Articles on nerve

Sciatic Nerve Pain?

Dr. Sunil Kumar Tank (PT), Physiotherapist
DEFINATION OF SCIATICA PAIN-The medical name of sciatica pain is known as Radiculopathy. Sciatica pain is also is caused by compression of a spinal nerve root in lower back. It can be often cause owing to degeneration of an intervertebral disc. Sciatica pain affects the back, hip, and outer side of the leg. It also describes signs of leg pain and may be due to numbness, tingling, and weakness that originate in the lower back and reaches the distance between the buttock and down the large sciatica nerve in the back part of the leg.Sciatica pain is not a disease in itself, it is a symptom of medical basis of medical condition, such as degenerative disc, lumbar herniated disc, or spinal stenosis. It is a pain in the lower extremity resulting from irritation of the sciatic nerve.Sciatica pain can transform to constant and incapacitating from irritating and infrequent. There are different sciatica symptoms and severity in different location based upon the condition causing the sciatica like spinal stenosis or lumbar herniated disc.Different situation of pain can be observed in different people. It can be severe and debilitating for some people and can be infrequent and irritating for others, also it can become worse and feel like burning sensation or like a jolt or electric shock.Almost 90% of the sciatica situation is due to spinal disc herniation pressing on one of the sacral or lumbar nerve roots. Other diseases which can be responsible for sciatica pain are spinal stenosis, piriformis syndrome, spondylolisthesis, pelvic tumors and also during pregnancy. SYMPTOMS OF SCIATICA PAIN-Tingling or burning in lower part of leg.A nonstop pain on one side of the rear.While sitting worse pain in the leg or rear.Difficulty in standing due to a shooting pain.One sided pain can be felt in lower body which extends from lower back to back of thigh and down through leg.Numbness and Muscle weakness in the affected leg or foot.CAUSES OF SCIATICA PAIN-Disc degeneration occurs with aging which irritate nerve root and causes sciatica pain.Lumbar herniated disc which occurs when the soft inner core of the disc leaks out is also a most common symptom of sciatica pain.Due to a narrowing of the spinal canal, Lumbar Spinal Stenosis occurs which commonly causes sciatica.When the nerve can get pinched cause of Isthmic Spondylolisthesis, Sciatica pain can get occurred.Due to Piriformis Syndrome, when the piriformis muscle pinches a nerve root which comprises the sciatic nerve, and can cause Sciatica pain. When the irritation of the sacroiliac joint which can also irritate the L5 nerve, can also occur sciatica pain.During Pregnancy , Sciatica type of pain can be felt.Due to being overweight ,not exercising regularly, Sciatica pain can occur.Due to wearing high heels.Due to sleeping on a mattress that is too soft.The roots of the sciatic nerve may get compressed due to Tumors within the spine.Due to the infected spine.Due to the injured spine. DIAGNOSIS AND TESTS FOR SCIATICA PAIN-PHYSICAL DIAGNOSIS:-Checking muscle strength and reflexes.L.R ( straight leg raising )Painful ROMIMAGINARY DIAGNOSIS:-– MRI: With the help of a powerful magnet and radio waves, the MRI  produces cross-sectional images of your back. Also gives a detailed images of soft tissues and bone.– X-Ray: With the help of an X-Ray machine, an overgrowth of bone that may be pressing on a nerve can be diagnosed.– EMG: With the help of an Electromyography the electrical impulses produced by the nerves and muscles are responded. It confirms the nerve compression caused due to narrowing of your spinal stenosis.– CT Scan: In the procedure called CT Myelogram, a contrast dye injected into your spinal canal, which circulates around spinal cord and spinal nerves, appears white on the scan.HOME TREATMENT FOR SCIATICA PAIN-You can use hot and cold compresses alternately. Due to hot packs, tense muscles relaxes which may compresses.With the help of cold ice packs, the swelling around the nerve reduces and numbs the pain.Massage can be helpful in reducing sciatica pain and helps the body to heal the sciatica pain by itself.Turmeric is also used for its anti-inflammatory properties. It can be used to reduce inflammation and nerve pain.Cayenne pepper can be also which contains an active ingredient known as capsaicin which can be used as a natural pain relievervisit my website for  Exercise & physiotherapy treatment :- www.thephysiopoint.com

