Thursday, 15 December 2016

Non-invasive back pain treatment offers recovery without Spine Surgery

Abhay Singh (name changed), 55, suffered from severe lower back pain for 7 years that included radiating pain and occasional numbness in both his legs. Repeated tests and MRIs showed Diffused Disc Bulge in all the discs from L1 to S1 on his spine, however all the treatments failed in improving his condition. He was unable to sit, stand or walk for more than 10 minutes at a time. After trying various Allopathic, Ayurvedic and Physiotherapeutic routes, he was told that surgery was the only option he had left.

Mr. Singh decided against surgery when he was told that chances of successful recovery after surgery are as low as 30 percent. He chose to keep looking for conservative, non-surgical recovery. He came upon Qi Spine Clinic website while searching for treatment options for his condition. Their comprehensive and accurate diagnostic method and non-invasive treatment approach seemed aligned to his goal of recovering surgery-free and he immediately booked an appointment.

At Qi, a Spine Specialist examined Mr. Singh’s condition and did a Digital Spine Analysis to diagnose the root cause of the problem. During the DSA, Mr. Singh discovered that 85% of back pain originates in the muscle tissues and not the bones. That is why the DSA was the best tool to analyze and diagnose the root cause of his pain: because it tested for Spine functionality before testing for anatomical problems. So while his diffused disc were definitely a problem, his pain originated from his severely weakened muscles. The test revealed several weak muscles for Mr. Singh and the doctor prescribed him a treatment course.

His precise treatment protocol helped isolate his muscle tissue and regenerate the weak tissue. Soon he resumed muscle functionality and could walk, sit and stand for longer durations without any pain. “I have started to live a normal life again. I can climb stairs effortlessly and can drive for hours without pain. A 12-hour drive to Udaipur single-handedly is a feat I can boast of. ” says Mr. Singh

Recent research has shown that conservative treatment has the best results for a majority of cases with mechanical back pain, and surgery is required in less than 5% of these cases. Though there are specific conditions where spinal surgery is clearly indicated, standard healthcare guidelines suggest that in patients with predominant back pain coming from degenerated discs, surgery should only be prescribed after medical / rehabilitative management options have been explored. The protocols formulated by the Qi Spine Research Academy allow the Spine Specialists at Qi Spine Clinic to precisely treat patients and help them recover surgery-free.

Qi Spine ClinicLocations: Mumbai, Pune, Delhi and Bengaluru
Call on: 07848842233/ 078279 07070

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Ankylosing Spondylitis

Ankylosing Spondylitis is a progressive disorder of spine. It is a debilitating condition of the spine in which there is increased fusion of the inter-vertebral spine. The causative factor causing the ankylosing spondylitis is still unknown. In certain cases a genetic predisposition for the following disorder is seen but still researches are on to understand the process as well as the pathomechanics of the disease. In certain cases the presence of the HLA B27 gene has also shown a pattern but nothing significant development can be noted.

Causes of Ankylosing Spondylitis can be enlisted as follows:
·         Idiopathic
·         Genetic

Signs and symptoms of Ankylosingspondylitis can be noted as follows:

The most common sign in an Ankylosing spondylitis patient is the presence of stiffness in the entire body. The major cause is the absence of mobility in the inter-vertebral spine that causes restriction of movements thus causing the patient to attain the stooped posture. The stiffness is more than that of pain. In Ankylosing spondylitis the process of ankylosing of the joints is enhanced thus restricting the quality of life on an individual. In this kind of patients, the proximal joints of the spine are more affected than the extremities thus hampering the spine to be utilized to its utmost benefit. Besides these signs and symptoms, there are more systemic manifestations of the disease. There is decreased vital capacity of the lungs due to widespread restriction due to the fusion of the rib cage thus hindering the full expansion of the lungs. This in turn causes them difficulty in breathing and even while laughing or sneezing as these activities causes increased intra abdominal pressure that in turn causes increased pressure on the spine. In certain cases, the tail bone is also affected. One can experience the inflammation of the sacro-iliac bone thus causing the sacroilitis condition.

Treatment for Ankylosing Spondylitis is not specific as the causative factor causing it has not been detected. The sole purpose of improvement that cane expected from ankylosing condition includes the following:
      Preventing further deterioration of the condition
·         Functional improvement
·         Improving the mobility of the spine
·         Inculcating active lifestyle that will keep the spine mobile and healthy.

