Raghavendra Orthopaedic & Diagnostic Center

Lower back pain is among one of those ailments that brings life to standstill. Nowadays most common reason for absence at job or college is Back pain. It gives you nothing bur restless and depressed day and sleepless night. It ruins your life's small moments of joy. 

What is low backache? 

It is the pain that felt in lower back which usually originates from joints, bones, muscles, nerves or other structures in spine. 

What is spine? 

Vertebral column or backbone or spine consists of 33 bones; called as vertebrae. Lower 9 are fused in adults. 

1. Cervical spine in neck region: 7 vertebrae (C1-C7)
2. Thoracic Spine in upper back: 12 vertebrae (T1-T12)
3. Lumbar spine in lower back: 5 vertebra (L1-L5)
4. Sacrum in Lower back Fused: 5 vertebrae (S1-S5)
5. Coccyx (tailbone) fused: 3-5 vertebrae. 

Significance of Vertebral column:

1. The major function of vertebral column is protection of spinal cord. 
2. It provides stiffening for the body and attachments for muscles. 
3. It transmits body weight while walking and standing. 

What is pain? 

It is a message originates from the location of injury; travels through nervous system and received by brain where it is interpreted as PAIN. 

Acute Backache

1. It is a sudden low back pain for abortion time. 
2. It can be because of trauma, trigger or a disorder such as Arthritis.
3. It limits movements, flexibility and even results into inability to stand or sit straight.
4. Acute pain can become more serious if left untreated. 

Chronic Backache

When back pain persists for more than 3 months; it is considered as Chronic. 

Causes:

• Muscle strain or ligaments strain

Improper posture, repeated heavy lifting strain ligaments and muscles if back which result into muscular spasm and severe backache. There are 3 specific movements that are responsible for back injuries. Bending, lifting and twisting. The danger lies in performing any two or more if them simultaneously. 

• Bulging or Ruptured intervertebral disc
• Spondylosis: Backpain caused by age related wear and tear of spinal discs. 
• Spondylitis: It is inflammatory Arthritis affecting the spinal bones. 
• Spondylolisthesis: It is forward displacement of vertebra over another. 
• Skeletal irregularities: If spinal curve is abnormal backpain can occur. 
• Osteoporosis: If vertebrae become porous and brittle, it can cause compression fractures. 
• Coccydynia: Pain at tailbone is called as Coccydynia. 

Pregnancy: Almost all women experience low back pain during Pregnancy. Maternal weight gain, increased lordosis (Curvature of spine), Stretching of ligaments, increased calcium demand can cause backpain in Pregnancy.

Diagnostic tools:

• History of illness 
• History of injury, trauma, accident etc. 
• X-Ray
• MRI/CT SCAN 
• Bone scan
• Nerve studies (Electromygraphy) 

Treatment:

• Medicines such as NSAID (Nonsteroidal Anti-inflammatory Drugs) and Muscle relaxants
• Heat therapy 
• Cold Compression therapy
• Physiotherapy
• Exercise 
• Surgery 
• Spinal Traction:
• It is non surgical way of decompression therapy that relieves pressure in spine. It can be performed by physiotherapist or by machines. 
• It is useful in backache due to slipped disc, herniated discs, Sciatica, degenerative disc diseases, pinched nerve etc. 
• A physician can determine the need of traction and weight for traction based on your medical history. 

Backache - Ayurvedic Aspects 

According to Ayurveda Backache (Kati shool, Kati graha, Trik graha, Prushtha Shool) is one of the common disease occurring because of vitiated vata dosha, so it is considered as "Vata- Vyadhi." 

Line of treatment of Vata - Vyadhi

Abhyanga (Massage): Sesame oil, Mahanarayan Oil, Prasarini oil can be used for Massage. 

Swedan (Fomentation): Moist steam of herbs like Dashmool , Nirgundi etc. 

Katibasti: Kati basti is pouring of lukewarm medicated oil and keeping it for sometime on the back region surrouded by ring made by black gram or whole wheat flour. 

Basti: Basti is one of the most important treatments if vitiated vata. Basti can be performed in various forms according to stage of disease and constitution of patient. 

Medicated oil and medicated decoction enema on alternate days for 8 days/15 days or 30 days.

Matrabasti: 60 ml medicated oil enema. 

Panchatikta ksheer basti: It is most useful in management of degenerative bone disease, in which herbs like Adulsa, Guduchi, Nimb, Kantakari and Patol are cooked in cow milk. Sometimes cow ghee can also be mixed. 