Coccydynia / Tailbone Pain

Dr. Rajveer Singh, Physiotherapist
“WHEN STANDING BECOMES EASIER THAN SITTING AND WALKING IS EASIER THAN SITTING IN A LUXURY CAR. IF YOU ARE NOT TAKING CARE TODAY, THEN TOMORROW YOU MIGHT PREFER TO WORK IN STANDING POSITION”.In this fast paced life, we often neglect our health until it significantly impair quality of life and we loose hope when pain becomes unbearable.Coccydynia/Tailbone pain, is a pain in coccyx bone or end part of spine, usually bought by sustain pressure or accidental pressure on coccyx by various reasons like-Sitting abruptly for prolong periods (Like IT industry and sitting professionals)Fall on buttocks like steps, bathrooms etc. Accidental injuries like bike or car accidents.Sports injuries like cycling, skiing, football, volleyball etc.Post pregnancySymptoms-Pain intensifies during and after sitting.Acute pain while moving from sitting to standing.Pain worsens by sitting on soft or hard surfaces.Deep ache around the coccyx.Sensitivity to finger pressure on tip of tailbone and sometimes rectal burning.Pain during and after bowel movements.Pain during sexual intercourse, either men or women.Pain increase during menstrual cycle.With coccydynia sometimes patients experiences sitting on knife or on pebbles that moves around. As the day progresses pain is felt while lying supine or straight and even during walking.There are some similar conditions where pain in coccyx can occur and it may not be coccydynia, therefore its better to have differential diagnosis done like-Pilonidal Sinus, Pudendal Neuralgia, Piriformis syndrome, S.I Joint Dysfunction etc.    

FAQs of Sciatica!

