Maharashtra Times features 2nd article as a part of “AROGYA MANTRA” series on Positive Spine Health on 6th June 2017
An article on How to Manage Neck Pain. A Safe Spine Initiative.
-Dr. Ketan Khurjekar
Working late in office almost every day, driving home via pothole ridden, traffic congested road and then sitting for long hours with a laptop. This is the routine which 36-year-old Vipul Sharma (name changed on request) has been following five day a week, for the past 10 years. That is, until his back and right leg started making things difficult for him since few months.
The situation only worsened with stiffness in lower back and radiating pain in right leg, soon the analgesics, which had been keeping him upright for work from quite some time, also became futile.
Only after two doctor switches and multiple therapy trials did Vipul eventually meet an orthopedic doctor who diagnosed him with herniated disc, a problem with one of the rubbery cushions (disks) between the individual bones (vertebrae) that stack up to make human spine1.
“Although herniations often result from jobs that require lifting, it is often noticed in the people with sedentary jobs. It is a difficult problem form diagnostic perspective as patients come with vague symptoms like that of chronic back ache and those disguised of sciatica. As such, awareness around this condition could save patient from further complications,” says Dr. Ketan Khurjekar(Chief Spine Surgeon, Sancheti Hospital, Pune).
A herniated disk occurs when some of the softer “jelly” pushes out through a crack in the tougher exterior due to incorrect posture. A herniated (torn) disk can irritate nearby nerves and result in pain, numbness or weakness in an arm or leg. On the other hand, many people experience no symptoms from a herniated disk1.
“The treatment involves non-steroidal anti-inflammatory pain medication (NSAIDs), but the long-term use of NSAIDs for patients with persistent back pain is not indicated due to its possible cardiovascular and gastrointestinal toxicity,” says Dr.Ketan.
Therefore, for complicated or advanced stage herniated disc, surgery could be a better option. And among the available surgical treatments, Minimal Access Spinal Treatments (MAST) comes out to be the better options for the patients like Vipul, who cannot afford to neglect their professional obligations for a long time.
Dr Ketan suggests MAST surgery as a long term solution rather than temporary pain relieving medications. “In conditions where the problem of herniated disc persists even after prolong medication, Minimal Access Spine Treatments can be a good alternative,” adds Dr Ketan Khurjekar.
MAST helps treating disorders of the spine with less disruption to the muscles. This can result in quicker recovery, decreased post – operative blood loss, and speedy patient recovery.
This surgery is very different from the earlier procedure which required the entire back to be slit open, apart from greatly restricting movement. Minimally Invasive Spine Surgery can be done by making two or three small openings and the patient can return to his normal routine after recovery.
In some MAST approaches, also called “keyhole surgeries,” surgeons use a tiny endoscope with a camera on the end, which is inserted through a small incision in the skin. The camera provides surgeons with an inside view, enabling surgical access to the affected area of the spine.
The highly innovative cutting-edge equipment used in this form of surgery not only makes MAST feasible but also brings in an element of effectiveness in the entire procedure. Like a Retractor System, with the help of which surgeons can gain clear access to the vertebrae to be treated and place the bone grafts and instrumentation required for spinal fusion, but with as little disruption to the surrounding muscles, nerves and other soft tissues as possible.
“With over two decades of research gone behind developing Minimal Access Spinal Technologies (MAST), it is one of the most efficacious surgeries allowing surgeons to successfully treat back pain and deformity with the least amount of invasion while achieving the same surgical objectives as open surgeries,” explains Dr KHurjekar.
Changing lifestyles including long-duration desk jobs, compounded with wrong sitting posture, physical inactivity and to top it all with stress is giving rise to certain conditions, commonly termed as ‘lifestyle problems/disorders’, of which many are entirely symptomatic like backaches. It should be noted that such apparently benign problems might have some grave underlying complexities, like in Vipul’s case.
Therefore, constant backache or any abnormality in posture should not be neglected and expert consultation should be sought immediately. Medical science, apart from advancing in terms of treatment, is also simultaneously evolving to provide that treatment to patients with maximum possible ease, considering their hectic lifestyle. So all you need now is to stop overlooking your health problems and look for modern medical solutions, geared up to put you back on the track where you had left your frenzied and charged-up life.
World Health Day, celebrated on 7 April every year, it’s a anniversary of the founding of the World Health Organization and focuses on increasing the life expectancy by adding good health to the lives of people.