In such cases breathing techniques are also advised that will further improve the breathing ability and keep the chest wall mobile with repetitive inhalation and exhalation techniques. Incentive spirometry or blowing balloons can be another such method to improve the lung capacity. Besides this, consulting a rheumatologist is also essential to achieve better outcomes of the patients.

Don’t be depressed but instead with advancement in medical technology and further studies, enhanced and scientifically proven support can be expected that will help in improving the quality of life of patients suffering from ankylosing spondylitis.

Monday, 5 December 2016

A second opinion helped him avoid surgery

Why is a second opinion so important when it comes to severe Back pain?

Dilip Ahuja (name changed), a 57-year-old Army Officer had been leading a healthy active life which included regular golf and long walks. But a year back it all came to a halt when he started experiencing severe lower back pain. Within 6 months pain and numbness had not only gripped his lower back, he also started experiencing shooting pains down his left thigh. His first medical consult resulted in an MRI and X-Ray prescription that showed a Disc Bulge and nerve compression.

Battling increasing pain every day, he frantically looked for options to relieve the pain after painkillers were proving ineffective.  A consultation with a senior Orthopedic led him to be prescribed a surgery. Frustrated with his options, he started slipping into depression. Alarmed by his deteriorating health, his family reached out to their friends for advice.

Another army officer who had suffered from a similar condition came down to meet him and advised him to seek a second opinion from a Spine Specialist at the QI Back & Spine Clinic. Unlike other parts of the body, the spine is a very complex structure and hence arriving at a clear diagnosis can be challenging. An effective treatment can only be advised after a clear diagnosis is made. It is a medical fact today that over 60% of back pain cases do not show up a clear diagnosis.

A multi-disciplinary approach to diagnosis is absolutely essential when it comes to the spine. Imaging tests tell an incomplete story as it is crucial to test spine function as well. Dilip underwent a Spine function test (DSA) which revealed a poor mechanical (muscular) structure. He was advised non-surgical treatment which isolated and strengthened this structure. The treatment was precise and within a week the pain was dramatically reduced. 6 months of agony was reversed 4 weeks and he returned to a normal active lifestyle. “I am very happy I came for a second opinion to QI and they could help me find a non-surgical solution to my problem. I am back to my optimistic, healthy self with almost 0 pain thanks to QI”, says Mr. Ahuja.

Repeated research over many years has proven without doubt that conservative treatment is essential when it comes to the spine. A Surgery is required in less than 5% of these cases that are very severe and have a high degree of neurological involvement. Medical guidelines suggest that patients with predominant back pain coming from degenerated discs, surgery should only be prescribed after medical / rehabilitative management options have been explored. The protocols formulated by the Qi Spine Research Academy followed by the Spine Specialists at Qi are the result of years of specialization, research and evidence based practice in the complex structure we call the spine.

QI Back and Spine Clinic Locations – Bengaluru, Mumbai, Pune and Delhi

Call on:  07848842233/ 086558 85566

Non-surgical Back Pain Treatment

The following are the non-surgical back pain treatment options available:

  1. Medications:

These may range from over the counter medications (aspirin, NSAIDS, acetaminophen) to prescription drugs (opioids). It is recommended that one only takes them as prescribed by the doctor due to their side effects on liver and kidneys.

2.  Hot and cold therapy:

Application of cold in the initial 48-72 hours post injury helps to reduce swelling,                     redness, warmth and thus cause numbing of the pain.

Heat therapy is beneficial post 5-7 days of injury. It helps to increase blood supply which helps to promote healing and wash out the dead tissue. It also promotes a general sense of relaxation. However, care should be taken to ensure that a low level heat is provided. Otherwise, it can cause burns and additional tissue damage.

Both these therapies act at tissue level to bring about the above mentioned effects. 

Their mechanism of action is given below :

  1. Physical therapy:

A licensed physical therapist will design a tailor made exercise regimen comprising of

stretching, strengthening, kinetic control, and conditioning exercises. He/She will also work to improve your posture and bio mechanics during various activities. These exercises are needed to be performed during the rehabilitative stage and also later on for maintenance and preventive stages.

4.  Massage:

Current literature suggests that massage might be beneficial in subacute(4-12 weeks) and chronic(more than 12 weeks) stage of back pain especially when combined with exercise and patient education. There is also evidence which states that the more experienced your massage therapist is the better are are benefits obtained from a massage.

  1. Chiropractic treatment:

These work along the principle of realigning the spine to relieve any undue pressure on

the nerves thereby reducing pain and disability. Studies on using this approach for back pain have mixed reviews.

