming medication, for example, advil or aleve.
- Use a warming cushion or an ice pack on your neck to give pain alleviation to sore muscles.
- Exercise routinely to help you recover quickly.
- Wear a delicate neck prop or neckline to get transitory help. In any case, you shouldn't wear a neck brace for temporary pain relief.
- Acupuncture: acupuncture is a highly effective treatment used to mitigate back and neck pain. Little needles, about the extent of a human hair, are embedded into particular points on the back. Every needle might be whirled electrically or warmed to improve the impact of the treatment. Acupuncture works by prompting the body to deliver chemicals that decrease pain.
- Bed rest: severe instances of spondylitis may require bed rest for close to 1-3 days. Long-term bed rest is avoided as it puts the patient at danger for profound vein thrombosis (dvt, blood clots in the legs).
- Support/brace use: temporary bracing (1 week) may help get rid of the symptoms, however, long-term use is not encouraged. Supports worn for a long time weaken the spinal muscles and can increase pain if not continually worn. Exercise based recovery is more beneficial as it reinforces the muscles.
- Lifestyle: losing weight and eating nutritious food with consistent workouts can help. Quitting smoking is essential healthy habits to help the spine function properly at any age.
Once the conservative treatment fails:
Early aggressive treatment plan of back leg pain has to be implemented to prevent peripherally induced cns changes that may intensify or prolong pain making it a complex pain syndrome. Only approx 5% of total lbp patients would need surgery approx 20% of discal rupture or herniation with neurologically impending damage like cauda equina syndrome 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 patient`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 l5-s1), 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.
Need for non-surgical options: outcome studies of lumber disc surgeries documents, a success rate between 49% to 95% and re-operation after lumber disc surgeries ranging from 4% to 15%, have been noted. “in case of surgery, the chance of recurrence of pain is nearly 15%. In fbss or failed back surgery the subsequent open surgeries are unlikely to succeed. Reasons for the failures of conventional surgeries are:
- Dural fibrosis
- Arachnoidal adhesions
- Muscles and fascial fibrosis
- Mechanical instability resulting from the partial removal of bony ligamentous structures required for surgical exposure decompression
- Presence of neuropathy.
- Multifactorial aetiologies of back leg pain, some left unaddressed surgically.
Epidural adenolysis or percutaneous decompressive neuroplasty is done for epidural fibrosis or adhesions in failed back surgery syndromes (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 sciatica gets complicated by pivd with disco-radicular conflict causing radicular pain sometimes disabling. In this era of minimally invasive surgery lot many interventional techniques have evolved to address the disc pathology. We are still working for the ideal, safe effective technique to tackle disco- radicular interphase. Here now we have devised a mechanical neuroplasty or foraminoplasty technique using an inflatable balloon tip catheter with guide wire via targeted transforaminal or interlaminar route aided by drugs instillation. Selected patients are procedured fluoroscopic guided with local anesthesia under prescribed sedation aseptically via preselected route depending upon location type of pivd causing root insult. First a suitable size needle is placed at desired site confirming with radiolucent dye through which hyaluronidase with saline or la was injected. A flexible guide wire is passed at selected location direction on which the inflatable balloon is threaded to the area of interest.
Adhesiolysis is achieved mechanically with inflating balloon for 10 seconds at a time location. We inflated the balloon with contrast agent to have visualization of adhesiolysis opening up of adhesions or root route. Here the balloon pressure time has to be kept in minimum to avoid neurological damage, for which we inflate balloon for 10 seconds at a time. Close observation is made to balloon shape, pressure patient`s response. Once dilatation is done the drug mixture of steroid with la or hynidase/ hypertonic saline is instilled over nerve in epidural space. We have logically used same approach for our balloon neuroplasty foraminoplasty as it is safe targets exactly the area of disco-radicular interphase or conflict. We can manage to address both the exiting and traversing nerve roots with single entry just by manipulating our guide wire to the place of offence. The procedure can be done via transforaminal route at level or level above or below, especially via s1 foramen. Now we are employing this technique for fresh cases coupling with intradiscal decompression aided by instant disc retrieval by epidural balloon inflation with good results. The idd is done by coblation/ laser/ dekompressor or rf biacuplasty. There is scope of coupling this technique with endoscopic spine surgery. By adding “balloon neuroplasty” to the armamentarium of the interventional pain management many patients can be benefited relieved of previously interventionally unmanageable disco-radicular pain including fbss sufferers.