The World Health Organization organizes international, regional and local events on the Day related to a particular theme. Good health is not merely the absence of disease; it is also a reflection of the social and mental well-being of people in a community. Thus, to achieve the WHO goal of providing health for all, reduce social tensions and mental ill-health to acceptable levels.
The theme of 2017 World Health Day campaign is depression. WHO is leading a one-year global campaign on depression. Depression has become the leading cause of health-related problems worldwide. As per the fact, From Year 2005 to 2015 more than 18% peoples are suffering from Depression.
Depression is a state of low mood and aversion to activity that can affect a person’s thoughts, behavior, feelings, and sense of well-being. New research shows that being sad for a prolonged period of time can also have a negative effect on bone health in both men and women. The chronic sadness may cause biochemical changes in the body that weaken our bones.
A majority of the women with depressive illness had been treated with antidepressant drugs, raising the possibility that these drugs contributed to the decreased bone density. The bone mineral density in the women with depression was on average 6% lower in the spine and 10% to 14% lower in the hip than in the normal women.
Here are a few ways to overcome depression:
Socializing is a key factor in fighting against depression. Stay in touch with your family and friends. Make sure you follow daily 20 minutes workout routine for a day. An active body keeps your mind fresh and ready to take on the day. Fight Your Fear Face-to-Face. Never lose confidence in your abilities and capacity to do anything.
The evidence is overwhelming that regular meditation is one of the best ways to heal depression. Regular exercise works as well as medication for some people to reduce symptoms of anxiety and depression, and the effects can be long lasting.
Treat your Depression with Real-time Work out Physiotherapy
It’s essential that we look after our bones, not just as children, but throughout adult life as well. And while adequate calcium intake and vitamin D are both great ways to strengthen bones and prevent on the onset of osteoporosis.
With an established role in assessing and diagnosing musculoskeletal and physical conditions, physiotherapists can be engaged in planning, decision making, advocating for, and case management of the physical health of people with mental health conditions.
Physiotherapists can encourage people with mental health conditions to take an active role in their own care by supporting and providing resources to facilitate Self-management.
Head of Spine Surgery Dept, Sancheti Hospital, Pune.
In true sense Spine is a Back bone of our Body. Strength in our back is rendered by calcium densed vertebrae and toned paraspinal muscles. Function of vertebral column is to protect the delicate spinal cord and to give a good posture.
Few days back, in out patient clinic, I saw one 60 years young lady and one 45 years old lady. The former one had mild low back pain while the later complained of generalised back pain of moderate to severe grade. What exactly must have happened?
I explained both of them the same thing; Strength in back is rendered by calcium densed vertebrae and toned paraspinal muscles. If you loose on either, the back pain will start. The 60 year old lady had started developing early changes of decreased calcium in bones which we call as osteopenia, but she had good strength in her paraspinal (back) muscles which supported her weaker vertebrae. As against that, the 45 year old lady had weaker paraspinal muscles as well osteoporotic bones. She was the victim of osteoporotic back pain.
What is Osteoporosis?
Osteoporosis is a systemic skeletal disease, characterized by low bone mass and microarchitectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk (WHO, 1994). In other words weaker bones which are fragile and amenable to easy fractures.
Normal Bone as against the Osteoporotic Bone
Very commonly we are put forward with series of questions. Is it a disease?
Is it hereditary?
Is it only in women?
Is it only a condition of old age?
And the most important – Can we prevent Osteoporosis?
As we grow old, it is accepted that bones are going to become weaker. If fragility of bones is going to be in physiological limit then definitely it is not called Osteoporosis. Age related Osteoporosis is called senile one. Estrogen is stimulator in increasing bone mass. After women achieve menopause or after the surgical removal of uterus (Hysterectomy), the symptoms of osteoporosis are felt. Osteoporosis is commoner in women because of postmenopausal hormonal changes.
Osteoporosis- A Silent Killer
Bone loss occurs without symptoms, making osteoporosis, a “silent killer.” Many people do not realize they have osteoporosis until they have a fracture. Fractures can cause pain or occur without pain. It is commoner to get hip and spine fractures with osteoporosis. As against the western population, osteoporosis is greatly under diagnosed and under treated in our country, even in the most high risk patients who have already fractured. The problem is particularly acute in rural areas but as well as seen in urban areas.
Following are the facts which we are absolutely unaware of-
Each year, there are an estimated 500,000 spinal fractures, 300,000 hip fractures, 200,000 broken wrists, and 300,000 fractures of other bones. About 80% of these fractures occur from relatively minor falls or accidents.
