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Groin Massage Techniques

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Groin Massage Techniques

A groin strain or a pull can be a painful condition affecting the adductor muscles, which are located on the inner side of the thigh. The function of these muscles is to bring the limbs together.

Causes of Groin Strain

Causes of Groin Strain

  • Athletes or individuals who are involved in sports, which require lot of running or quick changes in direction are more prone to groin strains.
  • Other activities such as kicking and jumping also result in injury to the groin muscles.
  • Falling and twisting the foot.

Massage for Groin Strain

  • Ice massage can be done 3 times daily. Muscle stimulation can be done with the help of the surge current at 7 along with ultrasound once daily. After this, light exercise can be done twice a day.
  • Sports massage for groin strain should be started after 4 days of injury. If the groin massage is done in acute stage, then it aggravates the injury.
  • A proper use of groin massage technique helps in faster recovery and healing from groin strain.
  • Prior to starting the groin massage, a stretch should be done.
  • The knee is flexed and then allowed to fall out, to the side.
  • Next, support the knee and apply mild pressure to push the leg as far as tolerable.
  • Place the hand firmly at the patient’s hip. Hold the inner side of the knee with the other hand.
  • The patient is told to push against the palm and should try to bring the leg towards the center.
  • While the patient is applying pressure for 10 seconds, you should keep the leg in place and then relax by allowing the leg to fall a bit further and stretching the groin.
  • Repeat this technique for 5 times.

Piriformis Syndrome Massage Treatment

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Piriformis Syndrome Massage Treatment

Piriformis syndrome is a disorder which results when the piriformis muscle compresses the sciatic nerve. The compressed sciatic nerve causes pain, tingling, numbness along the nerve path descending from the lower thigh down towards the legs. Other than the modern medical treatment, other alternative methods such as physical therapy, massage and stretching have found to be very beneficial in strengthening the muscles of the abdomen and the back in order to reduce the strain on the piriformis muscle.

Piriformis Syndrome Massage Treatment

Massage therapy when used along with ice massage is helpful in providing immediate relief. Some experts have recommended the alternating heat and ice massage to provide prompt pain relief. Other than this, simple stretching exercises also do wonders for reducing pain and improving range of motion substantially.

Massage Therapy for Piriformis Syndrome

Massage is one of the effective modalities to manage the piriformis syndrome. Massage should only be done by a qualified and trained massage therapist. Some points to remember are:

  • It is important to massage the gluteal region.
  • Patient should lie down in a prone position.
  • The massage therapist will then start massaging from the sacrum and down to the head of the femur.
  • This helps in stimulating the rotator muscles in the hip which in turn reduces the strain on the muscle.
  • While massaging, the therapist will apply deep pressure depending upon the pain threshold of the patient.

As mentioned before, ice therapy application along with massage technique provides many benefits. However, due to the deep nature of muscle, ice therapy will have very less benefit if it is used alone.

Watch 3D Video of Piriformis Syndrome

How Effective is Massage Therapy in Decreasing the Frequency of Migraines?

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How Effective is Massage Therapy in Decreasing the Frequency of Migraines?

Can Massage Therapy Help in Decreasing the Frequency of Migraines?

Migraine is an intense type of headache. It is usually accompanied by other symptoms such as nausea, dizziness, sensation of pins and needles and vision disturbances. Migraine is a severe headache, which greatly disturbs an individual’s daily life. Migraine can occur with or without ‘aura.’ Aura is one or more of the symptoms, which commonly occur before the actual migraine headache starts. Aura is a warning signal of the impending migraine. Chronic sufferers of migraine learn to perceive this as a warning signal. Migraines are believed to be caused by changes in the level of serotonin. Decreased serotonin levels cause constriction of the blood vessels in the brain which leads to ‘aura.’

The constricted blood vessels expand again causing increased blood rush to the brain and resulting in a severe headache. Other triggers of migraine are: Stress, sleep disturbances, fasting and dehydration, hormones (before menstruation or during menopause), bright or flashing lights, certain odors, smoking and cigarette smoke, alcohol consumption, extreme tiredness, muscle spasm, chocolate consumption, certain medications and caffeine consumption. Research has shown that regular massage decreases the frequency of migraines, sleep problems, stress and anxiety and leads to a better quality of sleep. Massage helps in increasing the serotonin level and thus results in benefits such as regulating sleep, mood, and appetite.

Regular Massage Can Decrease the Frequency of Migraines

How Effective is Massage Therapy in Decreasing the Frequency of Migraines?

Massage therapy benefits a migraine headache in two ways. Firstly, it helps in prevention of migraine. Massage when done regularly helps in relaxation and reduction of stress levels. This in turn reduces the probability of the migraine attacks.

The second benefit of massage in migraine is curing the migraine. Massage relaxes the spasm or the tenseness in the muscles and this leads to abating of the migraine.

Cold Stone Massage Therapy for Migraines

  • Cold stone massage therapy is effective in the treatment of migraines especially when it is used along with hot stone massage treatment.
  • Cold stone massage therapy when applied along with ice help in relaxing the nerves in the head. Cold stones can be placed on the forehead, the anterior region of the neck and on the posterior region on the nape of the neck.
  • Hot stones should be placed on the muscles in the upper chest and below the shoulder blades. This helps in relaxing the muscles present in these areas. Care should be taken not to place the hot stones close to the head or the neck as this further exacerbates the migraine or tension headache.

What is Massage Therapy? Its History, Role of Massage Therapist, Certifications

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What is Massage Therapy? Its History, Role of Massage Therapist, Certifications

What is Massage Therapy

Massage therapy has been used in many cultures around the world for a long time. Today, different types of massages are used for relief from a variety of health-related problems.

Massage is one of the ancient methods used in healing. There are Chinese records which date back 3,000 years recording the use and benefits of massage therapy.[6] Applied forms of massage have also been used by the early Hindus, Egyptians and Persians for many health related problems. There are papers written by Hippocrates which promote the use of rubbing and friction for circulatory and joint problems. In the present day, the advantages of massage are many and extensive. It is an acknowledged part of various physical rehabilitation programs. Massage therapy is also very beneficial for various chronic conditions such as arthritis, bursitis, low back pain, fatigue, diabetes, high blood pressure, infertility, immunity suppression, depression, smoking cessation and more. Massage also helps greatly in relieving stress and tension which every individual faces in one’s daily life and which leads to various ailments.[1]

Massage therapy is commonly considered a part of complementary and alternative medicine (CAM) in United States; however, it does have some traditional uses. The scientific evidence on massage therapy is quite narrow. Experts don’t know for sure about the changes occurring in the body during a massage and how they influence an individual’s health. Studies are being done to find out the answer to these questions which are being sponsored by The National Center for Complementary and Alternative Medicine (NCCAM).[2]

Massage therapy should be done by an experienced massage therapist. If it is done by an unqualified person or if done in the wrong manner, it can cause more harm than good. It has many benefits when done by a trained massage therapist.

Patients should always inform their health care providers if they are using any alternative and complementary practices along with details of their lifestyle and their health management. This helps in ensuring safe and coordinated care.

What is Massage Therapy?

Massage Therapy & Its History

As mentioned above, massage therapy dates back thousands of years. There are Chinese records which date back 3,000 years recording the use of massage therapy. Applied forms of massage has have been used by the early Hindus, Egyptians and Persians for many health related problems. There are papers written by Hippocrates which promote the use of rubbing and friction for circulatory and joint problems. There are many references to massage therapy in the writings from ancient Japan, China, Arabic nations, India, Greece, Egypt and Rome.[3]

Massage became extensively used in Europe through the Renaissance period. Massage therapy was introduced in the United States in the 1850s by two American physicians, who did their studies in Sweden. It was accepted and promoted for many health purposes. However, the use of massage therapy declined in the United States in the 1930s and 1940s due to advancement in scientific and technological field in medical treatment. In the 1970s, interest was revived in massage therapy, particularly in athletes, as it was found to benefit in many sports injuries.

Role of Massage Therapist

Massage therapists work in different locations such as, nursing homes, hospitals, private offices, studios and sport & fitness centers. Few massage therapists also visit patients’ homes or their workplaces. Their aim is to provide a soothing and calm atmosphere to relieve the stress and tension of the patient. Before starting the massage therapy, the therapist will ask questions to the new patients about their medical history, symptoms and expected results. They may also assess the patient’s condition through touch in order to locate the tense or painful areas and to evaluate the degree of pressure to be applied.