Dr. Vishwas Virmani, Physiotherapist
What is meant by sciatica?Sciatica means pain originating from the back and radiating down to the lower limbs. This pain is generally caused by bending forwards, lifting weights, coughing, sneezing, straining at stools, etc. This is the classical form of sciatica. This type of pain is generally seen in younger and middle-aged individuals. There is another form of leg pain, termed neurogenic claudication. This refers to pain, discomfort or heaviness classically noticed in the calf region or sometimes in and around the buttocks, on walking for some distance or standing for some time. This kind of pain may or may not be associated with any kind of low back pain. It is classically noticed in middle-aged and older population, who may unknowingly and incorrectly attribute this pain to age-related weakness!!What are the causes of sciatica?Sciatica and neurogenic claudication can be caused by causes within the spinal canal and outside the same. Causes within the spinal canal include slipped disc, bone overgrowth, slippage of one bone over the adjacent one or rarely, due to some kind of growth within the spinal canal. What is a slipped disc? Our spine is made up of a number of bones called vertebrae stacked one on top of another. A disc is a soft, gel-like structure present between two adjacent vertebrae. Normally, these discs act like shock-absorbers and also allow some movement between the two adjacent vertebrae, giving the spine its flexibility. When this disc slips beyond its normal confines, it can compress the spinal cord or its nerve roots located close by and lead to problems. Why does the disc slip out? Over the years, the disc develops small microscopic tears, which may unite together over a period of time such that with some trivial injury or some innocuous activity, the disc may slip out of its normal confines. As a part of the normal aging process, the spine may develop some extra bone growth, leading to compression of the adjacent spinal cord or its nerve roots leading to pain. Why is the pain noticed in the leg, when the disc has actually slipped out in the spine? When you press the switch at home, the tube-light that is located away from the switch goes on; on a similar rationale, whenever there is compression of the nerve root in the spinal canal, the pain is noticed elsewhere! It is because our brain is conditioned to perceive sensations in a particular way! Also, considering the same example for comparison, if the tube-light does not go on after pressing the switch, there could be something wrong with the switch, the intervening wires or the tube-light itself! So, any compression or problem affecting the nerves after they leave the spinal canal can also lead to sciatica. The most common condition that can affect the nerves after they leave the spinal canal is peripheral neuropathy, a condition wherein the nerves are weakened secondary to diabetes, chronic alcoholism, smoking, other forms of tobacco consumption, nutritional deficiencies, and other rare causes. A common complaint in patients with peripheral neuropathy is the presence of pain even at rest; a pain of a burning nature or numbness in glove and stocking distribution i.e. over the hands, just beyond the wrist joints and over the lower limbs, just beyond the knee joints. Additionally, as regards neurogenic claudication, compromise of the blood vessels that supply the legs can also lead to leg pain. How does the doctor diagnose the exact cause of sciatica?An accurate history is the most important diagnostic tool. The way the pain started and progressed; specific aggravating and relieving factors of pain; distribution of pain over your body, associated complaints such as weakness or numbness over the lower limbs will be a guide to short listing the possible causes of your low back pain and sciatica. A very important history relates to the difficulty in controlling or passing urine. A detailed clinical examination involving assessment of spinal motion, assessment of your neurology and certain special tests will allow to further narrow down the causes to 2-3 most probable ones. Though this process of history-taking and clinical examination may appear boring and long-drawn, it is the most crucial part towards prescribing the correct treatment for you. So, it is essential to cooperate with your doctor throughout this entire procedure, which gives more information to the doctor regarding your ailment than any other investigation on earth. How does the doctor investigate for sciatica?On the first visit, if your problem is short-lived and there are no major signs or symptoms, you may not need any further investigation. However, if your problem has been present for some time, or if there is some history of trauma, fever, any other major illness, or any notable findings on clinical examination related to neurological dysfunction; you are likely to require some further investigations. Commonly, plain x-rays of the spine may be ordered with or without some basic blood investigations such as hemoglobin, erythrocyte sedimentation rate [ESR], CRP, RA test, serum calcium, phosphorus and alkaline phosphatase. Based on these tests, or sometimes, in the presence of some very significant signs or symptoms, you may be asked to undergo MRI scanning. Plain x-rays demonstrate bony features; while MRI demonstrates the spinal cord, its nerve roots, the intervertebral disc between the two bones of the spine. Both these tests are complementary in nature; doing one does not necessarily mean that the other one is not needed. In some cases such as peripheral neuropathy, additional investigation in the form of EMG-NCV test, to assess the function of each of the various nerves in your limbs may be required. Rarely, a Color Doppler examination of the lower limb blood vessels may be asked for. Is there any nonsurgical treatment for sciatica?The treatment would depend on the duration of your problem, the presence of similar episode in the past, neurological function, response to previous nonoperative treatment and lastly, the subjective severity of your pain. Various nonoperative means of treatment include bed rest, painkillers, muscle relaxants, various modalities such as heat and electrical stimulation, activity restrictions, etc. During the acute period of sciatica, complete bed rest is helpful. If you sprain one ankle, you can hop on the other one and still continue to walk. But you have only one spine!! So, the only way to give rest to it is to go to bed! Among all the positions; sleeping, sitting, standing and walking, the load on the spine is least in the sleeping position. How should you sleep? You should sleep on your side, either right or left, whichever is comfortable, with a pillow in between your legs. What kind of bed should you sleep on? A cotton mattress is ideal! No need to sleep on hard beds, nor do you need to fall for any kind of so-called spine-friendly expensive mattresses sold out in the market! This bed rest should be for a period of 2-3 days. During this period, you should eat, drink and sleep in the bed. Only sponge bath is allowed. Ideally, you should not get up even to visit the washroom; you should use a bedpan or urine-pot. However, if this is too much of an inconvenience, you may be allowed to get up to use the washroom alone. How long should you take bed rest? If the pain has to respond to bed rest, it will do so within 2-3 days; continuing beyond this much time only further weakens your spinal muscles without really decreasing your pain; in other words, beyond 2-3 days, complete bed rest will do more harm than good to your back. Painkillers will be prescribed to allow a smoother and easier return to normal function. You would generally be prescribed these on a shorter term or on a longer-term tapering program so as to guard against possible over dependence on these agents, as these are associated with significant side effects if used excessively in the long term. These side effects may range from hyperacidity, gastric ulcer, kidney damage, bleeding disorders, constipation, addiction, etc.In addition, based