Medicines: Gokshuradi guggul, Trayodashang guggul, Yograj guggul can be used under proper guidance. 

Ashwagandha, Musta , Vidang, Ajmoda , Chopchini, Rasna, Devdaru, Punarnava, Shatavari, Shankhabhasma are some useful medicines for backache. 

Yogasana: Yogasana should be learned from experienced teacher. Some yogasana helpful for backache are:

• Pavanmuktasan 
• Supta  padangushthasana
• Tadasana
• Setubandhasana
• Parivrutta trikonasana
• Shalabhasana
• Bhujangasana
• Ardhmatsyendrasana
• Marjarasana
• Supta vakrasana
• Ushtrasan

DO'S AND DONT'S FOR BACKACHE 

• Bend at knees, not at waist. 
• Keep the object close to your body when lifting it. And keep low back straight. 
• Think before you act. 
• Learn exercise and perform regularly. 
• Sit in proper posture, adjust your work desk accordingly, walk straight. 
• Do not slouch. 
• Avoid high heels shoes. 
• Wear lumbar belt under proper guidance. 
• Avoid stress. Lose weight if you are overweight. 

  If you wish to discuss any specific problem, you can consult an ayurveda.

Knee replacement is a procedure where the weight carrying surface of knee joint is replaced surgically to ease the pain or any disability. People suffering from osteoarthritis, rheumatoid arthritis or psoriatic arthritis undergo knee replacement. All these conditions revolve around stiffness and painful knee. This surgery is usually performed on people aged over 50.

Surgery Types

Knee replacement is mainly of two main types:

1. Total knee replacement where both the sides of knee joints are replaced
2. Partial knee replacement where only single side of the joint is replaced

Procedure

In case of partial knee replacement with minimal invasion, a smaller incision, which is 3 to 5 inches, is required. This leads to minimal tissue damage, and the surgeon can work between the fibres of the quadriceps muscles. Here, an incision through the tendon is not required. This may result in less pain, recovery time is reduced, and motion is better as scar tissue formation is less.

In total knee replacement, four steps are performed:

1. Removal of damaged cartilage surfaces, which is at the ends of the femur and tibia, with a small quantity of underlying bone.
2. Replacement with metal components, which help as a recreated surface of the joint
3. Incision of knee cap with a resurface made of a plastic button, which is optional based on the case
4. Insertion of a medical-grade plastic spacer amid the metal components. This creates an effortless gliding surface.

After general or spinal anesthesia, an incision of 8-12inches is made in the front part of the knee. The joint part which is damaged is removed from the surface of the bones. The surfaces are then formed in a way to hold a metal or plastic artificial joint. The thigh bone shin, as well as knee cap, is attached to the artificial joint with either cement or a special material.

After Effects of the Procedure

After the surgery, patients may stay in a hospital for three to five days. Post surgery, notable improvement can be seen after a month or later. The patient is gradually relieved from pain with the construction of new gliding surface during surgery.

There will be slow progress in the movement. In the beginning, one may walk with a support of parallel bars and then with the help of crutches, walker, or cane. After full recovery in about six weeks, people can enjoy normal activities except running or jumping.

Presently, over 90% of total knee replacements function well for 20 to 22 years of surgery. Hence, knee problem is no problem at all!

The Rehabilitation After Total Knee Replacement: 

1. Full weight-bearing walking, knee bending, exercise next day after surgery 
2. Commode use, sitting on chair 2nd day 
3. 3rd day: Stair climbing, start cross leg sitting 
4. 2 weeks: Suture removal and walking to outdoors

Patients whose knee joints have been damaged by either trauma or progressive arthritis should consider total knee replacement surgery. The post-surgical hospital stay after knee joint replacement is usually three to five days. The surgery has a very high success rate and shows dramatic improvement after a month. This improvement is most notable one month or more after surgery. The pain caused by the damaged joint is reduced significantly when the new gliding surface is constructed during surgery. Initially, the patient will walk with the help of a walking aid until the knee is able to support full body weight. After six weeks, the patient can walk comfortably with minimal assistance. Patients with artificial joints are prescribed to take antibiotics during the course of any elective invasive procedures including dental work. Physiotherapy is an essential part of rehabilitation and it will increase the muscle strength and patient can enjoy most activities, except running and jumping. If you wish to discuss about any specific problem, you can consult a Orthopedist.