The massage is usually done with the patient lying on a table and wearing loose-fitting clothing or undressed (except for the region to be massaged, patient is covered with a sheet). The massage therapist uses oil or lotion to avoid friction on the skin. In some cases, massage is done with the patient sitting in a chair. Depending on the condition, the massage session may be short or brief or can also last for an hour or even more.[4]

Massage Therapy Training and Certification

There are around 1,500 massage training programs and massage therapy schools in the United States. Along with the hands-on training of massage techniques, students are also taught about the body and its function. Students also learn about ethics and business practices. Generally the massage training programs are approved by a state board. Few are also certified by an independent agency, such as the Commission on Massage Therapy Accreditation (COMTA).[5]

As of 2010, the District of Columbia and 43 states have laws standardizing the massage therapy. The National Certification Board for Therapeutic Massage and Bodywork endorses therapists passing a national examination. More and more states which authorize licensed massage therapists necessitate them to have at least 500 hours of training at a certified institution, meet certain education requirements and pass a national exam and include malpractice insurance. Other than the massage therapists, different health care providers such as physical therapists and chiropractors can also train for massage therapy.

Some Of The Common Certifications Or Licenses For Massage Therapists Are:

  • LMP: Licensed Massage Practitioner
  • LMT: Licensed Massage Therapist
  • NCTMB: Has met all the credentialing requirements (including passing an exam) of the National Certification Board for Therapeutic Massage and Bodywork, for practicing therapeutic massage and bodywork.
  • CMT: Certified Massage Therapist
  • NCTM: Has met the credentialing requirements (including passing an exam) of the National Certification Board for Therapeutic Massage and Bodywork, for practicing therapeutic massage

References:

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Phantom Pain: Types, Causes, Symptoms, Treatment- TENS, Antidepressants, Narcotics

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Phantom Pain: Types, Causes, Symptoms, Treatment- TENS, Antidepressants, Narcotics

What is Phantom Pain?

Phantom pain is a pain or a sensation which an individual feels as if it is coming from a part of body which no longer exists, e.g. after an amputation of a limb, the individual feels pain where the limb existed before. Phantom pain is not limited to limb removal. It can be felt after surgical removal of other body parts too, such as eye, tongue, breast or penis. Phantom pain can also be felt after spinal cord injury or nerve avulsion. The intensity of phantom pain differs from person to person. More than half of the amputees experience phantom pain at some point in their lives and few continue feeling it for the rest of their life.[1]

What is Phantom Pain?

However, in some patients, Phantom pain improves gradually without any treatment whereas others require medications and therapies to manage phantom pain.

In the past, phantom pain was thought to be a psychological phenomenon, but over the years it has been proved that phantom pain is very much a real pain which is felt by the patient to the point of making one’s  life uncomfortable. It originates from the brain and spinal cord.[2]

Phantom Pain

Classification and Types of Phantom Pain

There are various types of sensations that a patient may feel with an amputated limb.

  • Sensations pertaining to the posture, length and volume of the phantom limb such as a feeling that the phantom limb is acting like a normal limb e.g. sitting with the knee flexed. Sometimes, the amputee may feel that the phantom limb is as heavy as the other limb and sometimes the amputee experiences a sensation known as telescoping where one feels as if the phantom limb is gradually decreasing in length over time.
  • Amputee may have sensation of movement in the phantom limb such as one may feel as though the phantom foot is moving.
  • Other sensations which an amputee may feel are sensations of touch, temperature, pressure and itchiness. Many amputees report feelings of tingling, itchiness, heat, and pain in the phantom limb.

Causes and Risk Factors of Phantom Pain

  • The exact cause of phantom pain is not clear, but the pain seems to originate from brain and spinal cord.
  • Imaging scans such as Magnetic Resonance Imaging (MRI) and Positron Emission Tomography (PET) have shown activity in specific parts of the brain when the patient is experiencing phantom pain.
  • It is the belief of many professionals that phantom pain may partially be a result of mixed signals from the brain. After an individual has had an amputation, certain regions of brain and spinal cord stop receiving input from the amputated limb and as they try to adjust to this new condition, the result is a sensation or pain in the region of the amputated limb.
  • Other factors which are thought to contribute to phantom pain are: Damaged nerve endings, formation of scar tissue at the amputation site and recollection of pre-amputation pain by the patient.[3]

There are some risk factors which increase the chances of a patient feeling phantom pain. These risk factors are:

Pre-amputation Pain:

Research has shown that patients who experience pain before the actual amputation of the limb are more prone to experience pain after the amputation also, especially immediately after the amputation of limb. The reason for this is the memory of the pre-amputation pain still lingers in the mind of the patient and the brain continues to send pain signals even after the amputation is done.[4]

Ill-Fitting Prosthesis (Artificial Limb):

Artificial Limb

If the prosthesis does not fit properly on the stump, then it can cause damage or injury to the surrounding structures resulting in pain. Prosthesis should always be fitted under medical supervision to ensure that it attaches properly.

Stump Pain:

Patients who suffer from stump pain may also experience phantom pain. The cause of the stump pain may be damaged nerve endings or abnormal growth at the stump.[5]

Pathophysiology of Phantom Pain

Monitoring of the patients and experimental theories has led to various mechanisms and neurological basis for phantom pain. There is very little information as to the actual mechanism that causes phantom pain, but there are some theories given by experts which overlap each other. Previously it was thought that the stump neuromas were responsible for phantom pain. Although they can be one of the causes of phantom pain, they are not solely responsible for it, as patients with congenital limb deficiency can also suffer from phantom pain. This implies that the painful sensations are due to a central representation of the limb. Presently, there are many theories which are based on cortical reorganization and altered neurological pathways. Even though they are closely linked, they are divided into spinal, peripheral and central mechanisms.[6]

Signs and Symptoms of Phantom Pain

Many individuals who have had their limb amputated relate that they sometimes feel as if their amputated limb is still present. This condition where the individual gets the feeling as if the amputated part still exists, but feels no pain is known as phantom limb sensation. This can also occur in individuals who don’t have limbs by birth. Phantom limb sensations also include feelings of warmth, itchiness, cold and tingling. Phantom limb sensations are different from phantom pain. The former, as the name suggests, are only sensations and not actual pain. Pain present in the stump of an amputated limb should not be confused with phantom pain. Phantom pain is the pain which feels as if it is coming from a body part which no longer exists. The feeling of pain from an amputated limb or other body part is the determining symptom of phantom pain.

Some of the Characteristics of Phantom Pain are:

  • Pain starting within the first few days of amputation.
  • Pain occurs in episodes and is not constant.
  • Pain appears to originate from the part of the limb which is situated farthest from the body, e.g. pain in foot of an amputated leg.
  • The nature of the pain can be stabbing, shooting, squeezing, boring, burning or throbbing.
  • Pain may be provoked by certain conditions such as changes in the weather, emotional stress or compression on the remaining area of the limb.

Treatment of Phantom Pain

Treatment of Phantom Pain

Treating phantom pain can prove to be difficult. The common line of treatment followed by doctors is usually medications followed by noninvasive therapies comprising of acupuncture or transcutaneous electrical nerve stimulation (TENS). If the patient does not benefit from this, then more-invasive options are considered such as implanted devices or injections. Surgery is only considered if all the above options fail.

  1. Lifestyle Modifications go a long way in alleviating phantom pain. Patient can take the following steps to reduce phantom pain:
    • Patient should involve himself in other activities such as reading, listening to music or watching TV to distract him/her from phantom pain.
    • Patient should try meditation or other such activities for relaxation in order to reduce stress and tension in the muscles thereby alleviating the pain.
    • Staying physically active such as doing exercises or gardening, cycling, walking or swimming also helps in alleviating the symptoms of phantom pain.
    • Patient should follow his/her physician’s instructions and take medications on time. Medical advice should be taken before starting any herbal medicines.
    • Patient should take the utmost care when changing or removing the prosthesis as there is a likelihood of damaging the adjacent structures and causing more pain.[7]
  2. Medications: There are no medications specifically for treating phantom pain. Some medications for treating other conditions have been helpful in alleviating nerve pain. Different patients benefit from different medications so a different combination of medications need to tried to find out which works best for a particular patient. Some of the medications which help in relieving phantom pain are
  3. Antidepressants: Pain due to damaged nerves can be relieved by taking tricyclic antidepressants such as amitriptyline and nortriptyline. Antidepressants also help in improving sleep, which can make the patient feel better.
  4. Anticonvulsants: Drugs used for epilepsy such as gabapentin (Neurontin) and carbamazepine (Carbatrol, Tegretol) also help in alleviating nerve pain. They act by calming the damaged nerves thereby slowing down or preventing uncontrolled pain signals.
  5. Narcotics: In some patients, codeine and morphine, which are opioid drugs, help in relieving phantom pain. Patients having a history of substance abuse should avoid these medications. Side effects of narcotics include sedation and constipation.[8]
  6. Noninvasive methods which are helpful in alleviating phantom pain comprise of: Transcutaneous Electrical Nerve Stimulation (TENS), use of electric artificial limb, mirror box and acupuncture.
  7. Minimally Invasive methods such as local anesthetic or steroid injections, spinal cord stimulation and intrathecal delivery system may also help in relieving phantom pain.
  8. Surgery: If all the above methods fail, then surgery is done as a last resort. Surgery comprises of stump revision or neurectomy and deep brain stimulation.