Between 25% and 60% of women over 60 years of age develop spinal compression fractures.
A woman’s risk of developing an osteoporosis-related hip fracture is equal to her combined risk of developing breast uterine and ovarian cancer.
By age 90, one third of all women and 17% of men have sustained a hip fracture.
Though all above facts appear scary, they pose realistic picture and most important- they are preventable.
Bone is built in the first two decades of life. The critical years for building bone mass are from prior to adolescence to about age 30. The best prevention for osteoporosis is to build strong bones (maximize peak bone mass) during childhood and early adulthood. Prevention consists of a combination of adequate calcium and vitamin D intake, weight-bearing exercise and healthy lifestyle, including avoiding smoking and excessive alcohol intake. It is difficult to cure osteoporosis; we can slow down the process. Prevention takes edge over treatment.
Signs & Symptoms of Vertebral Fracture
Sudden onset of back pain.
Limited spinal mobility.
Deformity & Instability.
Back pain worsening on standing.
Osteoporotic Spinal Fractures pose a major concern, and we need to identify individuals at high risks.
Early menopause and associated back pain
Less calcium intake in diet and those who don’t get enough vitamin D
Age > 70
Lack of exercise, immobilisation
Malabsorption syndromes, Diabetes Mellitus
Patient on treatment with Phenytoin, Steroids
Smoking and excessive alcohol
Radiograph of the thoracolumbar spine is mandatory to
document Osteoporosis, normal alignment of the vertebrae,
disc spaces, and spinal curves. Bone densitometry, also
known as Dexa scan is a choice of investigation to grade the severity
of osteoporosis. T score being the indicator; result below -1 is
considered normal. T score value more than -2-5 is osteoporosis,
while between -1 and -2.5 is considered as osteopenic.
A . Normal Vertebra, B. Osteopenia, C. Osteoporosis, D. Osteoporosis with fracture.
Why elderly people are more afflicted?
Decreased bone mass.
Increased tendency to fall.
Impaired protective neuromuscular responses which will lead to repetitive fall.
1 Calcium rich diet –
a. vegetable: beet root, methi, spinach, lady finger, cauliflower, rajgira, nachani.
X-ray:- Osteoporotic Vertebral Fracture treated in the form of Cement Augmentation of the vertebra called Vertebroplasty.
Vertebroplasty and Kyphoplasty are minimally invasive procedures which aim at pain relief, and stabilization of the vertebral body. Kyphoplasty, has the ability to provide some correction of deformity with partial restoration of vertebral body heigh
On whom to perform vertebroplasty or kyphoplasty ?
Painful vertebral fracture at the end of 3 to 6 weeks
Disabling back pain leading to immobilization
High Roland – Morris and ODI scores (High Pain scores)
MRI showing change in bone marrow signals- suggestive of non-healing fracture
Procedure of Vertebroplasty (Cement Augmentation in Fractured Vertebra)
World Immunization Week: Aims to raise awareness about the critical importance of full immunization throughout life.
Immunization: Immunization is the process whereby a person is made immune to an infectious disease, typically by the administration of a vaccine. Immunization protects children and adults against harmful infections before they come into contact with them in the community.
Nine diseases can be prevented by routine childhood immunization – Diphtheria (infection of throat), Tetanus (disease of the muscles), Pertusis (whooping cough), Poliomyelitis (polio), Measles (Contagious Disease), Mumps (contagious), Rubella(German Measles ), Haemophilus influenza type b (Hib) and hepatitis B. All of these diseases can cause serious complications and sometimes death.
There are two types of Immunization. These are- Active Immunization & Passive immunization.
Active Immunization: Active immunization occurs when a person makes his own antibodies against disease. Passive Immunization: Passive immunity occurs when ready-made antibodies are given to a person.
Vaccination: Vaccines stimulate the body’s own immune system to protect the person against subsequent infection or disease.
Vaccines are some of the safest medical products available, but like any other medical product, there may be risks. Accurate information about the value of vaccines as well as their possible side-effects helps people to make informed decisions about vaccination.
Tetanus Vaccine: Disease of the Muscles
Tetanus is a serious disease caused by bacteria. The actual disease is caused when the bacteria release a poison into a person’s body. Tetanus gets into the body through cuts or wounds. Tetanus can cause extremely painful muscle cramps all over the body. This disease can be deadly. In the most common form of tetanus, the first sign is spasm of the jaw muscles, followed by stiffness of the neck, and difficulty in swallowing.