6.  Epidural injections:

This consist of injecting either steroids or anesthetic drugs into the epidural space that surrounds the spinal cord and spinal nerves. It is opted when the pain is very severe or in case of failure of other conservative treatments for back pain. There is limited evidence that epidural injections in combination with home stretching exercises are not better than just home stretching exercises. However, to ensure long term improvements in pain and disability, one needs to compliment this therapy with exercises recommended by your physical therapist.

  1. Lifestyle modifications:. These include giving up alcohol and smoking, doing regular exercises, diet modifications, meditation and yoga and getting adequate sleep etc. In addition to these, one must ensure that he/she maintains a good posture and takes regular ‘ergo breaks’. This will minimize the stresses on your joints thus avoiding pain.

  1. Ozone therapy is an experimental therapy that is extensively researched in recent times worldover. It involves injecting ozone gas into the spine that shrinks herniated discs thus alleviating back pain.

  1. Alternative therapy: These include acupuncture, acupressure, naturopathy, Music therapy, Su Jok therapy, etc. 

Back Pain in Pregnancy

Pregnancy is one of the most life changing event in any women’s life. As the pregnancy progresses, low back pain is one of the most commonly reported complaint by expecting mothers. The rate of prevalence of back pain during pregnancy is around 50-70%. These pains can range from mild ache related to specific activity to acute severe back pain that can eventually become chronic. Many at times the women is “expected” to have back pain. Some of the reasons behind this are as follows:

1.    Hormones: Pregnancy related hormones cause the ligaments to soften and joints to become loose. This is to accommodate the growing foetus and subsequent labor.

2.    Weight gain: The back needs to support your pregnant belly which puts additional stresses on the joint

3.    Postural changes: There is increase in lumbar lordosis, tendency to go into sway. Additionally with the breasts getting bigger, the pregnant mommy-to-be can go into a slouch posture. All these changes can contribute to back pain.

Studies have also shown that in females with history of back pain prior to getting pregnant, back pain can start earlier in the pregnancy.

Types of back pain experienced in pregnancy :( excluding labor pains)

1.    Low back pain (Lumbar area):
            This is localized low back pain located around the waist area at the centre of the back. It may or may not also refer pain down the leg.(Also called Sciatica). It is usually with prolonged postures (sitting, standing, lifting, repeated movements). There may be tenderness around lower back muscles.
2.    Posterior pelvic pain: 
            This condition is 4 times more common than low back pain. The expected mother usually experiences a deep pain below and to the sides of the waist as well as across the tailbone area. In severe cases, it may extend to both buttocks and upper part of the thigh. But it is usually never radiates below the knees. There may or may not be associated pubic bone pain. This pain maybe aggravated by:
a.    Rolling in bed
b.    Rising from seated position (getting out of car/tub/commode/bed)
c.    Walking
d.    Running
e.    Staircase climbing
f.     Forward bending
g.    Twisting
h.    Lifting

Tips to avoid back pain:
1.    Maintain good posture at all times.
2.    Do the exercises as approved by your doctor.
3.    Squat to pick things
4.    Wear comfortable footwear
5.    Consider using a support belt after discussing with your medical provider.

In Spite of back pain being a very common problem issue during pregnancy, it should definitely not be accepted as a part of pregnancy. It is essential to seek treatment for the same at the earliest and the guidelines need to be followed throughout the rest of the pregnancy and even post-delivery while nursing and taking care of the new-born.

Understanding Scoliosis and its progression

Scoliosis is “S” or “C” shaped curvature of the spine that may be structural or functional. It is seen more common in females than males.

What causes the spine to curve?

Scoliosis here is any stretch on the spinal cord, it causes the spine to coil thereby reducing the distance between the skull and the sacrum. If there is still some tension acting on the spinal cord then the spine curves further move until it's relieved of this tension. This ultimately results in scoliosis.

Progression of scoliosis is categorized under rapidly progressing scoliosis (primarily due to hormonal influences) and gradual progression (due to effects of gravity).

Rapidly progressing scoliosis:
Under this category, the worsening of the curve can happen at any of the three stages of women’s life:

1.    Puberty:
Puberty is a time of sudden growth which itself acts as an additional stressor for the advancement of the curve. Research had found direct link between the progression of scoliosis and the available growth potential in the individual. In simpler terms, if the growth period is still not over there are more chances of the curve to progress.