Tests to Diagnose Phantom Pain

  • As mentioned earlier, imaging scans such as magnetic resonance imaging (MRI) and positron emission tomography (PET), have shown activity in specific parts of the brain when the patient is experiencing phantom pain. However, there are no specific tests for diagnosis of phantom pain.[9] Diagnosis is done on the basis of history given by the patient, sign and symptoms and events occurring before the phantom pain.
  • Patient should give a detailed history such as the cause of amputation, site of amputation, the type of procedure done and post-amputation activities. Sometimes, muscle pain resulting from overstraining of the muscles near the stump is confused with phantom pain. Diagnosis and treatment depends on the patient’s history and symptoms.

References:

Heart Attack or Myocardial Infarction (MI): Causes, Risk Factors, Symptoms, Treatment

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Heart Attack or Myocardial Infarction (MI): Causes, Risk Factors, Symptoms, Treatment

What is Heart Attack?

Heart attack, also known as myocardial infarction (MI), is a condition which occurs when a blood clot obstructs the coronary artery thus blocking the blood flow to the heart. Coronary artery is a vital blood vessel which supplies blood to the heart muscle.[1] Any hindrance in the blood flow to the heart can damage or destroy the heart muscle. A heart attack can be dangerous if ignored. This happens when people confuse their symptoms with other minor illnesses such as indigestion and delay their treatment. Nowadays, treatment for heart attack has become more advanced. It is important that patients promptly recognize their symptoms and seek medical help immediately or call 911 if they suspect they are having a heart attack.

Heart Attack or Myocardial Infarction (MI)

Recovering from a heart attack depends on the patient’s lifestyle, frequency and duration of exercise, stress handling, diet etc. Patient should follow a healthy lifestyle to prevent a heart attack and control risk factors which contribute to the narrowing of the coronary arteries which supply blood to the heart.

Causes and Risk Factors for Heart Attack or Myocardial Infarction (MI)

The cause of a Heart Attack or Myocardial Infarction (MI) is blockage in one or more of the coronary arteries supplying the heart muscle. The cause of the blockage could be a clot which separates when a plaque ruptures. Other causes include accumulation of cholesterol which leads to narrowing of the coronary artery. The accumulation of cholesterol is known as plaques and this condition is known as atherosclerosis. When a heart attack occurs, one of these plaques may rupture leading to formation of a blood clot at the site of the rupture. If the clot is large, then it can completely block the blood flow. Atherosclerosis causes narrowing of the coronary arteries and this results in a condition known as coronary artery disease. The cause of majority of the heart attacks is coronary artery disease. Other uncommon cause of a heart attack is spasm of the coronary artery which causes hindrance in the blood flow to a part of the heart muscle. Certain drugs, such as cocaine, may cause life-threatening spasm of the coronary artery. Heart attack can also occur due to coronary artery dissection (tear in the coronary artery).[2]

Other uncommon causes of heart attack include coronary embolism where small blood clots or tumors travel from other parts of the body and get lodged in the artery.

A Heart Attack or Myocardial Infarction (MI) is the culmination of a process which usually progresses over several hours. As each minute passes, the heart tissue is deprived of blood and can deteriorate or die.[3] However, if there is reestablishment of the blood flow in time, then the damage done to the heart can be limited or prevented.

What Can Cause Heart Attack or Myocardial Infarction (MI)?

Risk Factors of Heart Attack or Myocardial Infarction (MI)

  • Age: Men aged 45 or more and women aged 55 or more are at higher risk for having a heart attack.
  • Tobacco: Individuals who smoke and those who are exposed to secondhand smoke continuously are at higher risk for having a heart attack. Smoking increases the risk of formation of deadly blood clots which cause heart attack.
  • Diabetes: Diabetes greatly increases the risk of a heart attack.
  • High Blood Pressure (Hypertension): High blood pressure gradually damages the coronary arteries by speeding up atherosclerosis thus increasing the risk for heart attack.
  • Hypercholesterolemia: Individuals who have high blood cholesterol or triglyceride levels are at higher risk for having a heart attack.
  • Family History of Heart Attack: Individuals with a family history of heart attack (siblings, parents or grandparents who have had heart attacks) are at increased risk.
  • Lack of Exercise: Individuals who don’t do any exercise or physical activity are at increased risk for having a heart attack as an inactive lifestyle leads to obesity and high blood cholesterol levels. People who do regular aerobic exercise have good cardiovascular fitness, which in turn decreases their overall risk of heart attack. Exercise also helps in lowering hypertension.
  • Obesity: Individuals who are obese, i.e. having a body mass index of 30 or higher, are at increased risk of heart disease, as it’s associated with diabetes, high blood cholesterol levels and high blood pressure.
  • Stress: Excessive stress, anger and other negative emotions increases the blood pressure along with increasing the risk for heart attack.
  • Illegal use of drugs: Stimulant drugs, such as cocaine or amphetamines, causes spasm in the coronary arteries which leads to heart attack.[4]

Symptoms for Heart Attack or Myocardial Infarction (MI)

  • A feeling of pressure, fullness or a squeezing pain in the center of the chest which lasts for some time.
  • Radiating pain outside the chest to the shoulder, arm, back and even teeth and jaw.
  • Increasing spells of chest pain.
  • Continuous pain in the upper abdomen.
  • Shortness of breath.
  • Sweating.
  • Anxiety.
  • Fainting.
  • Nausea.
  • Vomiting.
  • Heartburn.
  • Pain in the abdomen.
  • Damp skin.
  • Dizziness or lightheadedness.
  • Fatigue.[5]

Treatment for Heart Attack or Myocardial Infarction (MI)

If you come across an individual who is unconscious and you suspect a heart attack, then immediately call for medical help. If you are trained in emergency procedures, start doing cardiopulmonary resuscitation (CPR), which involves chest compressions and rescue breaths. Check the person’s airway and if it is clear, then deliver rescue breaths after every 30 compressions. If you aren’t trained, then continue doing compressions only.

Medications Given To Treat A Heart Attack or Myocardial Infarction (MI) Include:

  • Aspirin is given by emergency medical personnel immediately after the patient arrives at the hospital. Aspirin helps in reduction of blood clotting and thereby helps in maintaining blood flow through the narrowed artery.
  • Thrombolytics, also known as clot busters, help in dissolving the blood clot which is blocking the blood flow to the heart. The earlier a thrombolytic is given after a heart attack, the greater the chances of surviving and decreasing the damage to the heart.[6]
  • Super aspirins are similar to aspirin and help in preventing the formation of new clots. Super aspirins include clopidogrel (Plavix) and platelet aggregation inhibitors.
  • Blood-thinning medications such as heparin help in making the patient’s blood less “sticky” and decrease the risk of forming more dangerous clots. Heparin can be given intravenously or via an injection under the skin. Heparin is usually given during the initial days after a heart attack.
  • Pain relievers, such as morphine, are given for relieving chest discomfort and chest pain.
  • Nitroglycerin is used for treating angina (chest pain). This medication temporarily opens up arterial blood vessels thereby, increasing the blood flow to and from the heart.
  • Beta blockers are those medications which help in relaxing the heart muscle, slowing the heartbeat and decreasing the blood pressure. All this helps in taking the load off of the heart. Beta blockers restrict the amount of damage to the heart muscle and help in preventing future heart attacks.
  • Cholesterol-lowering medications such as statins, niacin, fibrates and bile acid sequestrants help in lowering the levels of unwanted cholesterol in the blood. These medications are best useful when given immediately after a heart attack for increasing survival rate.
  • Surgical procedures for treating heart attack include coronary angioplasty and stenting; and coronary artery bypass surgery.[7]

Lifestyle And Home Remedies Which Help In Preventing And Recovering From Heart Attack or Myocardial Infarction (MI) Are

  • Quitting smoking.
  • Avoiding secondhand smoke.
  • Getting cholesterol levels checked regularly.
  • Getting regular medical checkups.
  • Keeping your blood pressure under control.
  • Exercising regularly.
  • Losing the excess weight.
  • Following a heart-healthy diet.
  • Reducing stress levels.
  • Avoid drinking alcohol, if you do, drink in moderation.

Tests to Diagnose Heart Attack or Myocardial Infarction (MI)

Regular physical exams should be done to screen for risk factors which may result in a heart attack. Vital signs, such as blood pressure, pulse and temperature etc, are checked in the emergency room. Doctor will listen to heart and lung sounds using a stethoscope. Health history and family history of heart disease will be taken. Other than this, tests which will be taken include:

  • Electrocardiogram (ECG).
  • Blood tests to check for specific heart enzymes which slowly leak into blood if there has been any damage to the heart.
  • Chest x-ray to check the size of heart, its blood vessels and also to look for any fluid in the lungs.
  • Echocardiogram.
  • Angiogram (Coronary Catheterization).
  • Exercise Stress Test.
  • Cardiac Computerized Tomography (CT)
  • Magnetic Resonance Imaging (MRI)[8]

References:

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Q & A On Low Back Pain In 40 Years Old Young Adult

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Q & A On Low Back Pain In 40 Years Old Young Adult

I am 40 Year Old. Why My Lower Back Hurts?