Tetanus lives in the soil, so a child who plays outside can get infected even from a small injury. Vaccination is the most effective step you can take to be protected from this serious disease.
Polio is a disease caused by a virus. Most people infected with polio have no symptoms, and many recover without complications. But sometimes people who get polio develop paralysis. Paralysis is a disease in which patients not able to move their arms or legs. Polio can also cause death, usually by paralyzing the muscles used for breathing. There is no cure for polio infection, but it can be prevented by vaccination.
Most people should get IPV when they are children. Doses of IPV are usually given at 2, 4, 6 to 18 months, and 4 to 6 years of age. Most adults do not need IPV (Inactivated Polio Vaccine) because they were already vaccinated against polio as children. But some adults are at higher risk and should consider polio vaccination, including People who traveling to certain parts of the world, Laboratory workers who might handle polio virus, Health care workers treating patients who could have polio.
Feeling of pain or discomfort around the hip is always associated with backache, abdominal pain and sometimes also because of hip itself. Everything depends on a correct diagnosis and managing the pain thereafter. The pain about the hip can be due to back symptoms or abdominal problems like hernia and sometimes due to urinary tract infection also.
After having gone through a tedious walking day, the same day or next day one may experience tightness and discomfort around the hip. This is commonly seen from behind as the gluteus muscle is anti gravity muscle which has been working more than routine a day before. The modern habit of sitting more and walking less is the precursor for imbalance in the hip musculature.
The anterior portion of the hip gets contracted while the posterior glutei remains weak. This is classically seen after a prolonged sitting. Most of us would stoop forward and take some time for straightening out, experiencing a stretch on the anterior portion of the hip joint.
Simple problems of the hip joint like this can be easily corrected by undertaking a joint stretching and body flexible exercises as Yoga or specific exercises if the discomfort is more. Swimming is an excellent exercise which uploads the hip joint and helps in strengthening the muscles around the hip to give an excellent posture. Slow paced jogging and walking are also good starter for people who have neglected exercises for a long period.
However, before any of these can be tried, a proper diagnosis and your requirement from your hip should be evaluated by your specialist. This way one can determine which will be the best way in which you can go about your daily activities and hobbies without creating discomfort about your hip.
The other joints like that of knee and foot also play a large role in weight distribution about your hip and a faulty footwear with a bad gait pattern can be the cause of a nagging hip discomfort which will be easily corrected by proper footwear.
So, to take care of your hip by daily exercises and taking advice from an expert at the earliest is always suggested in case of hip pain.
Knee pain is an extremely common complaint, and it can stem from any number of causes. It can be due to an injury such as a kneecap dislocation or patella fracture, which should be treated on priority. Knee injuries can also happen as a result of torn or stretched ligaments. Putting excessive strain on your knee can cause problems such as tendinitis, or inflammation of the tendons. The knee needs to move back and forth, twist a little, and pivot too. The knee’s ligaments can tear, its tendons can swell up, osteoarthritis can take hold, and even everyday wear and tear can ruin a perfectly good set of knees. As you get older, the cartilage in your knee joints can begin to rupture, causing the development of osteoarthritis.
Talking to a medical professional is very important if you are suffering from knee pain. Once it reaches a chronic stage, it is very difficult to totally get rid of it. Treatment of a knee problem differs depending on the cause, but the focus is mainly on effective non-surgical methods of reducing pain and stimulating healing, if the stage is not chronic. The sooner your doctor finds out about the cause of your knee pain, the faster will be the treatment.
However, you can avoid knee problems with day to day measures:
The knee bears three times a person’s body weight going up stairs and nearly five times the weight going down stairs. Even a five-pound weight loss can make a huge difference in overall knee health. This tip should be implemented as early as possible. If you have carried a lot of weight for a long time, your knees may already have arthritis. Losing weight then can help prevent further deterioration, but it can’t undo arthritic damage that is already present.
Don’t ignore pain:
When the knees begin to hurt, or swell on a regular basis, listen to your body and take a break. Don’t think you can push through the pain. Take time off or adopt a low-impact activity like walking, cycling or swimming. Too many people wait until knee pain has gotten out of control. At that point too, surgery is not the only option, but the truth is that the majority of overuse problems don’t require surgery and can often be treated efficiently through activity modification, shoe inserts and weight loss.
