Faith physiotherapy clinic

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.