Lower back pain may be mild, moderate or severe in intensity. Mild pain may be secondary to muscle ache or spasm of paravertebral muscles.

Moderate to severe pain can be secondary to several causes as follows:

A. Causes of Mild Lower Back Pain in Patients Aged Between 40 to 65 Years Old:

  • Undiagnosed scoliosis.
  • Prolonged sitting or standing in improper position while traveling or working in front of computer or at desk.
  • Sleeping on hard mattress.
  • Tear or sprain of ligaments.
  • Tear or sprain of paravertebral muscles.
  • Pregnancy.
  • Obesity.
  • Stress – physical or emotional.
  • Manual work – lifting and carrying heavy object.
  • Sciatica.
  • Myofascial muscle disease.
  • Fibromyalgia.

B. Causes of Moderate to Severe Lower Back Pain in Patient Aged Between 40 to 65 Years:

Causes of Moderate to Severe Lower Back Pain in Patient Aged Between 40 to 65 Years

  • Disk bulge or herniation.
  • Paravertebral or spinal abscess.
  • Spinal tumor or osteoblastoma.
  • Epidural or spinal hematoma.
  • Facet joint arthropathy.
  • Posttraumatic epidural or spinal abscess.
  • Tear or sprain of ligaments.
  • Tear or sprain of paravertebral muscles.
  • Facet joint subluxation or injury.
  • Subluxation of lumbar vertebrae.

How Common is Low Back Pain?

The prevalence of chronic low back pain has increased significantly from 1992 (3.9%) to 2006 (10.2%). 84% of patients with history of lower back pain pursued active treatment 2.

There isn’t any study done to indicate prevalence of low back pain among patients between 40 and 60 years. Substantial heterogeneity exists among low back pain epidemiological studies. Incidence of first ever episode of low back pain is between 6.3% and 15.4%. Recurrence of low back pain at 1 year ranges from 24% to 80%3.

When Should One Consider Further Investigations or Tests for Low Back Pain In Young Adult Aged 40 Years?

If pain continues after 4 to 6 weeks, you must consider further investigations or tests for back pain.

Which Investigations are Most Favorable for Proper Diagnosis of Low Back Pain in 40 Year Old Young Adult?

Most favorable initial investigation is X-Ray and MRI or CAT scan4.

What Other Investigations May Be Needed For Diagnosing The Cause of Low Back Pain In 40 Year Old Young Adult?

  • Blood examinations to rule out infection and abscess.
  • EMG (Electromyogram) studies to diagnose muscle diseases.
  • Discography.4

Whom Should a 40 Year Old Young Adult Consult To Treat His Low Back Pain?

Spine

It depends on your insurance policies. You may have to see first primary care physician (PCP). PCP may consider further investigations depending on severity of pain and outcome of initial clinical examinations. Eventually after 4 to 6 weeks PCP will advise further investigations. Depending on outcome of investigation, PCP will refer you to specialist for followup treatment. If you do not need any referral from PCP to specialist then you should see Neurologist for initial evaluation and diagnosis. If you are referred for physical therapy (PT) or injection treatment you should consult PMR physician regarding PT or interventional pain specialist for injection treatment.

Who Should Be Consulted for Back Surgery On A Young Adult?

Either Orthopedic Surgeon or Neurosurgeon performs back surgery. Back surgery is subspecialty of Orthopedic and Neurosurgery training.

What Are the Treatment Options For Low Back Pain In Young Adult?

Treatment choices are several non-invasive and invasive treatments. Benign backache may not need any of the following treatment except NSAIDs and rest. But choice is as follows:

A. Noninvasive Treatment for Low Back Pain In Young Adult:

  • Non-opioid medications such as NSAIDs (Tylenol, Motrin, Naproxen and Celebrex), antidepressant analgesics (Elavil and Cymbalta) and antiepileptic analgesics (Neurantin and Lyrica).
  • Manual treatments which may be helpful for Back Pain are as follows:
    1. Massage treatment5.
    2. Spa Therapy6.
    3. Yoga therapy7.
    4. Chiropractic manipulations8.
    5. Physical therapy9.

B. Invasive Treatments For Low Back Pain In Young Adult Are As Follows:

  • Interventional Pain Therapy:
    1. Epidural Steroid Injection10.
    2. Facet joint injection11.
    3. Selective nerve root injection12.
    4. Trigger point injection13.
    5. Acupuncture13.
  • Surgical treatment for low back pain in young adult depends on the cause of the pain. Surgical treatment options are:
    1. Discectomy.
    2. Spinal fusion.
    3. Removal of abscess or hematoma.
    4. Excision of tumor mass.
    5. Spinal cord stimulator.
    6. Intrathecal catheter and pump to deliver intrathecal pain medications.

Also Read:

Also Watch:

References:

  1. Modic changes, possible causes and relation to low back pain.Albert HB, Kiaer P, Jensen TS et alAll The Back Research Center, Part of Clinical Locomotion Science, University of Southern Denmark, Lindevej 5, 5750 Ringe, Denmark. Med Hypotheses. 2008;70(2):361-8.
  2. The Rising Prevalence of Chronic Low back Pain FREE
  3. Janet K. Freburger, PT, PhD; George M. Holmes, PhD; Robert P. Agans, PhD; Anne M. Jackman, MSW; Jane D. Darter, BA; Andrea S. Wallace, RN, PhD; Liana D. Castel, PhD; William D. Kalsbeek, PhD; Timothy S. Carey, MD, MPHArch Intern Med. 2009;169(3):251-258. doi:10.1001/archinternmed.2008.543.
  4. The Epidemiology of low back pain.Hoy D, Brooks P, Blyth F, Buchbinder R.University of Queensland, School of Population Health, Herston Rd, Herston, QLD 4006, Australia.Eur Spine J. 2012 Sep 26.
  5. HIZ’s relation to axial load and low back pain: investigated with axial loaded MRI and pressure controlled discography.Hanna H, Tommy H.Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.Complement Ther Clin Pract. 2012 Nov;18(4):227-34. doi: 10.1016/j.ctcp.2012.07.001.
  6. The effectiveness of Swedish massage and traditional Thai massage in treating chronic low back pain: a review of the literature.Netchanok S, Wendy M, Marie C, Siobhan O.School of Nursing and Midwifery, Research Centre for Clinical and Community Practice Innovation, Griffith Health Institute, Griffith University, 170 Kessels Road, Nathan Campus, Nathan/QLD 4111, Australia.Pain Med. 2013 Jan;14(1):145-58. doi: 10.1111/pme.12002.
  7. Effects of different frequencies (2-3 days/week) of aquatic therapy program in adults with chronic low back pain. A non-randomized comparison trial.Baena-Beato PA, Arroyo-Morales M, Delgado-Fernández M, Gatto-Cardia MC, Artero EG.Department of Physical Education and Sport, University of Granada, Granada, Spain.
  8. A Systematic Review and Meta-analysis of Yoga for Low Back Pain.Cramer H, Lauche R, Haller H, Dobos G.Department of Complementary and Integrative Medicine, University of Duisburg-Essen, Essen, Germany.Clin J Pain. 2012 Dec 14.
  9. Adding chiropractic manipulative therapy to standard medical care for patients with acute low back pain: the results of a pragmatic randomized comparative effectiveness study.Goertz CM, Long CR, Hondras MA, Petri R, Delgado R, Lawrence DJ, Owens EF, Meeker WC.Palmer Center for Chiropractic Research, 741 Brady St., Davenport, IA 52803 , Palmer College of Chiropractic, West Campus, 90 E. Tasman Dr., San Jose, CA 95134.Spine (Phila Pa 1976). 2012 Oct 10.
  10. Initial Management Decisions Following a New Consultation for Low Back Pain: Implications of the Usage of Physical Therapy for Subsequent Health Care Costs and Utilization.Fritz JM, Brennan GP, Hunter SJ, Magel JS.Department of Physical Therapy, University of Utah, Salt Lake City, UT; Physical Therapy Division, Intermountain Healthcare, Salt Lake City, UT.Arch Phys Med Rehabil. 2013 Jan 18. pii: S0003-9993(13)00029-4. doi: 10.1016/j.apmr.2013.01.008.
  11. Fluoroscopic caudal epidural injections in managing chronic axial low back pain without disc herniation, radiculitis, or facet joint pain.Manchikanti L, Cash KA, McManus CD, Pampati V.Pain Management Center of Paducah, Paducah ; Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY, USA.J Pain Res. 2012;5:381-90. doi: 10.2147/JPR.S35924.
  12. Management of low back pain with facet joint injections and nerve root blocks under computed tomography guidance. A prospective study.Fotiadou A, Wojcik A, Shaju A.Hinchingbrooke Hospital NHS Trust, Huntingdon, PE29 6NT, Cambridgeshire, UK.Skeletal Radiol. 2012 Sep;41(9):1081-5. doi: 10.1007/s00256-011-1353-6.
  13. A pilot study examining the effectiveness of physical therapy as an adjunct to selective nerve root block in the treatment of lumbar radicular pain from disk herniation: a randomized controlled trial.Thackeray A, Fritz JM, Brennan GP, Zaman FM, Willick SE.Department of Physical Therapy, University of Utah, 520 Wakara Way, Salt Lake City, UT 84108, USA.Phys Ther. 2010 Dec;90(12):1717-29. doi: 10.2522/ptj.20090260.
  14. Comparison between the effects of trigger point mesotherapy versus acupuncture points mesotherapy in the treatment of chronic low back pain: a short term randomized controlled trial.Di Cesare A, Giombini A, Di Cesare M, Ripani M, Vulpiani MC, Saraceni VM.Complex Operative Unit of Physical Medicine and Rehabilitation, Policlinico Umberto I Hospital, University of Rome La Sapienza, Piazzale Aldo Moro, 5, 00185, Rome, Italy.Ther Med. 2011 Feb;19(1):19-26. doi: 10.1016/j.ctim.2010.11.002.