Strengthen the supporting muscles:
Weak muscles and lack of flexibility can result in knee injuries. When the muscles around the kneecap, hip and pelvis are not strong, the knee stays unstable and imbalanced. All orthopaedic doctors focus on the importance of strengthening the quadriceps and hamstring muscles to support the knee, as well as the body’s core muscles, including the oblique, lower back muscles, and upper thigh.
Living with a chronic upper back pain hampers you from working regularly or participating in activities that you enjoy. Fortunately, an orthopaedic doctor can provide back pain relief, or guide you with effective pain management techniques that can significantly improve your life. Before you visit an orthopaedic doctor, spare some time to read the patient’s guide to upper back pain.
Why does it occur?
Upper back pain occurs mainly due to overuse of the muscles that support the spinal column of the upper back. With chronic back pain, you are prone to experience a muscle sprain or strain that results in upper back pain. Moving on to another common cause we find an injury to muscles, ligaments, or discs that support the upper back, a major problem for recurring back pain. A consequence of the same can be a herniated disc, spinal fracture, or pressure on the sciatic nerve. Poor posture, sports injuries, car accidents, slips, falls, and lifting or carrying heavy objects can all cause muscle sprain, strain, or injury. Medical conditions like scoliosis, osteoarthritis, osteoporosis, and degenerative disc disease can also play a significant role in contributing to upper back pain.
When is it the right time to visit an orthopaedic doctor?
Visiting an orthopaedic doctor is suggested if your back pain starts becoming incredibly severe, if it is interfering with your daily life, or if the back pain worsens or fails to get better after ‘at-home’ treatment. However, do not wait for it to become intolerable. If your back pain occurs along with symptoms of a heart attack, do not delay in visiting the best orthopaedic doctor around you. Or if you have paralysis, severe back pain and neck pain, loss of bladder or bowel control, sciatic pain, fever, painful urination, or worsening weakness or numbness in your legs, treatment at home will prove to be of no use. In such cases, you should undoubtedly visit an orthopaedic doctor near you.
Conservative and Advanced treatments
The treatment suggested by your doctor will be in accordance to the cause and severity of your pain. Generally, conservative and non-surgical treatment methods are put on the prescription list, which may include rest, activity modification, heat or ice, physical therapy and exercise, and pain medication. If the pain still persists, even after the conservative and non-surgical treatments, your doctor may suggest spinal manipulation or decompression, physiotherapy, massage therapy, acupuncture, and other pain management techniques.
If you frequently suffer from sports injuries, you can take a few steps to lessen your risk of future injuries. An orthopaedic doctor can keep a check on the health of your musculoskeletal system, and can recommend ways to prevent sports injuries. Here is a look at how you can prevent a few of the most common and frequent sports injuries that are suffered by sportsmen.
Keeping a Check on Sprains and Strains
Those who play regularly are aware of the most susceptible injuries – sprains and strains. In order to minimize your risk of sprains and strains, you should incorporate stretching and strengthening exercises into your physical conditioning routine. If chronic joint pain has already hit you, the most important area you should focus on is the injured point. Strengthen the muscles that surround the injured joint to prevent future possibilities of sprain and strain. Conditioning and stability exercises are the key to protect your muscles and joints. Your orthopaedic doctor may also recommend that you use supportive footwear and supports.
Avoiding Limb, Joint, and Muscle Pain
The most important and the most neglected part of any sport activity is proper warm up. Professionals should never think twice about warming up before they get involved in any rigorous sports activity. Begin each workout with a warm-up session to improve your circulation and flexibility, strengthen your muscles, and prevent sports injuries. If you suffer from an injury while working out or playing a sport, you should cease activity immediately and evaluate the injury. Working out through an injury is strictly prohibited. It can make your pain worse. Before resuming physical activity, you should visit an orthopaedic doctor to check the status of the injury. Your doctor may suggest some rest and rehabilitation or physiotherapy before playing sports again, to strengthen your muscles and ensure that you don’t injure yourself further.
Controlling Risk of Repetitive Stress Injuries
Repetitive stress injuries are the results of performing the same physical activity over and over again, with stress and strain focussing on the same area on your bones and muscles or on the already injured areas. Runners, weight lifters, and tennis players are just a few of the athletes who often develop this sports injury. Don’t ignore these two important facts that can help you in preventing repetitive stress injuries:
Never resume a physical activity abruptly after a long period of absence.
Take a break or cease the activity as soon as you feel fatigued.