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Hi I am Dr. Kirti Yadav, senior physiotherapist from Mat-Harbor family clinic, Gurgaon.
Today I want to talk about a very common problem which every one, if we count about the population 100% then 70% of people they talk about Disk pain. So I want to enlighten this topic today. If there is a normal pain and ache in your neck or back you go to a doctor and the doctor assess you and tells you to get an MRI done. Whenever you get an MRI done there is some level of disk involvement and the doctor ask you to take rest, not to do exercise and all those things and then just being fear of disk pain you don’t exercise for the rest of your life.
So just to come onto that area, just to enlighten this topic, as a physiotherapist I want to tell you about the fact. Disk pain, YES it happens but it happens in 20% of the cases. The rest 50% of the cases have been misdiagnose, they take disk pain and they don’t do exercise all of their life. Now we don’t exercise, we don’t strengthen up our muscle that is the problem that we get these pains and aches and the muscle is being stretched which is counted to be as the disk pain. Now when we talk about this, when you get an MRI done even today if I get my MRI done I will have some level of disk involvement whether the disk is causing you pain or not that is more important. The nature of pain tells you about the disk involvement.
So if you have tingling sharp shooting burning kind of pain which travels through a nerve, which travels through area, it dignifies, it signifies the disk pain. But if you have a localized dull, aching kind of pain please don’t take it as a disk pain and don’t take it as a nerve pain. So just coming to the treatment part. About 50% of the people who don’t have disk pain, who says we have cervical spondylitis but they don’t have cervical spondylitis they have trapezius muscle involvement. In that case what we do please strengthen up your trapezius muscle, please strengthen up your shoulder muscle so that you don’t have these pains and aches again and again. Why this happens? This happens because of repetitive strain injuries that happens because of more of computer use more of mobile use, texting and other sedentary live cells which we are going in. So the ultimate solution for pains and aches muscular is strengthening the particular part.
If you want to know more about this, if you want to talk more about it you can contact me through Lybrate.
Most commonly known as a military neck a straight or forward curve of the neck is abnormal and may cause an unkind progression of symptoms leading ultimately to cervical disk degeneration.
Reversal of cervical lordosis explained
The anatomy of the neck features a lordotic curvature in its typical and healthy state. This means that the cervical region has a gentle curvature with the open end of that curve facing the rear of the body. The base and top of the curve will be further posterior than the mid point, which will be further anterior.
When the lordosis is straightened, the neck becomes more upright and linear. This is more common than the next progression of atypical curvature, which is the subject of this article.
Actual reversal of curvature means that part or all of the cervical spine develops a kyphotic profile, with the open end of the curve facing anteriorly. Usually, this reversal is extremely mild, but is still very abnormal. What we now see is the middle of the curve being positioned posterior to the top and bottom.
In essence, picture the letter c and now turn it backwards: This is the shape of a reversed cervical lordosis.
Reversal of cervical lordosis causes
The spinal curvature in the neck is constantly in flux to some degree.
Congenital conditions and developmental conditions can have lasting effects on the natural degree of curvature typically demonstrated from patient to patient. These circumstances may be explainable due to injury or degeneration, or may be idiopathic:
Scoliosis can affect the normal lordotic curvature in the neck.
Cervical spondylolisthesis is a major source of reversed lordotic curvature.
Severe disc pathologies can facilitate a gradual loss or reversal of cervical lordosis.
Vertebral irregularities, such as wedging, can definitely contribute to lordotic alteration.
Traumatic injury, including vertebral fracture, can create the ideal circumstances for a reversal of lordosis to take place.
Severe neck muscle spasms can actually reshape the spinal curves, although these are usually temporary expressions and not actual structural conditions.
Effects of reversal of cervical lordosis
The neck is designed to curve in order to balance the spine, absorb stress, distribute force and provide proper movement of the head. When this curvature is diminished or reversed, symptoms may result, although this is not an inherent part of any altered lordotic condition.
Patients may experience stiffness and tension in the neck. Pain may be present and may even be severe in rare cases. Neurological dysfunction is possible in extreme cases, since the neuroforamen might not align properly, thereby causing a cervical pinched nerve.