Pulled Neck Muscle or Neck Strain: Causes, Symptoms, Diagnosis, Treatment

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Pulled Neck Muscle or Neck Strain: Causes, Symptoms, Diagnosis, Treatment

Pulled neck muscle or neck strain is a condition where there is injury to the muscles and tendons which support and help in movement of the head and neck. The neck is a part of body which has the ability for a wide range of motion and this makes it less stable and more prone to injury than other parts of body.[1] The neck comprises of many vital anatomic structures such as the airway (breathing tube), spinal cord, and blood vessels supplying the brain. Usually Pulled Neck Muscle or Neck Strain Injuries do not involve serious injuries to these vital structures. Pulled Neck Muscle or Neck strain injuries are also commonly not associated with fractures or dislocations of the cervical bones.[2]

Pulled Neck Muscle or Neck Strain

Pulled Neck Muscle or Neck Strains are the injuries to the muscles and tendons which help in neck movement. Other injuries to non-moving structures like ligaments, joint capsules, bursae, nerves, blood vessels and cartilage are known as sprains. Both neck sprains and strains may include tears to the ligament and muscles of the neck and other related structures. There may also be injury to the cervical nerves due to stretching or compression.

Causes of Pulled Neck Muscle or Neck Strain

Injury to the neck causes Pulled Neck Muscle or Neck Strain. These injuries commonly occur due to indirect trauma such as hyperextension or hyperflexion of the neck (whiplash injuries). Extreme rotation and compression of the neck may also result in Neck Strain. Some of the common causes of neck injuries resulting in Pulled Neck Muscle or Neck Strain are:

  • Automobile accidents are largely responsible for many whiplash injuries, as they often cause hyperextension or hyperflexion of the neck.
  • Individuals having occupation which require repetitive or prolonged neck extension are more prone to suffering from Pulled Neck Muscle or Neck Strain Injury.
  • Wrong or abnormal posture when awake or sleeping may also cause Pulled Neck Muscle or Neck Strain.[3]

Signs and Symptoms of Pulled Neck Muscle or Neck Strain

  • Pain is the main symptom of pulled neck muscle or neck strain.
  • Immediate pain at the time of injury.
  • Patient may not be able to perform daily work or activities.
  • Symptoms such as weakness, numbness, tingling, dizziness and loss of coordination are indicative of injury to nerves.
  • Stiffness of the neck which may radiate into the lower back.
  • There may be difficulty in chewing, swallowing, and breathing; however, these symptoms are rare.[4]

Serious Symptoms of Pulled Neck Muscle or Neck Strain

  • Acute and constant pain.
  • Severe neck pain at night.
  • Persistent and severe spasms of neck muscles.
  • Difficulty in performing daily activities.
  • Weakness.
  • Numbness.
  • Tingling or loss of function, especially in the upper extremities.
  • Difficulty breathing.
  • Dizziness.
  • Headache.
  • Nausea.
  • Vomiting.
  • Tinnitus (ringing in the ears).
  • Decreased hearing.

Serious Symptoms Indicating Injury to the Spinal Cord

  • Bowel or bladder retention.
  • Bowel or bladder incontinence.
  • Inability to urinate.
  • Weakness in the legs or loss of ability to walk.
  • Loss of balance.
  • Vertigo or dizziness.
  • Nausea and vomiting.
  • Tinnitus (ringing in the ears).[5]

Investigations To Diagnose Pulled Neck Muscle or Neck Strain

  • Medical history and physical examination.
  • Neuromuscular testing helps in determining if there are any injuries to the nerves and joints of the neck.
  • X-rays help in assessing the trauma to the cervical spine.
  • CT scan for assessing complex fractures, dislocations, disc protrusions, disease of the vertebrae and spinal stenosis.
  • Myelography (imaging of the spinal cord).
  • MRI.
  • Discography.
  • Radionuclide scanning.[6]

Treatment For Pulled Neck Muscle or Neck Strain

  • A cervical collar is beneficial for moderate pain.
  • Rest is important.
  • Placing a small pillow under the nape of the neck helps in giving proper neutral positioning.
  • Application of dry or moist heat helps in relieving muscle spasm.
  • NSAIDs (nonsteroidal anti-inflammatory drugs), such as ibuprofen and naproxen, helps in relieving pain and inflammation.[7]
  • Opioids, such as codeine, can be given for acute pain.
  • Muscle relaxants are also helpful.
  • Patient should try to guard the neck against extension, as this will make the pain worse.
  • Physical therapy, such as cervical traction, is helpful for persistent pain.

References:

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Tests to Diagnose Back Pain or Backache: Blood, Radiological Examinations

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Tests to Diagnose Back Pain or Backache: Blood, Radiological Examinations

Cost of providing treatment for backache and the life span has increased over last 5 decades. Backache is more common among elderly patients. Cost of treatment includes the cost of investigations to evaluate and diagnose the etiology of back pain. Backache is most often related to work injury, auto accident, and degenerative diseases. Investigations are precise and valuable to diagnose the cause, so appropriate treatment is provided. All back pain may not need most expensive investigations or frequent repetition of such investigation. Most of the investigations are considered when symptoms are exaggerated or area of symptoms has changed. Clinical diagnosis is considered as subjective expert conclusion and not objective finding. Subjective clinical diagnosis is different when two physicians examine same patient. One may diagnose a lower back pain as lumbar disc bulge and another physician may diagnose same symptoms as lumbar disc herniation. The difference in subjective diagnosis is eliminated when objective test is available like MRI. Both physicians will conclude same diagnosis based on the findings of MRI image.

Tests to Diagnose Back Pain or Backache

Why physicians often prefer to repeat MRI or any other investigation when symptom characters are changed? Question has multiple answers but most common reason is to see the objective evidence. Physicians are questioned by patient, insurance provider and legal communities regarding objective evidence of diagnosis. Patient wants the truth, insurance providers want to eliminate the added cost of investigation and legal community want to use the evidence to protect the interest of patient or third party. Investigation is the main source of debate and argument in legal issues. Investigations must be provided as objective evidence to protect patient and service provider like physician. The cost of providing medical treatment is increasing every year so does the quality of treatment and lifestyle.

How can the cost of investigation and treatment be contained? Preventing duplication of same investigation and avoiding unnecessary treatment can contain the cost. Similarly cost can be kept low if investigation is not repeated when symptom character or diagnosis is not changed. Investigations are repeated when patient decides to take second or third opinion. Consultant physicians often find it difficult to get the copy of past investigations. Difficulties are created by government guidelines like HIPPA violations, hospital or lab guidelines because of fear of HIPPA violation and guidelines of insurance providers. Insurance provider prefers to let the investigations be available to physician who is employed by insurance provider. Hospital or lab prefers to share investigation with physician who has hospital or lab privileges. Physician would not treat patient if objective evidence were not available.

Backache is caused by abnormalities of vertebral column, pinch nerve and autoimmune diseases. Diagnosis is important to conclude proper treatment. The lab and radiological studies performed to diagnose backache is as follows.