on individual merit, you may also be prescribed muscle relaxants so as to relax and soothe your back muscles. This is so because whenever you have neck or back pain, your muscles tend to go into spasm [sustained contraction] and hence, lead to pain. It is essential to break this spasm with a muscle relaxant so as to give effective pain relief. Physiotherapy modalities may be used. This consists broadly of passive and active physiotherapy. During acute pain, generally, only passive physiotherapy would be used. This would be in the form of heat in various forms or electrical stimulation in various forms. Since complete bed rest has a more scientific role in relieving your back pain, in the acute phase of your back pain, it would not be recommended for you to travel every day from home to the hospital for purposes of physiotherapy; unless of course, if you are admitted in to the hospital for complete bed rest! In this case, you could get the additional benefit of physiotherapy modalities such as SWD [short-wave diathermy], TENS [transcutaneous electrical nerve stimulation] and IFT [interference therapy]. After pain relief, you would be prescribed active physiotherapy i.e., spinal exercises. Based on whether you have pure sciatica or neurogenic claudication, your exercise protocol would be decided by the doctor. Though complete bed rest would be prescribed only for 2-3 days, you would need to have some activity restrictions to help your spine get back into shape and stay that way!! You would not be allowed to bend forwards; sit on the floor; lift weights; use the Indian type of commode [toilet-chairs are available on rental basis as well as on sale in many medical shops]; travel [particularly not on 2 and 3 wheelers]; and smoke. These restrictions would be generally enforced for a minimum period of about one month. Smoking would be forbidden lifelong! When is surgery essential?Surgery would be indicated when there is no pain relief despite symptomatic treatment as mentioned above or when there is a significant neurological deficit or, repeated episodes of sciatica so as to get a permanent solution to the problem. What is the nature of surgery?Microdiscectomy is the usual surgery for sciatica. This is a surgery performed through the microscope so as to make this a relatively safer procedure. Is it a major surgery? We were told that we should not get a spine surgery done as it can lead to loss of control of urination and defecation! Or, in other words, what are the risks involved? Even if you are walking out on the streets, you never know when some vehicle will come from behind you and knock you over! So, would you stop walking on the street for fear of this risk? Everything in life carries some inherent risk associated with it. The option for surgery would be offered only if the benefits of surgery significantly outweigh the risks. Rather than asking as to what are the risks of going in for surgery, it would be more prudent to ask as to what are the risks and benefits of getting the surgery done as compared to not getting the surgery done? Spine surgery has had a lot of advances in the past decade or two; there are better imaging facilities like MRI, better surgical instruments, surgical microscope to aid vision in the surgery, computer navigation system to further increase the safety level of surgery, better training and information in an overall sense making spine surgery no longer the taboo that it once was! So, if you have a problem that genuinely requires surgery, there is no point in tying yourself down to the bed for days or months on end; because ultimately life is mobility and mobility is life! Discuss the details of your surgery and its attendant risks with your doctor to quell any fears and to clear any and every doubt of yours! If you so desire, your doctor can even arrange to give you references of patients who have undergone similar surgeries. Can we not replace the disc back into its place; in other words, won't it be harmful to remove the disc? The disc that has slipped out can no longer carry out its normal function; rather, it is causing harm to the body rather than doing anything good! So, trying to replace the disc back into its position is not a viable option. If the disk is badly damaged and if the back pain is more severe than the leg pain, then there remains the option of replacing the damaged disk with an artificial disk. How is the postoperative recovery and rehabilitation?Generally, you would be admitted one day prior to the day of surgery. You would be advised to stay starving after the dinner the previous night. Surgery would generally be carried out the next day morning. After the surgery, on the 2nd day, you would be made to walk with a lumbosacral belt. You would be discharged after 3-4 days. Sutures [stitches] would be removed generally on the 10th day following the surgery. By this time, you would be walking around and essentially be independent in doing activities of daily life. You would be allowed to take bath 48 hours after the suture removal. For 3-4 weeks, you would be allowed restricted mobilization within the house. During this period, you would be encouraged to increase your activities by weekly increments. 1 month later, you would be started on spinal strengthening exercises. 3 months later, you would be started on spinal stretching exercises. For 3 months at least, you would not be allowed to bend forwards, lift up weights, travel on 2-wheelers/ auto rickshaws/ jeeps, sit on the floor, or use Indian type of toilet commode. You would have to use the lumbosacral belt for a month at all times other than lying down and while taking bath. Continuing to wear the belt beyond one month after surgery would only weaken your muscles and it is hence, recommended to wean yourself off the same thereafter. Towards this end, you would have to take off the belt for 2 hours in the day time in the first week [after having completed one month following the surgery], for 4 hours in the day time in the second week, for 6 hours in the third week and so on. You would not be allowed to smoke for lifelong! Will I be able to return back to work after the surgery?Though you would be up and about, walking about within the first ten days following the surgery, you would be allowed only limited mobilization within the house in the first one month following surgery. Thereafter, if you are having a sedentary light job, then you may be allowed to resume work, provided you do not have to travel for a prolonged time on some bumpy road(s). If you were having some job that required some moderate labor, you would be allowed to resume work about three months after surgery. If you were involved in heavy manual labor, it would be wiser to seek some permanent job modification in these situations. Staying off work for more than three months post-surgery is not recommended at all. What about newer surgical techniques such as laser discectomy, endoscopic discectomy, disc replacement, etc.?Microscope allows for the use of both eyes while working, giving binocular vision and thereby, good depth perception that is essential for the safe performance of these surgeries. This binocular vision is lacking in endoscopic discectomy. Percutaneous laser discectomy has not been proven to be scientifically superior to microdiscectomy. Long-term scientific studies regarding the efficacy of endoscopic and percutaneous laser discectomy techniques have failed to show any significant advantage over conventional techniques. Disc replacement is a promising new technology that helps replace the damaged disk with a new artificial disk that simulates the normal disk. This surgery is generally offered to patients who have significant back pain with or without leg pain. Generally, patients with a sedentary lifestyle are best suited to this type of treatment. It is a better and more physiological surgical solution rather than the more prevalent option of inserting screws and rods to fix the spine and lose spinal mobility thereby. Several scientific studies have been published reporting the safety and efficacy of disk replacement.