In the worst circumstances, central spinal stenosis in the neck might affect the viability of the spinal cord, possible enacting the most dire of symptoms throughout the body.
Patients will also be more prone to injury, since the normal shock absorption qualities of the typical curvature have been lost.
While all these effects are certainly possible, they are not usual. In fact, a great majority of patients have minor symptoms or even no symptoms at all from mild reversed lordotic curvatures.
The pathology leading to a neck curve reversal (cervical kyphosis shown below right) may be inspired by a multitude of conditions as follows:
Post head injury
Poor sitting/working postures
Congenital spinal curvatures
Degenerative cervical discs (a form of osteoarthritis that can either be the cause of or the result of a cervical kyphosis)
Compression fracture of vertebral body
Infection of the cervical spine
Anatomy: straight vs. Curved
I've always heard that it was good to stand up straight.
stand upright, stick your chest out and hold your shoulders back! otherwise you're going get widows hump.
Are these expressions as familiar to you as they are to me? one might think that having a curved neck goes against what we heard from parents and teachers as we were growing up, but the reality is that there is a little bit a truth in both. Maintaining good posture throughout our lives is crucial to both the health of our spine and vital organs. On the contrary, a special type of curve called a lordosis is a good thing, both in the neck and lower back.
When we look at a person from the back their spine should be truly straight, so that the left and right sides of one's body is symmetrical. However, when we view a person from the side, the front and back of their body is different and this is reflected in a coinciding curvature of the spine. Both the lower back and neck are hollowed out (concave) and the mid or thoracic spine is protrudes (convex). Thus there is an alternation of curves functioning to provide stability, shock absorption and aid in propulsion. A straight spine would be very stiff and not flexible. Imagine the plight of a pole vaulter with an inflexible pole.
Nature's design of our spine and rib cage facilitates breathing and offers protective and supportive framework for vital organs. Spinal disks are shock absorbers and because they are in the front of the spine, lordotic curvatures keep them from having to bear weight. Kyphosis or loss of such curvatures bears weight upon the disks, leading to their ultimate degeneration. This process of deterioration is a form of osteoarthritis and in the spine is known as degenerative spondylosis.
Although most physiotherapists or conservative orthopedists can recognize a cervical curve reversal upon viewing the patient's posture, a definitive diagnosis may be obtained via a standing lateral (side view) x-ray of the neck. Cause can often be determined by corroborating a comprehensive history, a thorough examination, x-rays and questions about sleep, work and lifestyle.
In my professional career I found that the majority of young adults presenting with cervical kyphosis either had a whiplash or were stomach sleepers from an early age. For desk jockeys 40-60 years of age, many hours of sitting with their head flexed forward almost dictates the fate of developing kyphosis. In prior years I considered cervical kyphosis a job hazard for the careers of accountants, attorneys and often teachers because of years spent with their head in a book or paperwork. However, the digital age offers some relief in that respect. A well-planned, ergonomically-friendly office can do wonders for protecting the spine in the sedentary worker.
Treatment for cervical curve reversal (kyphosis)
During my chiropractic practice I had the opportunity to note a good percentage of correction toward a more normal lordosis (noted on x-ray) for 70% of patients under my care. This was almost always consistent with those patients that followed all recommendations and were model participants in their own care. Here is the recommended treat plan:
Spinal manipulation of stiff and fixated spinal segments by a qualified physio
Flexibility exercises for flexion and extension of cervical spine
Resistance exercises for flexors and extensors of the neck
Learn the Alexander technique for maintaining good posture (hint: the basic philosophy is to sit and stand like you were hanging by a string from the vertex of your skull. Liken it to a puppet on a string).
Elimination of stomach sleeping
Avoid standing on your head, although some yoga postures may be beneficial
Use of orthopedic neck pillow while sleeping.
Breast cancer is one of the most common cancers in women about 1 in 8 women in the USA develop invasive breast cancer. The incidence of breast cancer has increased with changes in lifestyle including smoking, drinking and loss of physical activity. The risk factors are age, ethnicity and family history cannot be changed. However, there are some risk factors that can definitely be acted upon to reduce the chances of developing breast cancer.