Tests to Diagnose Back Pain or Backache Include

Blood Examination:

  • Erythrocyte Sedimentation Rate (ESR)– ESR is increased when backache is caused by rheumatoid arthritis (autoimmune disease) and infection (epidural abscess, discitis or osteomyelitis).1
  • C-reactive Protein (CRP)– CRP is increased in patients with history of arthritis (osteoarthtis) or inflammation of joint disease (rheumatoid arthritis). Cytokins and related protein factors are elevated in early stages of rheumatoid disease. Cytokine factors are used as a marker to diagnose early stage of rheumatoid arthritis.1
  • White Blood Cell Count: Increased in patients with history of epidural abscess, arthritis, osteomyelitis or infections.
  • Rheumatoid Factors (RF)– RF is a protein molecule known as antibodies. Seventy to ninety percent of patients suffering with rheumatoid arthritis show presence of RF. RF test is often non-specific test, since RF is also present in patients suffering with other type of autoimmune disorders. Symptoms of Rheumatoid arthritis are less severe when RF is absent.
  • Citrulline Modified Proteins (anti-CCP)-Specific antibodies produced in rheumatoid disease prior to symptoms and during symptoms binds to Citrulline. The test is specific. Test is always positive in rheumatoid shoulder joint arthritis despite RF being absent. Anti-CCP predicts severity of rheumatoid arthritis and disease (RD) and also subclinical RD.
  • ANA Blood Test– ANA is a non-specific antibody test. Results are positive in all autoimmune disease.
  • HLA-B27 Genetic Marker– Test is positive in inflammatory joint diseases like Psoriatic Hip Joint Disease, Ankylosing Spondylitis and Reiter’s Syndrome.
  • Antineutrophil Cytoplasmic Antibodies (ANCA)– ANCA is an abnormal antibody seen in-patient with history of hip joint pain caused by Wegener’s granuloma. Blood examination for ANCA level is performed to rule out Wegener’s granuloma as a cause of hip joint pain.

Radiological Examination-

  • X-Ray: Assists in diagnosis of osteoporosis, fracture, dislocation, foraminal stenosis and degenerative disc disease.
  • Computerized Tomography (CT) Scan: CT scan is an important apparatus for osteoporosis, fracture, dislocation, foraminal stenosis, degenerative disc disease, herniated disc and soft tissue injury (tendon, muscle tear).
  • Magnetic Resonance Imaging (MRI): This is a frequently used investigation in diagnosis of backache. MRI is a reliable investigation tool in diagnosing osteoporosis, fracture, dislocation, foraminal stenosis, degenerative disc disease and herniated disc. Note: 40% of MRIs show bulging discs in asymptomatic patients. 20% cases with ruptured discs were never found on MRI.
  • Myelogram: Myelogram was a most frequent study performed prior to surgery in the past. Myelogram has been conducted less often as MRI studies became more frequent. Myelogram is an x-ray study in which a radio-opaque dye is injected directly into the spinal canal. Myelogram provides more reliable information of spinal stenosis and foraminal stenosis.
  • Ultrasound: Ultrasound provides information about blood clot or calcified stones. Ultrasound is used often to rule out arterial venous blood clots in lower legs.
  • EMG: Electromyography studies are performed to evaluate the nerve damage and radiculopathy.
  • Bone Scan: Measures calcium concentration in bones and helps in diagnosis of bone tumor, compression fracture and osteoporosis.
  • Bone Densitometry: For detecting osteoporosis.
  • Epidural or Cerebrospinal Fluid (CSF) Analysis– Epidural fluid or spinal (cerebrospinal) fluid is analyzed to diagnose epidural abscess, discitis, osteomyelitis or meningitis as a cause of back pain.
  • Ultrasound– Ultrasound study of back is performed to diagnose epidural abscess or hematoma.2

References:  

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Treatment for Back Pain or Backache: Medications, Manual Therapy, Interventional, Surgery

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Treatment for Back Pain or Backache: Medications, Manual Therapy, Interventional, Surgery

Treatment for Back Pain or Backache Include:

Treatment for Back Pain or Backache

Medication Treatment for Back Pain or Backache

  1.  Nonsteroidal Anti-inflammatory Drugs (NSAIDs) – Motrin, naproxen, Daypro and Celebrex.1
  2.  Tramadol – Ultram, Ultracet, Ryzolt and Conzip in USA, Ralivia in Canada.
  3.  Opioids:
  • Hydrocodone (vicodene, loratab and norco).
  • Oxycodone (percocete and oxycontine).
  • Morphine (Morphine IR: short acting and long acting).
  • Dilaudid.
  • Methadone.

4. Muscle Relaxants – Cyclobenzaprine (Flexeril), Soma, Skelaxin and Robaxin.2

5. Antidepressants:

  • Tricyclic antidepressants (Elavil)
  • Prozac
  • Trazodone (Desyrel)
  • Duloxetine (Cymbalta)
  • Milnacipran (Savella)

6. Anti-anxiety: Benzodiazepine.

7. Antiepileptic:

  • Gabapentin: also known as Neurantin.
  • Pregabalin: Also known as Lyrica.

Manual Therapy Treatment for Back Pain or Backache

  • Chiropractic Treatment: Spinal manipulation.3
  • Massage Therapy: Massage is manual massaging of superficial and deeper layers of muscles and connective tissue.
  • Physical Therapy or Physiotherapy: Physiotherapy is a manual therapy of muscles and joint. The therapy involves application of heat, ice, ultrasound and electrical stimulation, as well as some muscle-release techniques to the back muscles and soft tissues.

Interventional Pain Treatment for Back Pain or Backache

  • Cortisone Injection: Cortisone is injected in joint or soft tissue, which is a source of pain.
  • Trigger point injection is performed when pain is extremely severe and associated with severe muscle spasm.
  • Peripheral nerve block with cortisone injection.
  • Epidural Injection: Caudal, inter-laminar or transforaminal cortisone injections are performed for back pain localized in neck, mid back or lower back. Radicular pain is treated with epidural injection.
  • Sympathetic ganglion block for sympathetic pain.
  • Nerve ablation is performed using following method:
    1. Cryo-ablation
    2. Radiofrequency nerve ablation
    3. Chemical neuroablation using phenol
  • Spinal Cord Stimulator – Electrode placed in epidural space and generator placed in abdominal wall passes electrical stimulation passing through epidural electrode.
  • Intrathecal Pain Medication: Programmable pump delivers opioid pain medication in to cerebrospinal fluid (CSF) through catheter placed in CSF.
  • Botox Injection – Botox blocks the nerve stimulations to muscles and prevents muscle spasm.

Surgical Treatment for Back Pain or Backache

  • Nerve Decompression– Radicular pain caused by pinch nerve is treated by Microdiscectomy, percutaneous disc removal, discectomy and laminectomy.
  • Spinal Fusion– If radicular pain associated with back pain is caused by facet joint disease, then pain is treated by spinal fusion surgery or instrumentation of back. The vertebrae are splinted together with metal plates, screws or cages.
  • Removal of Tumors– If cancer or tumor mass causes pain by squeezing or pinching nerve, then one of the treatments is surgical removal of tumor.
  • Vertebroplasty – Body of vertebrae if fractured because of osteoporosis or trauma and causes severe pain then the symptom is treated by surgery. Surgery is insertion of cement to correct collapse vertebrae. Choices of surgical treatment are kyphoplasy or vertebraplasty.

Alternative Treatment for Back Pain or Backache

Several choices of alternative treatments are available. Most of these treatments are not scientifically evaluated. Patient who do not want to take opioids prefer to try alternative treatment. Also patient who had tried all conventional treatment and failed to achieve pain relief, prefer to try the choice of alternative treatments.

  • Biofeedback.
  • Electroacupuncture.
  • TENS (Transcutaneous Electrical Nerve Stimulation).
  • Magnet Therapy.
  • Homeopathy.
  • Ayurveda.
  • Aromatherapy.
  • Reflex.
  • Nutritional Medicine – Herbs, healthy eating, avoid caffeine.
  • Spiritual practice is used for chronic pain treatment.
  • Good sleep.
  • Mind-Body Practices: Pain may be felt less severe if individual can control body with mind.
  • Energy Manipulation Therapies: Alternative therapy teaches and enhances energy manipulations, which helps to reduce pain and also modulate endorphin resulting in increased pain tolerance.

References:  

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Signs and Symptoms of Back Pain or Backache: General, Radicular, Autonomic, Muscle Spasm

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Signs and Symptoms of Back Pain or Backache: General, Radicular, Autonomic, Muscle Spasm

Back pain is either neck, mid back or low back pain. Back pain lasting more than 3 months is considered chronic back pain.1 Back pain is caused by abnormalities of paravertebral muscles, facet joint and irritation of the spinal nerve. Paravertebral muscle spasm and facet joint abnormalities causes predominantly only backache. Irritation or pinch of spinal nerve causes backache and radicular pain.

Signs and Symptoms of Back Pain or Backache

Signs and Symptoms of Back Pain or Backache are:

1. General Symptoms

  • Insomnia– Patient is unable to sleep on back if backache is caused by paravertebral muscle spasm or facet joint arthropathy. Sleeping habits of lying on back or side may influence the triggering of pain. Insomnia is because of sudden occurrence of severe pain.2
  • Weight Loss– Patient suffering with severe back pain often complaints of loss of appetite resulting in loss of weight. Loss of weight is also secondary to inadequate food intake. Inadequate food intake is also secondary to narcolepsy caused by pain medications. Narcolepsy (sleeps all the time) results in decreased food intake and loss of weight.
  • Fever– Fever is rare with back pain. Fever is observed if back pain is caused by disc infection (discitis), osteomyelitis of vertebra or epidural abscess. Fever suggests infection.
  • Age– Severe back pain is common among elderly because of degenerative disease. Facet joint osteoarthritis is common among elderly and symptoms are equally divided in cervical (neck) and lumbar (lower back) spine.3
  • Loss of Appetite– Loss of appetite is secondary to pain and generalized degenerative disease. Loss of appetite and loss of weight are linked.
  • Nausea– Nausea is common because of opioid therapy. Nausea is also observed if cause of the pain is infection.
  • Thirst– Patient complaints of increased thirst. Increased thirst is secondary to side effects of the medications either opioid or muscle relaxants.
  • Constipation– Constipation is rarely caused by backache disease. Constipation mostly result from side effects of opioid therapy.
  • Tiredness– Severe pain and inactive life style causes tiredness. Tiredness is also caused by side effects of pain medications or muscle relaxants.