2.    Pregnancy:
During pregnancy, due to biomechanical changes the centre of gravity is constantly changing. Additionally, the hormone Relaxin, cause all the ligamentous structures of the body to become lax. So if a women is not doing exercises that will build up the muscles to support her spine it can cause further deterioration of the scoliotic curve.

3.    Menopause:
Menopause causes demineralization of bones due to hormonal imbalances. This can result in osteopenia and osteoporosis in bony structures. As a result of this the scoliosis can increase.

            Gradual progressing scoliosis:
Due to the change in alignment of bones, the muscles on either side can get either over stretched or over shortened. It can further lead to muscular imbalances which in then inefficient to support the skeletal structure against the gravitational forces. This becomes more challenging if the movement is occurring away from the mid-line of the body.

Need for tailor-made scoliosis exercises:

Since all scoliotic curves are not the same, one needs to be sensitive with the presentation of the scoliotic individual and formulate an individualized exercise program to halt the progression of the curb, to improve breathing and to relieve pain. Depending on your presentation, you may be additionally prescribed a brace, or a customized orthotic or a special shoe. It is important that you see a specialist in this regard.

Tuesday, 29 November 2016

Lower Back Pain Remedies

Lower back pain (LBP) is a very common condition. Certain basic guidelines that you can follow as a remedial measure are described below:

1.    Heat and cold therapy:
a.    Cold application is beneficial especially in acute cases (first 48-72 hours post injury). It helps in reducing swelling and inflammation. Icing also brings about numbing effect which helps to control pain.
b.    Heat application is beneficial in increasing blood flow and thus in promoting healing. Hence it is generally used in the sub-acute to chronic stages of injury. Care should be taken to ensure that a low level heat is given to avoid any burns or injuries from the excessive heat.

2.    Gradual return to activity:
Usually after an episode of lower back pain, one develops fear and avoids certain/many activities limiting their quality of life. Such a fear-avoidance behaviour in the long run results in the back pain to get chronic and debilitating. Additionally, secondary pains can develop due to lack of mobility. Hence it is very important to gradually return to some level of activity once your pain settles. A physical therapist can assist you in return to function activities to alleviate your fears.

3.    Consult a specialist:
            This is paramount in cases of a serious or life threatening condition such as:
a.    Loss of bowel bladder control
b.    Extreme numbness in all 4 limbs, or both feet
c.    Paraesthesia (altered sensation)
d.    Fever
e.    Where trauma is involved
f.     History of cancer, sudden weight loss
            In these situations, the patient needs immediate medical attention.

4.    Adequate sleep:

Research has found that chronic lower back pain individuals usually suffer from impaired sleep. It includes:
a.    Reduced sleep time and the quality of sleep
b.    Increase in the time taken to fall asleep
c.    Overall poor day time function
d.    Increased sleep dissatisfaction and distress
            Paradoxically, inadequate sleep is found to increase your level of pain. If you are one of such individuals it is very important to address your sleep issue by consulting a specialist.

5.    Cognitive behavioural techniques (CBT):
            In a chronic lower back pain patient, certain behavioral or coping strategies are developed by the individual which themselves can pose a hurdle to recover from lower back pain. CBT promotes healthy coping strategies in such individuals and can be used as an adjunct to physical therapy.

6.    Core recruitment/activation:
            Core muscles serve as a muscular corset to stabilize our spine irrespective of whether there is any limb movement involved or not. The term “Core strengthening” is quite misleading. The exercises are aimed more towards facilitation or motor relearning of the inhibited muscles. The term “neutral spine” has often been used in this regard which is a position of power and balance of the spine. In spite of its growing trend, there is need for more research in this regard, to determine its clinical outcomes in lower back pain patients.

7.    Lifestyle modification: Research links excessive smoking and alcohol intake to lower back pain.  Being overweight puts additional stresses on back contributing to lower back pain. A healthy diet is essential to ensure one gets all the nutrients.

8.    Ergonomics: Taking care of your posture is essential to avoid any unwanted stress on your spine, thus avoiding additional pain. Have your office or home assessed to determine whether it is ergonomically designed for you.

9.    Additional treatment approaches are also available for treating lower back pain such as acupuncture, acupressure, chiropractic, naturopathy, ayurveda, herbal medicines etc.

It is important that one takes an informed decision to determine the best remedial option that might suit themselves for the treatment of lower back pain. Since a previous episode of lower back pain is one of the risk factors for a future episode, one must continue with healthy lifestyle and exercises even after they are pain free.

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