Stretch Nerve Instead!!!

Dr. Swapnil Mate, Physiotherapist
You have heard about people stretching their muscles when the muscles are tight, but have you heard about nerve stretching?What exactly is nerve stretching? Why do we need to stretch our nerves? How do we stretch our nerves?Nerve stretches do not really 'stretch’ the nerves, but they help to improve the movement of the nerves through the joints and muscles by improving their ability to slide and glide. Like our muscles, the nerves in our bodies can also become tight. It can be due to staying in a position for too long, or due to tightening of muscles around the nerves.Nerve stretches can reduce the tightness in the nerves and also help relieve pain that is associated with tight nerves. There are some simple to do nerve stretches that you can perform on your own for the nerves in your arm. Upper Limb Consist on 3 Major Nerve which serves entire your arm from neck region - these are as follows.Median Nerve StretchMedian nerve is the nerve that runs along the palmar side of our wrist and can sometimes be compressed in the wrist resulting in a condition called Carpal Tunnel Syndrome (CTS). Persons with CTS normally complain of tingling or numbness in the thumb and fingers, in particular the index and middle fingers.To stretch the median nerve, place open palm on wall with finger tips pointing away from trunk and parallel to the floor. Rotate trunk away from wall keeping the elbow straight and feel the stretch in arm and forearm. Return to the starting position and repeat on the other side.Radial Nerve StretchThose with radial nerve tightness may experience numbness, pins and needles or pain on the upper arm, elbow and outside half of the thumb.To stretch out the radial nerve, clasp hands palm to palm, keeping the arms facing inwards with elbows straight, and lifting the hands overhead. Return to the starting position and repeat.Ulnar NerveThe ulnar nerve is also commonly known as the “funny bone” nerve. Prolonged gaming can sometimes stress the ulnar nerve and cause pain at the wrist.To stretch the nerve, place thumb and index finger together to form a circle while keeping the other fingers straight. Place your straight fingers, palm up, around your chin and bring your “circle” up to your eyes to form a mask. Return to starting position and repeat.Sciatic Nerve StretchSitting for long periods can sometimes cause the sciatic nerve to tighten up. The nerve runs from the lower back down the leg to the foot and a person with tight sciatic nerve can experience numbness, pain or pins and needles anywhere along the length of the sciatic nerve.To stretch the nerve, lie on your back facing up, hug one knee to the chest by holding the thigh under the knee. Straighten the knee to about 90-100 degrees and lift the lower leg towards the ceiling. Bend your ankle and point up and down for 10 times before returning to the start position.Ulnar nerve stretchMedian Nerve StretchRadial Nerve StretchSciatic Nerves stretch

Carpal Tunnel Syndrome

Dr. A Mohan Krishna, Orthopedist
Carpal tunnel syndrome:The carpal tunnel is the space between the bones and ligaments of the wrist through which median nerve passes. Carpal tunnel syndrome develops when the nerve becomes compressed. It is common condition of the hand that affects women more frequently than men.The symptoms of carpal tunnel syndrome include:Pins and needles or tingling sensations (Paraesthesias) Pain or numbness in the hand, typically worse at the night.Clumsiness and weakness of the hand.A weak grip and an impaired ability to bring the thumb across the palm to meet the other fingers.Pain in the wrist,forearm or shoulder.Causes:Any condition that narrows the carpal tunnel or produces swelling of or fluid retention by the contents of the tunnel can cause carpal tunnel syndrome. The many possible causes includeHormonal changes.Obesity,Diabetes mellitus,Rheumatoid arthritis,Acromegaly – bone enlargement due to pituitary gland abnormality.Under activity ofthyroid (hypothyroidism)Renal failure,AlcoholismAmyloidosis : rare condition in which abnormal proteins accumulate in tissues and organs.Paget’s disease: a chronic bone disease that affects elderly people. The bones become deformed and thickened.Tumors: such as lipoma (Fatty tumours), ganglions (fluid filled cysts formed in tendon), and deformities of wrist after the fractures.The use of hand held vibrating tools – very rarely causes carpal tunnel syndrome.Diagnosis:The typical history of pain and weakness in the hands usually suggest the diagnosis of carpal tunnel syndrome, but it is important to exclude other conditions that may produce similar symptoms, such as a prolapsed cervical disc or arthritis of thumb joint.Clinical examination:This may reveal disturbances in sensation in the area supplied by the median nerve,wasting of the muscles at the base of thumb and poor grip.Tinel’s sign: tapping the median nerve at the wrist may reproduce the pain and tingling of carpal tunnel syndrome in the affected person. Flexing the wrist against resistance has  a similar effect.Imaging:an x-ray of the wrist may be used to rule out bony abnormalities, while MRI gives a clear picture of the soft tissues. Nerve conduction studies: Nerve conduction studies are conducted to see the conduction and velocity of impulses across the median nerve. This test can be used for documentation of carpal tunnel syndrome.Treatment:Treat the underlying cause: The underlying causes should be treated. For example overweight patients should be encouraged to lose some weight and patients with hypothyroidism should receive thyroid hormone replacement therapy.Some patients recover without treatment, while others respond to rest or simple measures such as the use of wrist splint for week or so. In cases where the condition is persistent however several treatments are available.Anti-inflammatory drugs: may help to relive tendon swelling and pressure on the wrist in rheumatoid arthritis.Wearing night splints at night, which hold the wrist, slightly forward, may help night pain.Diuretics (which increase the volume of urine) are sometimes prescribed to remove excess fluid from the body.Steroid injections into the carpal may provide relief, but must be performed with utmost care. It is particularly important not to inject the median nerve itself any improvement may be temporary.In persistent cases,surgery will be performed in order to reduce pressure on the large media nerve.Surgery:Surgery is usually advisable for persistent or worsening symptoms to prevent permanent loss of sensation and wasting of the muscles in the hand. In such cases without surgery, symptoms are likely to persist. Surgical treatment usually involves dividing transverse carpal ligament in order to relieve the pressure on the median nerve. Freeing the nerve enables normal nerve conduction to resume.Traditionally, median nerve decompression was open surgical procedure, but also new technique of endoscopic carpal tunnel release is also being practiced.Generally, both open and endoscopic techniques have excellent results although it may take few months for grip strength to return to normal.