2. Radicular Pain

Radicular pain is either acute (lasting 3 to 6 months) or chronic (continues after 6 months). Radicular pain is caused by either irritation or pinch of the spinal nerve. Spinal radicular pain is divided in cervical, thoracic and lumbar segments. Radicular pain is also known as radiculopathy when associated with tingling, numbness or weakness.

Cervical Radiculopathy:

  • Cervical radicular pain travels along the cervical nerve in neck, shoulder and upper arm.
  • Pain may or may not be associated with tingling, numbness and weakness of upper extremity. Pain radiates along C5, C6, C7 and C8 nerve distribution.

Thoracic Radiculopathy:

  • Thoracic radicular pain is also known as intercostal neuralgia.
  • Pain is spread along the intercostal nerve mostly localized under the ribs.
  • Intercostal muscle weakness is difficult to diagnose during clinical examination.

Lumbar Radiculopathy:

  • Symptoms are observed along L1, L2, L3, L4 and L5 Nerves.
  • Chronic pain symptom may be associated with sensory abnormal symptoms like tingling and numbness.
  • Severe pain may be associated with abnormal motor symptoms like muscle weakness or abnormal joint reflexes.
  • Pain may be distributed in one or more than one segment of lumbar spinal nerve.
  • Weakness is observed in thigh, calf or feet muscles.
  • Numbness and weakness in thigh muscles suggest L2 nerve is pinched or irritated. Similarly tingling, numbness or weakness with pain in knee joint and calf suggest L3 and L4 nerve abnormality.
  • Weakness is also observed during ambulation and movements of lower extremities.

3. Tingling and Numbness

  • Tingling– Tingling is caused by irritation or pressure over sensory nerve. Tingling symptoms following pain suggest nerve is pinched and treatment may improve the function of the nerve.4
  • Numbness– Numbness could be permanent abnormality. Early treatment of the cause of the numbness may improve the symptoms. Severe pressure, squeeze or ischemia causes numbness and immediate removal of cause may prevent permanent numbness.

4. Weakness in Extremity

Weakness in upper or lower leg indicates abnormal function of motor nerve in neck and lumbar dermatome. There are 8 nerves in neck and 5 in lumbar dermatome. The weakness of particular muscles can guide the area of pinch nerve.

5. Autonomic Dysfunction

Bowel and bladder functional disturbances such as urinary and bowel incontinence are observed in few cases suffering with lower back pain.

6. Muscle Spasm

  • Muscle spasm is observed in neck, mid back, lower back, upper or lower extremities. Spasm may be associated with weakness.
  • Symptoms in specific muscles depend on the particular nerve injury. Location: Neck, mid-back or lower back.

7. Facet Joint Pain

  • Facet joint pain is observed following degenerative bone disease or osteoarthritis of the joint.
  • Pain may be secondary to trauma causing injury to joint or ligaments.
  • Pain is localized over the diseased facet joint.
  • Pain is frequent, predictable and recurrent.
  • Pain is associated with tender spots over the joint in neck, mid back or lower back.

8. Pain Caused By Ligamentum Flavum Hypertrophy

  • Ligamentum flavum hypertrophy is more often seen in male than female.
  • Seen in middle to old age male population, rare in younger patients.
  • Symptoms are localized over the dermatome of neck, middle back, or lower back.

Dermatomal Distribution of Symptoms:

Cervical Lesion-

  • Neck
  • Shoulders
  • Arms
  • Forearm
  • Hands
  • Fingers

Midback Lesions-

  • Chest wall
  • Intercostal nerve.

Lower Back Lesions-

  • Buttocks
  • Thigh
  • Lower back
  • Legs
  • Feet
  • Toes.

References:  

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Pathophysiology of Back Pain or Backache: Radicular, Muscular, Facet, Referred, PRS

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Pathophysiology of Back Pain or Backache: Radicular, Muscular, Facet, Referred, PRS

Backache is caused by trauma, inflammation or nerve injury. A pathophysiological change in nerve, muscles, ligament, and joint of spinal canal causes chronic backache.

Pathophysiology of Back Pain or Backache

Pathophysiology of Back Pain or Backache:

  • Radicular Pain: Chronic pain caused by pinched nerve or irritation of the nerve at nerve root close to spinal cord or at foramina before its exit from the spinal canal.1 Radicular pain is associated with tingling, numbness or weakness. Pain, tingling and numbness are symptoms of sensory nerve injury called as radiculopathy. Sensory symptoms are associated with weakness if motor nerve is irritated or squeezed.
  • Muscular Pain: Backache is also secondary to muscle spasm, muscle strains (pulled muscles) and tear in the back muscles. Backache is often observed in fibromyalgia and myofascial pain syndrome.2
  • Facet (zygapophysial) Joint Pain: Facet joint pain is seen in older patients suffering with degenerative disk disease and in individuals following surgery or motor vehicle accident.
  • Ligamentum Flavum Hypertrophy: This is observed after trauma, whiplash injury and surgery.
  • Posterior Ramus Syndrome (PRS): Also recognized as Maigne syndrome or thoracolumbar junction syndrome. Cause of unexplained activation of the posterior ramus of thoracolumbar nerves is unknown.
  • Referred Pain – Visceral pain from stomach, pancreas and kidney disease is often referred to lower back and mid back3:
  • Pregnancy: Chronic low backache is a common complaint in second and third trimester.
  • Spondylosis: Spondylosis occurs following thinning of the intervertebral discs because of loss of moisture and disc volume with age. Minor trauma under these circumstances causes inflammation and nerve root impingement, which can produce classic sciatica like pain without disc rupture.
  • Metastatic Cancer: Metastasis of primary cancer of breast, lung, prostate, or colon is very often detected in the vertebral column. Tumor located on the spine may press against a nerve, resulting in radicular and back pain. Tumor may invade into facet joints and present symptoms like facet joint pain.4
  • Spinal Stenosis: Narrowing of the spinal canal is called spinal stenosis and narrowing of foramina is called foraminal stenosis. Spinal stenosis eventually may cause spinal cord compression within the spinal canal. Spinal cord compression will result in symptoms of cauda equina syndrome.
  • Foraminal Stenosis: Spinal foramen acts as a conduit to pass spinal nerves at each segment to distal organs. Foraminal are narrowed by protrusion of thick ligaments, facet joint hypertrophy, bony spurs and intervertebral disc herniation. Foraminal stenosis will squeeze the nerves causing pinched nerve symptoms.
  • Spondylolisthesis: Also known as slipped disc or subluxation of the vertebrae.5 Anterior or posterior displacement will cause facet joint injury and dislocation as well as spinal stenosis.
  • Degenerative Disc Disease: This is mostly observed in older patients. Thinning of discs causes foraminal stenosis and disc herniation.
  • Disc Bulge and Herniation: Bulged disc is a result of protrusion of the jelly like central portion (nucleus pulposus) of the disc. Bulged disc pushes against a nerve root causing symptoms such as tingling, numbness and weakness in the dermatome of the injured nerve and group of muscles.
  • Fracture of Vertebrae: Pain, numbness and weakness may be secondary to pinched nerve or spinal cord compression. Weakness, paralysis and autonomic dysfunction (bladder and bowel dysfunction) indicate spinal cord injury. Severe whiplash injury or fall can cause fracture and dislocation.
  • Long-Term Steroids: Steroid treatment for long term will cause osteoporosis and osteoporosis may cause fracture of the vertebrae. Fractured vertebrae may lead to severe intractable chronic pain as described earlier.