- Weight management: Obesity is one of the major risk factors for breast cancer and managing weight and a good body mass index will help reduce the risk of developing breast cancer. This is especially important in women undergoing menopause.
- Reducing smoking: The benefits of quitting it are manifold and reducing the risk for breast cancer is one of them. This will, as a byproduct, also result in a host of other benefits including improved quality of life, reduced chances of heart disease, stroke, and other cancers.
- Physical activity: In addition to helping in weight management, this also helps reduce the risk of breast cancer. Ideal recommendation is 30 minutes of physical activity per day, plus strength training.
- Breastfeeding: This helps in reducing the risk of breast cancer. Prolonged feeding is shown to have a greater protective benefit.
- Hormone replacement therapy: When possible, limit the use of hormone replacement therapy for prolonged periods of time. Explore options of non-hormonal substitutes or use the least permissible or required dose. Be sure to get periodic check-ups when on hormone therapy.
- Reduce exposure to environmental pollution: Higher levels of pollutants are linked to a higher incidence of breast cancer. When possible, avoid getting exposure to environmental pollutants.
- Screening: If there is a strong family history or other risk factors, then screening can help detect breast cancer very early in the process. Recommended ages for mammography are as follows:
- If you are age 40 – 44: Go for annual mammograms after discussing risks and benefits with the doctor.
- If you are age 45 – 54: Go for annual mammogram.
- If you are age 55 or over: Mammograms are recommended every other year. You can choose to continue to have them every year. Self-breast exams are not sufficient. However, if being done, they can also be an input to an abnormality.
- Cautious use of birth control pills: Birth control pill usage to be discussed with your gynaecologist if you are above 35 years of age and smoke. The good news is that the risk associated with it disappears slowly after the pill is stopped.
These will help reduce the risk of developing breast cancer, early detection, and improved prognosis.
Different methods to treat Disc problems
Hello friends, I am Dr Gaurav Khera. I am an orthopaedic surgeon, doing joint replacements and spine surgeries at the Access healthcare. Now today I will be talking about the lumbar degenerative disc disease. Now it sounds very big, but it is not as complicated as it sounds. It basically is what you people commonly know as a disc disease. So it is a fairly common problem that is seen in our population today. In fact about 30 or 40% of the patients who come to our OPD have lower back pains, some have other disc problems and very commonly seen after 40 years of age and this incidence gradually increases up to 60-70 years of age. The other ecological factors which are associated with this are, first of all smoking, secondly it is, mild to moderate trauma, thirdly its seen in people who lift heavy weights, fourth is obesity, especially central obesity, that is if you have a very heavy waistline.
Now what is Lumbar degenerative disc disease? Now, our spine is composed of multiple bones, which are starting from your neck and they come all the way down to your hip, divided into the cervical, dorsal, lumbar and sacral spine. And between these bones, there are these small pieces of discs, which act as cushions. When your body walks, these act as shock absorbers between your body’s bones. Now this discs, when these come out of their normal place, it gives or presses against the nerves which are passing through these areas and it causes pain. This is what happens in the disc disease. Basically, in the patient it will come as a lower back pain, and this pain will be travelling down to the hip, and it will also be coming down to the legs. Some people complain that as they walk, the pain increases.
They also complain of tingling numbness. They complain that sometimes their fingers or their toes are feeling numb. These are some of the very common symptoms which are being seen. Few people may have only lower back pain, and these are the people who do not have very significant disc disease. Now there are two main causes of the disc disease. First is an inflammatory reaction that occurs in the disc, and second is the micro motion instabilities that occur. Inflammatory reactions may occur as a result of some small traumas which may occur such as when you may injure your back. Such inflammatory reactions occur in the form of small swellings in the body. And micro motion instabilities are when the body ages, the disc which has an outer fibrous thick layer, that degenerates, and as it degenerates, the pulp which is there at the centre, of the discs, tends to degenerate. What I mean is it comes out of its normal space. And as it comes out of the normal place, it comes and tends to press on the nerves and these are the two most common causes.