Inflammation and resultant pain in the joints are usually the basic tenets of Arthritis. This joint disorder can be painful and often, a debilitating one. It can also make the joints stiff. There are many ways of dealing with this problem, but with Ayurveda, one can get to the root cause of the ailment and its presence. This helps in taking a well rounded holistic approach towards treating it with ancient know how that revolves around herbs and other natural substances which have great medicinal value, lifestyle changes, diet, exercise and Yoga, oil massages, and other methods. Arthritis is known as Sandhivata in Ayurvedic jargon.

Read on to find out how Ayurveda can help in dealing with Arthritis.

• Herbs: One can make use of various herbs that contain Linoleic Acid to help in providing lubrication to the joints so as to prevent pain and stiffness. These herbs include Borage seed oil which is extracted from Borage seed, Evening Primrose oil, Blackcurrant seed oil, Capsaicin, Curcumin, Feverfew, Flaxseed oil and a standard Ayurvedic concoction that combines Ashwagandha, Gugulla, ginger, cumin and haldi or turmeric. These substances can help in treating the joints that are suffering from the pain of Arthritis.
• Diet: In Ayurveda, to treat ailments like Arthritis, it is usually recommended that a patient should start by flushing out the body toxins from within. Diet is one of the ways in which this can be done. A detoxification diet to clean the colon would be one of the foremost ways of doing a cleanse. Further, in one's daily diet, there should be a good dose of vegetables, fruits and other juices. Also, one must have plenty of herbs and spices, which can be used to season the food. Curd should generally be avoided and garlic should be used liberally. The various properties that help in an inside out cleanse that will help the system function in a better manner so that the treatment of ailments is also effectively supported.
• Exercise: In Ayurveda, a certain amount of daily exercise, which spans at least 45 minutes to one hour, is a must. A pattern of healthy eating, restful sleep and exercise is what usually helps in treating ailments like Arthritis. For this ailment specifically, light exercise like walking is recommended. Various Yoga asanas that involve sitting, standing, balancing and lying down poses as well as restful poses will also help in treating knee, shoulder and lower back pain specifically. Also, mustard oil massages can help in reducing the pain.

These are the few ways in which Ayurveda can help Arthritis patients live a more normal life with minimal pain. If you wish to discuss about any specific problem, you can consult an Ayurveda.

An ankle sprain can make life miserable. A sudden twist or stretching (due to incorrect walking, incorrect posture, wearing high heels, walking on an uneven and rough surface, exercise, games) can result in ligament(s) tear (partial or complete tear), affecting the ankle. An ankle sprain is often confused with a twisted ankle. However, the two are different as chalk and cheese. A sprained ankle can be extremely painful, taking few weeks to months to heal completely (depending on the severity).

Symptoms:

An ankle sprain is independent of age and sex, affecting anyone and everyone under the sun. The symptoms characteristic of an ankle sprain includes:

1. The affected region of the ankle may swell up immediately.
2. Difficulty in walking. In severe forms, a person may find it difficult to place a step.
3. The area appears bruised and tender.
4. Excruciating pain and discomfort (severe case).
5. Stiffness and, in some cases, discoloration of the skin around the tear.

At no point should the sprain be taken lightly. Seek medical assistance at the earliest. Negligence on your part can aggravate the situation. In extreme cases, an ankle sprain can add to your agony and discomfort, affecting the joints, bones, blood vessels, tendons, and cartilage.

Diagnosis and Treatment:

Diagnosis:

Accurate diagnosis can make the treatment effective, thus accelerating the recovery process. In case of an ankle sprain;

1. Physical examination of the affected area and a thorough case study is an important diagnostic step followed by many doctors.
2. X-ray of the affected ankle region can help in a better and more accurate diagnosis.

Treatment:

The course of treatment depends on the extent of the damage. In case of a minor sprain, doctors mostly recommend

1. Keeping the affected ankle area bandaged (ACE bandage) and well protected. A crutch or a brace is a blessing for people who face difficulty in walking.
2. Time and again, apply a cold compress on the sprained ankle. A cold compress can help reduce the swelling effectively.
3. In case of extreme pain and swelling, your doctor may recommend an acetaminophen (Tylenol) or ibuprofen
4. Rest as much as possible. While sleeping, use cushions or pillows to keep the leg elevated.

In rare cases where the sprain refuses to heal and becomes unresponsive to the above treatment, doctors may recommend an Arthroscopy or a Reconstruction surgery.