You Think Ice Is Cool? Think Before You Drink

Dr. Richa Garg, Ayurveda
Summer is almost here and most of us are guilty of coming home and directly heading towards the fridge for some cold water as a relief from the scorching heat outside. Even though ice has many health benefits, drinking ice water or cold water can only give temporary relief and drinking ice water regularly has its downside.Here are some reasons why you shouldn’t drink ice or cold water:1. Interferes with your digestion:Drinking ice water or cold water hampers the process of digesting food as it causes your blood vessels to shrink. This can slow down the process of digestion and as the food is not digested properly, the nutrients are lost or not absorbed by the body. 2. Robs you of nutrients:The body’s temperature is 37o C and when you drink something at a very low temperature, your body has to spend energy to regulate its temperature. This spent energy is otherwise used to digest food and absorb nutrients, thereby leaving your body short of nutrition.3. Increases your chances of getting a sore throat: Drinking cold water can cause the buildup of respiratory mucosa, which is a protective layer of the respiratory tract. When this layer gets congested, the respiratory tract is exposed and becomes vulnerable to various infections and hence the chances of your throat turning sore are high. 4. Decreases your heart rate:Drinking ice water or cold water decreases your heart rate. Studies have shown that drinking ice water stimulates the vagus nerve. The vagus nerve is the 10th cranial nerve and is an important part of the body’s autonomous nervous system that controls involuntary actions of the body. The vagus nerve mediates the lowering of the heart rate and the low temperatures of ice cold water act as a stimulus to the nerve which causes the heart rate to drop." So whats the solution now..... Here we go..... use the Desi Fridge (earthen pot) being used since ages to keep you cool in increasing summers obviously an impact of global warming."