All disc patients are not to be operated. When we get these patients, the first and foremost investigation that we do is a X-Ray. And if required, we go in for a MRI. Frankly MRI is the known standard to diagnose the disc disease. The findings of a MRI are always coordinated with the clinical findings. Once we have diagnosed that it is a disc problem, we have to establish that what the compression on the nerves is. If the nerve compression is a lot, and if we think that we cannot do anything other than surgery, then we take the patient for a surgery.
If not, we take the patient fro physiotherapy, lifestyle changes and few medications. These medications may carry on for few weeks to few months. And a lot of exercise has to be carried on regularly. Lifestyle changes such as weight loss, stoppage of smoking is very important. And if you can achieve this, then your problems are very easily solved. If you have any queries regarding your disc problems or back pains, then you can get in touch with me for the same.
You can reach me in my clinic, which is there in Indrapuri, by the name of Dr Khera’s Wellness Clinic or you can also contact me through Lybrate for the same. Thank You.
Many women develop uterine fibroids by the time they hit the age of 50 years and above. These are non-cancerous growths that may occur in the uterus. Most women go through severe bleeding and pain as well as discomfort as a result of these fibroids. Age, family history of the same condition, obesity or being overweight, eating habits and even ethnicity play a large role in deciding the risk of each individual patient. These fibroids can grow in the submucosal, intramural and subserosal areas.
Following are the common side effects of uterine fibroids:
- Frequent urination: Due to the pressure of the fibroids on the uterus, the patient may experience a constant feeling of fullness in the lower pelvic area of the body, which may lead to frequent filling of the bladder. This gives rise to frequent trips to the washroom for urination.
- Heavy Bleeding: Severe bleeding is one of the most common causes of the presence of these kinds of fibroids. The patient may experience a lot of bleeding during menstrual periods, as well as pain and cramps the rest of the time. The periods will also be very painful when there are fibroids in the uterus or the uterine lining.
- Painful Intercourse: It is a well-known fact that any kind of infection or growth as well as sores and other such ailments can lead to vaginal dryness as well as pain during sexual intercourse. This is true for uterine fibroids as well, which can lead to severe pain during sexual activity. These fibroids can also give rise to pain in the lumbar or lower back region.
- Abdomen Swelling: The abdomen may go through significant swelling in such a condition and the patient may even look like she is pregnant. The growth can push the shape of the abdomen outwards and create a full feeling.
- Pregnancy Complications: The presence of uterine fibroids can give rise to several complications during pregnancy and even after child birth. One of the most common problems in this case is bleeding, followed by more severe outcomes like miscarriage. The women suffering from uterine fibroids are at greater risk of undergoing a caesarean section for the delivery of the baby. The baby may also be born breech and a premature delivery may take place.
- Infertility: This is also a rare side effect of the uterine fibroids and is generally seen only in very severe cases.
- Cancer: Only one in every 1000 cases might transform into malignant tumours. These uterine fibroids are generally known to be non-malignant.
Any symptoms must be reported to a gynaecologist at the earliest to avoid any serious complications.
I am a man of 50 years and have no complications except slip disc between l4-l5 which is ok if I take proper precaution. From last few months I feel considerable pain in my both knee after sitting on a chair for few hours constantly and then trying to move. When I am keep walking pain is not there. I have to sit in front of computer whole day long. Kindly advise.
Sir I have a problem of slipped disc in cervical spine. I am a dance choreographer so I should do my profession or I should stop it.
Uterine fibroids are referred to as benign, abnormal growths which tend to develop in the uterine walls of a woman. The size of such growths can range from a few centimeters to even excess of a few inches. As such, they can cause the uterus to increase to the size of a five month pregnancy. Although, the symptoms of fibroids are not always apparent, they often cause heavy bleeding and pain in women. A recent research concluded that around 60 to 75 percent women contract such fibroids by the age of 50, at least once in their life.