Precaution and Care:

A little alertness and agility on your part can help to deal with an ankle sprain better.

1. In the case of a severe sprain, try and avoid self-medication as much as possible. It can do you more harm than good.
2. Exert minimum or no pressure on the affected ankle area.
3. Indulge in some strengthening exercise as recommended by your physician. It is advisable that you warm up before any exercise.
4. Avoid heavy, strenuous work as much as possible.
5. Wearing correct footwear is important. Women who have had an ankle sprain should avoid wearing heel shoes. If you wish to discuss about any specific problem, you can consult an Orthopedist.

The Anterior Cruciate Ligament or ACL tear is a very common problem with athletes and with people who have an active lifestyle. In fact, this can also be caused by any accident due to sudden movement.

Importance of ACL-

The ACL is the supporting ligament, which runs diagonally from back to front right in the middle of the knee, connecting the femur bone and the tibia, and helps the tibia not to come before the femur. Thus the balance of the knee during back and forth movements and the entire stability of the knee joint is secured by this very important piece of ligament.

What leads to an injury to the ACL?

Here are a few actions that may result in a ligament tear.

1. Sudden stopping while running or slowing down from a fast speed

2. Sudden change in direction

3. Uncontrolled jumping from a height

4. Direct hitting with an object or person

What happens when the ACL is torn?

If the ACL is torn, the stability of your knee is gone, and you feel as if you have no control over the joint. Moreover, it causes extreme pain and instant swelling. Swelling usually appears within 24 hours of the injury.

Treatment of ACL Injury-

Recovery from an ACL tear is possible only after a surgery. Without surgery, the affected will not be able to return to sports or athletics, or may not be able to run and make swift movements again as before. However, to avoid surgery, there are non-invasive treatments for the aged and people who require moving less.

• Non-invasive Treatment: Bracing is one treatment where braces are given to support the knee joint during movement and also to avoid further injury. This is effective for the elderly who need minimum movement and may manage daily activities with a braced knee. Also, crutches add to the support and let the weaker knee get rest. This is followed by physical therapy. But the swelling has to reduce before starting it. Many exercises and controlled movements over a long time help in getting back agility in movement gradually.

• Surgical Treatment: Once the swelling subsides, doctors would plan for an Arthroscopic (Key-Hole Surgery) ACL reconstruction. In this Doctor make a graft of a tendon. This graft is inserted into the joint and fixed in anatomical position in femur and tibia Arthroscopically so that the newly created ACL functions like the natural one. This is the only way to get back the ligament in whole as the torn ligament cannot be stitched. Surgery is done through arthroscope and recovery time is 15 days for resuming day to day activities and 3 to 6 month for resuming sports activities with continued physical therapy after the surgery. If you wish to discuss about any specific problem, you can consult a orthopedist and ask a free question.

Heel pain is a common problem in the body where the affected person experiences pain radiating from the heel bone. Heel pain usually progresses slowly over time, it is recommended to consult a medical professional, if heel pain turns severe. The pain tends to most severe after one has been inactive for some time such as after waking up in the morning.

Causes
Heel pain is usually caused when tissues present in the bottom of the heel (Plantar fascia) is damaged. These tissues connect the heel bone with the bones of the feet and help in absorbing shocks. Tears are formed in these tissues when they are damaged or when they get thicker. These tissues are at an increased risk of wear and tear for those who are over 45 years old. The risks also tend to increase if the person is obese or whose occupation requires standing for lengthy periods of time.
Among other causes of heel pain are heel bone fractures, fat pad atrophy (a condition where a layer of fat present under the heel bone is reduced) and bursitis (inflammation of the fluid-filled sacs present around the joints). Peripheral neuropathy is a condition where damage occurs in the peripheral nerves (that transmits signals between the central nervous system and the rest of the body), this can cause pain in the heel.

Symptoms
The symptoms of heel pain include:

1. Experiencing pain while jogging or walking
2. A feeling of pins pricking the heels after waking up in the morning
3. Inability to bend the heel
4. Painful swelling
5. Pain in the heel accompanied by fever

Prevention and treatment
Heel pain can be prevented by taking certain preventive measures such as restricting usage of high heeled shoes without proper support and stretching the heel regularly. Medications such as painkillers are used to treat symptoms of heel pain. If you wish to discuss any specific problem, you can consult a physiotherapist.