References:  

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Causes and Risk Factors of Back Pain or Backache

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Causes and Risk Factors of Back Pain or Backache

11 Causes of Back Pain or Backache:

Causes and Risk Factors of Back Pain or Backache

  1. Discogenic Back Pain: Bulged disc, herniated disc, degenerative disc disease can cause severe back pain or backache.(1)
  2. Musculoskeletal Back Pain: Facet joint pain, para vertebral muscle spasm can also cause pain in the back.
  3. Back Pain Caused by Infection: Discitis, facet joint arthritis and osteomyelitis.
  4. Injuries or Traumatic Back Pain: Whiplash injury after automobile accident or a fall may cause back pain
  5. Fracture:
    • Fracture of vertebrae, facet joint, lamina, transverse process or spinous process causes back pain.(2)
    • Tear and Sprain of synovial membrane, ligaments and muscles can result in backache.
  6. Dislocation Resulting in Back Pain: Person can experience pain in the back if there is dislocation of facet joint.
  7. Back Pain Caused By Metastasis: Primary Cancer of the breast, lung or prostate are known to cause backache.
  8. Bone Disease: Medical conditions like osteoporosis, scoliosis, spondylolisthesis, rheumatoid arthritis, osteoarthritis, ankylosing spondylitis and spinal stenosis can cause chronic back pain.
  9. Systemic Disease: One can have acute or chronic back pain if they have endometriosis, kidney disease, fibromyalgia, chronic fatigue syndrome and muscle pain.
  10. Failed Back Syndrome: Pain may persist after back surgery secondary to following causes:
    • Recurrent disc herniation.
    • Surgical injuries to facet joint.
    • Facet Joint: Hyper mobility, joint instability.
    • Muscular Deconditioning.
    • Fibrotic scar tissue of surrounding nerves, ligaments, muscles and joint.
  11. Pregnancy: There can be chronic low back pain during pregnancy secondary to following causes
    1. Stretching of the ligaments and muscles within the pelvis.
    2. Nerve irritation.

Risk Factors for Back Pain or Backache:

  • Diabetes, type 2.
  • Obesity
  • Stress: Physical and emotional stress secondary to family and job dissatisfaction can be a factor for back pain.
  • Pregnancy: Pregnant women are much more likely to experience backache.(3)
  • Sedentary lifestyle and lack of exercise is known to be a factor for back pain.
  • Age – Older adults are more susceptible to back pain than young adults or children.
  • Gender – Back pain is more common among females than males.
  • Smoking: It can not only cause cancer, but can also cause back pain.
  • Strenuous physical exercise (especially if not done properly) or work: Lifting heavy weights in wrong posture can cause injury to the back.
  • Peripheral vascular disease.

References:  

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Classification and Types of Back Pain or Backache: Somatic, Osseous, Referral

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Classification and Types of Back Pain or Backache: Somatic, Osseous, Referral

Back Pain or Backache Can be Classified as:

Classification and Types of Back Pain or Backache

Somatic Back Pain or Backache

  • Superficial: Localized in skin and subcutaneous tissue e.g. skin abscess, laceration, incision, contusion, hematoma and hair follicle infection.[1]
  • Deep: Localized in muscles and tendon e.g. muscle tear, muscle injuries, severe spasm, myofascial pain and fibromyalgia.[1]

Osseous Back Pain or Backache

  • Disc: Discitis, herniation and bulge.
  • Facet Joint: Arthritis, joint injury, joint hypermobility, joint instability and joint hypertrophy.
  • Vertebral Body: Metastatic tumor and fracture.
  • Foramina: Stenosis, fracture of pedicle and lamina, encroached by tumor mass.
  • Fracture: Body of vertebrae, transverse process and spinous process.[2]

Back Pain or Backache Caused by Nerve Lesion

  • Radiculopathy: Pinched nerve at foramina secondary to stenosis or tumor encroachment, bulged disc or herniated disc pinching the nerve.[3]
  • Spinal Stenosis: Spinal canal is narrowed secondary to facet joint hypertrophy, ligamentum flavum hypertrophy, disc bulge and herniation, subluxation of vertebrae due to tumor mass compromising the spinal canal.[4]

Referral Back Pain or Backache

Pain caused by diseases in distant organs may be felt (referred) in back (neck, mid back and lower back) as a backache. Many disorders within the abdomen, such as appendicitis, aortic aneurysms, kidney diseases, kidney infection, bladder infections, pelvic infections, and ovarian disorders among others, can cause pain referred to the back.[5]

References:

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Back Pain And It’s Effects on Economy and Work Productivity

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Back Pain And It’s Effects on Economy and Work Productivity

Back Pain And It’s Effect on Economy

In USA 65 million Americans have experienced back pain at least one time. Chronic back pain is observed in 16 million adults in USA at a given time. Healthcare cost incurred for investigation, lab study, treatment and disability payment is close to 12 billion dollars every year. Loss of income for not being able to work is close to 50 billion dollars per year. Back pain influences ability to work and also results in higher healthcare cost.(1)

Back Pain And It's Effect on Economy

Back pain in younger patient is caused by injury. Injury is caused by auto or work accident and domestic fall. In case of auto and work accident, cost of treatment is shared by auto insurance and workman’s compensation. Personal private insurance or Medicaid assumes cost of treatment of young individual following domestic fall if patient is uninsured. Back pain is also common among elderly population. Back pain in older patient is mostly caused by degenerative diseases. Medicare pays cost of treatment of elderly patients. Increased spending by Auto insurance and Workman’s Comp for treatment of back pain raises insurance premium. The increased cost is shifted to healthy individuals. Increased spending by Medicare and Medicaid for treatment of back pain is deducted from tax revenue.

Back Pain Effects on Work Productivity

Chronic back pain has major impact on work productivity.(2) Decline in work productivity has been observed secondary to sick leave, restricted work, and secondary gain due to injury. Up to 90% of people experience an episode of back pain without other health concerns and these symptoms will decrease or disappear on their own within one or two months. During this period patient may be referred to several physician and may undergo several investigations. Young and elderly suffer with back pain, though the cause of back pain is different. Back pain in younger population is caused by sports injury, automobile accident and work accident. Young population studies have indicated chances of early improvement and better early recovery by staying active and avoiding more than a few days of relative bed rest. According to the NHS (National Health Service)-UK, back pain is the largest cause of work-related absenteeism in the United Kingdom. Although back pain may be painful and uncomfortable, it is not usually serious and is not a life threatening disease. Cost of treatment for back pain includes cost of investigation, physician fees, hospital cost, lab studies and legal fees.

Treatment of back pain includes medications, chiropractic treatment, physical therapy, acupuncture, interventional pain therapy and surgery. Apprehensive patient may see multiple physicians and may demand several investigations to identify the cause of pain to his satisfaction. Demanding patient with low pain tolerance may drive cost of investigation and treatment higher. While patient with tolerance to pain and suffering may delay the treatment or may even avoid seeing multiple physicians, which will result in lower cost of treatment. Most of the cause of back pain is treated for symptomatic relief. The most unpleasant symptoms, which results from back disease along with pain are tingling, numbness and weakness in lower leg. Symptoms of tingling, numbness and weakness causes apprehension and worries. Patient demands the relief of associated symptoms hoping he or she may be paralyzed and bed ridden for rest of the life. Wide range of treatment choice available for back pain often results in trial of multiple treatments in short period of time thus increasing cost of treatment. Epidural injection is performed with and without hyaluronidase medications. Addition of hyaluronidase with cortisone had increased cost of treatment but valued benefits were not observed.1

Spending for investigation and treatment of back pain is much higher when compared to other common diseases. The reason for higher expenses is probably addition of cost of multiple treatments, which is provided to patient simultaneously and repeated several time. This retrospective study by Hart OR suggest higher resource use for management of back pain.2

The single therapeutic beneficial treatment for low back pain is yet unknown though scientist and medical specialist have tried several conservative and invasive treatment. Insurance providers have expressed their concern about increased cost of treatment of back pain, but avoided any research funding. American academy of pain medicine has expressed the concern of prevalence of chronic pain and annual cost in lost productivity. Patient and families have expressed the concern regarding loss of income and family hardship. The capital market drives on profit and loss. Profits are decreasing as salaries and bonuses have skyrocketed.

Medical equipment manufacturing companies, pharmaceutical industries and hospitals have increased the cost of their services and product. Insurance companies also want to increase profit by decreasing expenses. Expenses are shifted to patient by increasing co-pays and deductible. Insurance provider hopes patient will avoid or postpone the treatment. Insurance companies have created several layers for physician to get approval for lab or radiological studies and treatment.

Young male or female patients worry of back pain following auto, work or domestic accident. He or she is worried about loss of wages, job, how to pay for domestic expenses, co-pays, deductible and getting out of misery of back pain to go back to work. Physicians and hospitals are worried about how to get pre-authorization for investigations and treatment. Insurance companies are worried about increased cost of treatment and decreasing profit. Best outcome for young patient is to resume his work with no or less pain and for elderly patient is to continue with outdoor activities.

References:

  1. https://www.ncbi.nlm.nih.gov/pubmed/15062712
  2. https://www.ncbi.nlm.nih.gov/pubmed/15257978
  3. Epidural lysis of adhesions for failed back surgery and spinal stenosis: factors associated with treatment outcome.
    Hsu E1, Atanelov L, Plunkett AR, Chai N, Chen Y, Cohen SP. Anesth Analg. 2014 Jan;118(1):215-24.
  4. A study of National Health Service management of chronic osteoarthritis and low back pain.
    Hart OR1, Uden RM2, McMullan JE3, Ritchie MS4, Williams TD5, Smith BH6.
    Prim Health Care Res Dev. 2014 Mar 27:1-10.

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