Depending on the site of formation, uterine fibroids are distinguished into different types. Intramural fibroids in the lining of the uterus and subserosal fibroids which develop outside the uterus are the most commonly observed fibroids.
What causes Uterine Fibroids?
Although, the exact reason for the formation of fibroids are obscure, medical professionals have determined certain factors that may affect their formation. Some of them are:
1) Hormones: Progesterone and estrogen, produced by the ovaries regenerate the uterine lining during each menstrual cycle and trigger the growth of fibroids.
2) Family history: If you have had a family history of uterine fibroids, then you are likely to develop the condition yourself as well.
3) Pregnancy: The production of progesterone and estrogen increases during pregnancy which increases the likelihood of fibroids.
What are the signs of this condition?
Depending on the location and size of the tumors, symptoms of such fibroids include:
1) Heavy bleeding and blood clots during periods
2) Pain in the pelvis
3) Frequent menstrual cramps
4) Pressure and pain in the lower abdomen
5) Swelling in the abdomen
6) Pain while intercourse
What is the procedure of treatment?
Ultrasound and pelvic MRI are common diagnostic procedures to check for uterine fibroids. After diagnosis, depending on your age, size of the fibroid and your comprehensive health, the doctor would prescribe you with appropriate medications. Only after medications prove futile, doctors opt for minimally invasive surgeries.
I am 29 years old. I am from bangladesh. I have a problem with my backbone. I have slipped disc. I have been suffering from this since 2011. I consulted with some local doctors. They prescribed me with some exercise but no improvement till now. I feel that a bone or two is/are displaced somewhere my waist. I need expert suggestion.
Bone cancer is a cancerous tumour in the bone, destroying the normal bone tissues. Tumours on bone tissues are not always cancerous or malignant, they are mostly benign. Primary bone cancer is when the malignant tumour begins to form in the tissues of the bones, but when these cancerous cells spread to other body parts like breasts, prostate or lungs, it is called metastatic cancer. Primary bone cancer is less common than metastatic cancer.
Bone cancer can be of three different types:
Osteosarcoma: In this case, the malignant tumour arises from the osteoid bone tissue. This occurs mainly in the upper arm and knee areas.
Chondrosarcoma: In this case the cancerous cells form in the cartilaginous tissues, causing a lot of pain. This occurs mostly in the pelvic area.
The Ewing sarcoma generally arises in the bone but it can also form in the soft tissues. Other kinds of soft tissues affecting cancerous cells are known as soft tissue sarcomas.
There aren’t many clear defined causes; however, several factors have been identified by researchers.
Osteosarcoma is seen to occur more frequently in people who have been through a high external radiation therapy dose.
In people who have frequently been treated with anticancer medications, children tend to be most affected.
Heredity may be an adding cause, although the percentage of hereditary transfer of cancer cells is very low.
People with hereditary bone defects or implants have a higher chance of acquiring bone cancer.
The most common and saddening symptom of bone cancer is painful, although not all bone cancers cause pain. Unusual or persistent swelling or pain around a bone maybe a red flag for bone cancer. In case of a situation like this, immediate doctor’s opinion is required.
Usually, diagnosis of a bone cancer can be made using X-rays; for example, a bone scan, a computed tomography scan, a magnetic imaging procedure—positron emission tomography, and an angiogram. Biopsy and blood tests are also helpful in bone cancer diagnosis.
The size, location and stage of cancer, age, and health of the person decide the kind of treatment that should be given to the patient. Various treatment options include chemotherapy, radiation therapy and cryosurgery.
The combined survival rate of all sorts of bone cancers is 70%. This percentage may vary with the type of bone cancer and also its stage.
I want to know about exercises being done in case of diffuse disc bulge at l1-l2 level indenting anterior the cal sac mildly with bilateral mild neural foraminal narrowing.
If the effects of daily stressors are getting the best of you, brahmi supplementation may be something to explore. Stress reduction is perhaps brahmi’s most well known, traditional use. A study evaluating brahmi supplementation reported significant mood improvement among participants, as well as decreased levels of cortisol, the stress hormone. This suggests that brahmi counteracts the effects of stress by regulating hormones involved with the stress response.