Cervical Spondylosis

Dr. Yogesh Pithwa, Spine Surgeon
What is meant by cervical spondylosis?The term “cervical” refers to the spinal column in the neck region. The term“spondylosis” refers to any ailment of the spine!! The term spondylosisis used loosely for all kinds of neck pain, from the purely innocuous ones to the ones those require surgical intervention. This neck pain may be in the nape of your neck, or very often may be present between the two shoulder blades.What causes cervical spondylosis?Cervical spondylosis can be caused by a slipped disc or a bony overgrowth or a combination of both. What is a slipped disc? Our spine is made up of a number of bones called vertebrae stacked one on top of another. A disc is a soft, gel-like structure present between two adjacent vertebrae. Normally, these discs act like ‘shock-absorbers’ and also allow some movement between the two adjacent vertebrae, giving the spine its flexibility. When this disc slips beyond its normal confines, it can compress the spinal cord or its nerve roots located close by and lead to problems.Why does the disc slip out? Over the years, the disc develops small microscopic tears, which may unite together over a period of time such that with some trivial injury or some innocuous activity, the disc may slip out of its normal confines. As a part of the normal aging process, the spine may develop some extra bone growth, leading to compression of the adjacent spinal cord or its nerve roots leading to pain.How does cervical spondylosis manifest?One of the commonest complaints is neck pain that may be present either at the nape of the neck or between the two shoulder blades. This pain would generally be noted on some kind of neck movement or on coughing or sneezing. Similar to “sciatica” that occurs in the lower back, when the pain starts radiating down into the upper limbs, it is referred to as “radiculopathy”. Another complaint of cervical spondylosis is unsteadiness while walking. This is the most important complaint to note as very often, this complaint gets relegated to the normal aging process in the older population in whom it is most frequently noted.Can any other condition mimic cervical spondylosis?Any compression or problem affecting the nerves after they leave the spinal canal can also lead to pain along the hand. The most common condition that can affect the nerves after they leave the spinal canal is ‘peripheral neuropathy’, a condition wherein the nerves are ‘weakened’ secondary to diabetes, chronic alcoholism, smoking, other forms of tobacco consumption, nutritional deficiencies or other rare causes. A common complaint in patients with peripheral neuropathy is the presence of pain even at rest, pain of a burning nature or numbness in ‘glove and stocking’ distribution i.e. over the hands, just beyond the wrist joints and over the lower limbs, just beyond the knee joints. Additionally, once the nerves leave the spinal cord, they have to travel through a narrow space termed “thoracic outlet” at the base of the neck so as to reach the upper limbs. There may sometimes be compression at this level, leading to pain radiating down into the upper limbs. Neck and back are often termed the mirrors of the mind. Hence, stressful periods are likely to give you some neck or back pain as well! Poor posture is also a common culprit for neck and back pain.How does the doctor diagnose my condition?An accurate history is the most important diagnostic tool. The way the pain started and progressed, specific aggravating and relieving factors of pain, distribution of pain over your body, associated complaints such as weakness or numbness over the upper or lower limbs will be a guide to short listing the possible causes of your neck pain. A very important history relates to difficulty or clumsiness while walking.A detailed clinical examination involving assessment of spinal motion, assessment of your neurology and certain special tests will allow to further narrow down the causes to 2-3 most probable ones. Though this process of history-taking and clinical examination may appear boring and long-drawn, it is the most crucial part towards prescribing the correct treatment to you. So, it is essential to cooperate with your doctor throughout this entire procedure, which gives more information to the doctor regarding your ailment than any other investigation including an MRI.How does the doctor investigate for cervical spondylosis?On the first visit, if your problem is short-lived and there are no major signs or symptoms, you may not need any further investigation. However, if your problem has been present for some time, or if there is some history of trauma, fever, any other major illness, or any notable findings on clinical examination related to neurological dysfunction, you are likely to require some further investigations.Commonly, plain x-rays of the spine may be ordered with or without some basic blood investigations such ashemoglobin, erythrocyte sedimentation rate [ESR], CRP, RA test, serum calcium, phosphorus and alkaline phosphatase.Based on these tests, or sometimes, in the presence of some significant signs or symptoms, you may be asked to undergo MRI scanning. Plain x-rays demonstrate bony features, while MRI demonstrates the spinal cord, its nerve roots, the intervertebral disc between the two bones of the spine. Both these tests are complementary in nature, doing one does not necessarily mean that the other one is not needed.In some cases such as peripheral neuropathy orthoracic outlet syndrome, additional investigation in the form of EMG-NCVtest, to assess the function of each of the various nerves in your limbs may be required. Rarely, a Color Doppler examination of the upper limb blood vessels may be asked for.Is there any non surgical treatment for cervical spondylosis?The treatment would depend on the duration of your problem, presence of similar episode in the past, neurological function, response to previous nonoperative treatment and lastly, the subjective severity of your pain. Various nonoperative means of treatment include painkillers, muscle relaxants, various modalities such as heat and electrical stimulation, cervical traction, activity restrictions, etc. Painkillers will be prescribed to allow a smoother and easier return to normal function. You would generally be prescribed these on a shorter term or on a longer-term tapering program so as to guard against possible over dependence on these agents, as these are associated with significant side effects if used excessively in the long term. These side effects may range from hyper acidity, gastric ulcer, kidney damage, bleeding disorders, constipation, addiction, etc.  In addition, based on individual merit, you may also be prescribed muscle relaxants so as to relax and soothe your neck and back muscles. This is so because whenever you have neck or back pain, your muscles tend to go into spasm[sustained contraction] and hence, lead to pain. It is essential to break this spasm with a muscle relaxant so as to give effective pain relief.Physiotherapy modalities may be used. This consists broadly of passive and active physiotherapy. During acute pain, generally, only passive physiotherapy would be used. This would be in the form of heat or electrical stimulation in various forms such as SWD [short-wave diathermy], TENS [transcutaneous electrical nervestimulation] and IFT [interference therapy]. Cervical traction too, aids in relaxing the aching neck. In severe cases, you may be recommended to get admitted in the hospital for a day or two to get this physiotherapy on a more aggressive note.  