Provocative discography: coupled with ct a diagnostic procedure prognostic indicator for surgical outcome is necessary in 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-chemoneucleoplasty: ozone discectomy a least invasive safe effective alternative to spine surgery is the treatment of choice for prolapsed disc (pivd) done under local anaesthesia in a day care setting. This procedure is ideally suited for cervical and lumbar disc herniation with radiculopathy. 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 post operative discomfort or morbidity and low cost. If despite the ozone therapy the symptoms persist, percutaneous intradiscal decompression can be done via transforaminal route with drill discectomy/ laser or coblation nucleoplasty/ biacuplasty/ disc-fx / endoscopic discectomy are good alternatives before opting for open surgerical discectomy; which has to be contemplated in those true emergencies, as mentioned above as the first choice. In biacuplasty radiofrequency energy is used in bipolar manner heating shrinking the disc making it harder as well for weight bearing. It also seals the annular defect ablates annular nerves relievingback pain. In laser or coblation nucleoplasty energy is used to evaporate the disc thereby debulking it to create space for disc to remodel itself assisted by exercises.
Dekompressor: a mechanical percutaneous nucleotome cuts drills out the disc material somewhat like morcirator debulking the disc reducing nerve compression. A mechanical device cuts drills out the disc material debulking the disc reducing nerve compression curing sciatica brachialgia. It comes in needle size of 17g for lumbar discs 19 g for cervical discs. In lumbar region postero-lateral approach is used in cervical discs anterolateral approach is used.
Disc-fx : endoscopic discectomy: in this novel technique a wide bore needle is inserted placed sub-annular in post disc just under the disc protrusion. Disc is then mechanically extracted with biopsy forceps to empty the annular defect. This painful sensitive annular defect supplied be sinuvertebral nerve is thermo-ablated with radiofrequency which also seals the defect to prevent decrease recurrences. Next higher procedure, endoscopic discectomy is done with endoscope put through sheath inserted via posterolateral transforaminal or posterior interlaminar approach. Mostly done under local anaesthesia its fast becoming standard of care for disc protrusion extrusions causing spinal canal stenosis with root or cord compression with leg pain.
Laser discectomy done for closed bulging discs is an outpatient procedure with one-step insertion of a needle into the disc space. Disc material is not removed; instead, nucleus pulposus is debulked by evaporating it by the laser energy. Laser discectomy is minimally invasive, cost-effective, and free of postoperative pain syndromes, and it is starting to be more widely used at various centers.
Seld: epiduroscopic laser neural decompression is considered an effective treatment alternative for chronic refractory low back and/or lower extremity pain, including lumbar disc herniation, lumbar spinal stenosis, failed back surgery syndrome with morbid adhesion neuritis that cannot be alleviated with existing noninvasive conservative treatment. This procedure is done under vision via an epiduroscope inserted via caudal canal or transforaminally employing front or side firing laser fibers /or fine instruments. If you wish to discuss about any specific problem, you can consult a pain management specialist.
I am Dr Rakesh Nair. I am an exclusive knee replacement surgeon. Today I am basically going to talk about how to prevent damage to the knees by doing the right type of exercises. So, the topic today is going to be Osteoarthritis and Osteoporosis. How are they interconnected? How are both important in terms of treatment?
Let us start initially with Osteoarthritis. What do I mean by Osteoarthritis?
Osteoarthritis means a worn out joint. The same knee which has souls start wearing out as you get older. Therefore, it is called a Primary. So, whether you have a problem at some age or not, this pain is going to happen to you, whether it happens at 25, 35, 40, 45 years. It might also happen at the age of 75 years. Most of my patients are going for surgery between the age group of 75-85 years. So here I am going to show you the right forms of exercises where your knee can last for the lifetime. So, we are looking at an average of 8 spans of 80-85.
So, will your knee last long?
The chances are very less because the present data says that the 80% of the general population has artificial knees because we are out living our knees. We are living much more than our knees can last.
What is Osteoarthritis? means what exactly happens to the joint?