Alzheimer’s disease is a debilitating and heartbreaking disease, usually caused by a plethora of physiological, genetic, and environmental factors. Amyloid formation in neurons can cause significant brain damage and influence the development of alzheimer’s disease. It’s important to understand that, to date, no herb, plant, drug, or anything — including brahmi — has been found to be the magic bullet against alzheimer’s. Based on its history as an herbal therapy to promote neurological function, some have suggested that brahmi may be a promising therapy for alzheimer’s.
Breast cancer is an abnormal growth of cells in the tissues of the breast. Mainly it occurs in females but less than 1% of all the breast cancer cases develop in males. The majority of breast cancers start in the milk ducts. A small number start in the milk sacs or lobules. It can spread to the lymph nodes and to the other parts of the body such as bones, liver, lungs and to the brain.
With more reliable early detection methods as well as the trend towards less invasive surgery, there is hope that even more women with breast cancer will be treated successfully and will go on to resume their normal lives.
Signs & Symptoms
It is painless, especially, during the early stage. Watch out for the following changes in the breast:
- A persistent lump or thickening in the breast or in the axilla.
- A change in the size or shape of the breast.
- A change in the colour or appearance of the skin of the breast such as redness, puckering or dimpling.
- Bloody discharge from the nipple.
- A change in the nipple or areola such as scaliness, persistent rash or nipple retraction (nipple pulled into the breast).
Consult a doctor immediately if you notice any of these changes.
Being a woman puts you at risk of getting breast cancer. There are certain factors that increase the risk of breast cancer. Some of them have been listed below:
- The risk increases with age; most cases of breast cancer develop after the age of 50
- Genetic alterations in certain genes such as BRCA1 and BRCA2
- Family history of breast cancer
- Being overweight
- Early menarche (onset of menstruation before the age of 12)
- Late menopause (after the age of 55)
- Never had children
- Late childbearing
- No breast feeding
- Excessive consumption of alcohol
- Use of hormonal replacement therapy (HRT) for a long period of time
However, most women who have breast cancer have none of the above risk factors. Likewise, not having any of these risk factors does not mean that you will not get breast cancer.
Early Detection and Screening
More treatment options are available when breast cancer is diagnosed at an early stage and hence the chances of recovery is also higher. So regular breast screening is important for early detection even if there are no symptoms. Following are the ways of screening:
- Breast Self-Examination (BSE): Perform BSE once a month about a week after your menses are over. If you no longer menstruate, choose a date each month which is easy to remember e.g. your date of birth or anniversary.
- Clinical Breast Examination: Get a breast specialist to examine your breast once a year if you are 40 years and above.
- Mammogram: Go for a screening mammogram once a year if you are 40 to 49 years old and once every two years if you are 50 years and above even if you do not have any symptom. It is not recommended for younger women (less than 40 years of age) as they have dense breasts, making it difficult for small changes to be detected on a mammogram. So ultrasonography of the breasts is advisable to them.
Types of Breast cancer
- Non-Invasive Breast cancer: These are confined to the ducts within the breasts. They are known as Ductal carcinoma in-situ (DCIS).
- Invasive Breast cancer: It occurs when cancer cells spread beyond the ducts or lobules. Cancer cells first spread to the surrounding breast tissue and subsequently to the lymph nodes in the armpit (Axillary lymph nodes). These cells can also travel to the other parts of the body such as bones, liver, lungs or brain and hence known as metastatic breast cancer.
Making A Diagnosis
If you notice any unusual changes in your breasts, you should see a doctor immediately. He will examine you clinically and may ask you to undergo some tests so that a definitive diagnosis can be made. Further, the staging work up is done to find out the stage of the disease and management accordingly.
Treatment of breast cancer may include various methods such as surgery with or without breast reconstruction, chemotherapy, radiation therapy, hormonal therapy and targeted therapy. Treatment options offered, depend upon the number of factors such as the stage of cancer and likelihood of cure, your general health and your preference. If you wish to discuss about any specific problem, you can consult an oncologist.