The knees are made up of bones which are a thigh bone which is on the upper side and it is covered with the fine layer of the cartilage which is hardly 1 cm. The same thing is with the bone which is the Shin bone which is the lower part, again which is covered with the cartilage. Between these layers, we have a lubricant fluid connecting both the legs on the side we have strong ligaments which hold the joint together.
What exactly happen in Osteoarthritis?
In Osteoarthritis, the same cartilage which you see starts wearing out. There are small pieces which start wearing out. The joint which straight started getting bent which either like a bow like a deformity or a knock knee deformity depending on how strong or how weak your muscles are. When a straight knee finally become bent then we have to look for some surgical options.
What are the symptoms of pain in the knee?
The first and the foremost symptoms are when a patient feels pain while climbing and getting down from stairs. So this is the first sign of Arthritis when you get to know that your knee is wearing out. Then they complain of pain, swelling. In the advanced stages, we will see the patients with bent knees, either bent inwards or outwards.
Today, I am going to tell you that can we prevent this damage?
For this, I am going to stress on exercise protocols for strengthening. Now, you need to understand that there is a difference between cardiac training and muscle strengthening. Most patients believe in walking as an exercise. But I would say that walking is the main form of exercise if not balanced properly with strengthening is going to cause wear and tear on the knees.
First, you need to strengthen the muscles which are there in the front and the back of the knees. So we are talking about strengthening the cardio steps and about strengthening the hamstrings. I would be giving you the practical demonstration of how we can do the same.
These are the normal exercises which I ask 70 years old individuals to do.
- Initially, the patient is lying down and push the knees downwards. Neeche dabaav daalo or thoda dheela karo. Push down and relax and do it till the count of 50. So, this is the basic first exercise you should do when you start any other exercise.
- The second exercise is leg race. This should also be from 5-50 counts. When you can comfortably do 50 counts at a time then we start the same in sitting posture.
- Lie down with the face down and start bending the alternate knees upwards and then release. This is what you would do for a hamstring strength
So these are the exercises which you can do from the age of 20 years to 80 years. Depending on the muscle strength, you can gradually increase the intensity of an exercise and take it to the next level.
If you are able to strengthen your knees simultaneously as you increase your cardio activity, that would be the best form without any damage to your knees. Another thing is that if you can balance your cardio in terms of saying that if you could do cycling, swimming, walking or running and balance all 25% of your work out when you are working out in the gym. So when you are going to the gym, the first thing should be doing is not going to the tread mill, you should start with the cycling as it is non-weight bearing exercise. Do it for 10 minutes, gradually as you warmed up you can do cross stepper and lastly, you can go to the tread mill. That is the commonest mistake when we talk about cardio. Tread mill should not be the primary exercise when you go to the gym.
Maximum work can get by the trainers in the gym because most of the times you end up doing squats and crunches. Basically, your lower body is not that strong to take the whole grant of the weight. So, I would suggest that if you are 35, 40, 45 years and if you are little heavy in the upper body then please do not start with free hand squats.
First, do the machines. On machines, you can do leg extensions, hamstrings and press rings. And when you start feeling that your lower body is capable of taking weight then start doing squats and lunges. And if you are going to avoid it, it will not make much difference, you can increase your muscle strength in terms of your leg extension and hamstrings.
Running can cause irreversible damage to the knees after the age of 40-45. The 25-year-old individual can run because at the young age, the cartilage has the tendency for the recovery. But after the age of 35 years, there is degeneration. If you want your knees to stay healthy between the age of 35-80, then you need to take care good care of it.
Let me give you some tips on running.
It is important that you wear good running shoes while running and walk on a good walking track. Avoid walking on the roads. Please try to walk on the grass or a mud track. Because walking on the road may cause nerve stress.
Before you start indulging into exercise, I would suggest you to have blood tests of Calcium, Vit- D3 and Vit- B12. You will be surprised, when you are deficient in either of these and you are going to take the exercise to the next level, then you will face some damage. Only if the reports of these blood tests are normal then only take your exercise to the next level. Otherwise, there will always the chance of injury.
I always ask females to do basic bone density along with the blood tests which I told you previously. Maximum damage to the female body is done during menopause. But if your basic density of Vit- D3, Vit- B12 and calcium is normal then you will suffer from least damage even after the menopause.
All the above mention tips will definitely help you.
For further information, you can contact me through Lybrate.