After pain relief, you would be prescribed active physiotherapy i.e., spinal exercises. Based on your complaints, your exercise protocol would be decided by the doctor.You would need to have some activity modifications and restrictions to help your spine get back into shape and stay that way!! If you have a job on hand that requires you to sit continuously for hours on end, then you can sit for 15-20 minutes and then get up and walk around for about 5 minutes, gently shrug your shoulders and perform circular movements in the air with your shoulders, first in the clockwise direction and then in the anti - clockwise direction. Bifocal lenses in spectacles would require you to bend your neck backwards while reading which is not a very healthy practice for your neck spine. Smoking interferes with the nutrition of the disc in between the vertebrae and hence, would need to be abandoned forever! Try to sit in a chair that has a high backrest that supports your neck as well. Try to keep the computer at your eye-level. Do not stack up pillows underneath your head so as to be able to read while sleeping! Ideal position to sleep is sideways with a pillow underneath the head just about adequate to fill up the gap between the side of your head and your shoulder. While lying down with the face upwards, use a very thin pillow or just fold a bed sheet and keep it underneath the head. When is surgery essential?Surgery would be indicated when there is no pain relief despite symptomatic treatment as mentioned above or, when there is significant neurological deficit or, repeated episodes of pain so as to get a permanent solution to the problem. What is the nature of surgery?Microdiscectomy is the usual surgery for cervical spondylosis. This is a surgery performed through the microscope so as to make this a relatively safe procedure. When many levels are involved, the surgery may be done from the backside, otherwise, it would be from the front. Is it a major surgery? We were told that we should not get a spine surgery done as it can lead to paralysis! Or, inother words, what are the risks involved? Even if you are walking out on the streets, you never know when some vehicle will come from behind you and knock you over! So, would you stop walking on the street for fear of this risk? Everything in life carries some inherent risk associated with it. The option for surgery would be offered only if the benefits of surgery significantly outweigh the risks. Rather than asking as to what are the risks of going in for surgery, it would be more prudent to ask as to what are the risks and benefits of getting the surgery done as compared to not getting the surgery done? Spine surgery has had a lot of advances in the past decade or two, there are better imaging facilities like MRI, better surgical instruments, surgical microscope to aid vision in the surgery, computer navigation system to further increase the safety level of surgery, better training and information in an overall sense making spine surgery no longer the taboo that it once was! So, if you have a problem that genuinely requires surgery, there is no point in tying yourself down to the bed for days or months on end because ultimately life is mobility and mobility is life! Discuss the details of your surgery and its attendant risks with your doctor to quell any fears and to clear any and every doubt of yours! If you so desire, your doctor can even arrange to give you references of patients who have undergone similar surgeries. Can we replace the disc? In other words, won’t it be harmful to remove the disc? The disc that has slipped out can no longer carry out its normal function, rather, it is causing harm to the body rather than doing anything good! So, trying to replace the disc back into its position is not a viable option. However, it is possible to replace the damaged disk with an artificial disk that would function similar to the natural disk.How is the post operative recovery and rehabilitation?Generally, you will be admitted one day prior to the day of surgery. You will be advised to fast after dinner the previous night. Surgery would generally be carried out the next day morning. After surgery, on the 2nd or 3rd day, you will be made to walk with a cervical collar. You may be discharged after 3-4 days. Sutures [stitches] would be removed generally on the 10th–14th day following the surgery. By this time, you will be walking around and essentially be independent in doing activities of daily life. You will be allowed to take bath 48 hours after the suture removal. For 3-4 weeks, you will be allowed restricted mobilization within the house. During this period, you will be encouraged to increase all your activities in gradual weekly increments. A month later, you will be starting with spinal strengthening exercises. You will have to use the cervical collar for about 1-3 months at all times other than while taking bath. You will not be allowed to smoke for life!Will I be able to return to work after the surgery?Though you would be up and about, walking about within the first ten days following the surgery, you will be allowed only limited mobilization within the house in the first one month following surgery. Thereafter, if you are having a sedentary light job, then you may be allowed to resume work, provided you do not have to travel for a prolonged time on some bumpy road(s). If you were having some job that requires some moderate labor, you would be allowed to resume work up to three months after surgery. If you were involved in heavy manual labor, it would be wiser to seek some permanent job modification in these situations. Staying off work for more than three months post-surgery is not recommended at all.What about alternative techniques such as manipulation, bone setting, homeopathy, acupressure?Death has been reported following violent manipulation of the neck by some people. Hence, it is not at all recommended. As long as no neurological deficit [loss of sensation, weakness or clumsiness while walking] is present, alternative medicines may be tried. However¸ procrastination in the presence of neurological deficit is not recommended.What about newer advances in the treatment of this condition?Microscope allows for the use of both eyes while working, giving binocular vision and thereby, good depth perception that is very essential for the safe performance of these surgeries. This binocular vision is lacking in endoscopic discectomy. Percutaneous laser discectomy has not been proven to be scientifically superior to microdiscectomy. Rather than doing the conventional surgery of fusion at the level of discectomy, it is possible to replace the disk with an artificial one.This would simulate normal spinal function and hence, is a better surgery than the conventional fusion. However, it is costlier than the conventional fusion surgery·.

Amazing Facts About Your Eyes You Should Know!

Dr. Charu Tyagi, Ophthalmologist
On the face of it, our eyes are just simple orbs in our head, but the fact is that they’re very complex organs. There are seven main parts in the eye that play a role in transmitting information to the brain, detecting light, and focusing. A problem with any of these parts means a problem with your vision.Our eyes are very complicated and amazing. They seem pretty simple, but there’s really a lot to know about how they function.You may think you know them pretty well, but here are some fun facts you may not know about eyes:The average blink lasts for about 1/10th of a second.While it takes some time for most parts of your body to warm up to their full potential, your eyes are on their “A game” 24/7.Eyes heal quickly. With proper care, it only takes about 48 hours for the eye to repair a corneal scratch.Seeing is such a big part of everyday life that it requires about half of the brain to get involved.Newborns don’t produce tears. They make crying sounds, but the tears don’t start flowing until they are about 4-13 weeks old.Around the world, about 39 million people are blind and roughly 6 times that many have some kind of vision impairment.Doctors have yet to find a way to transplant an eyeball. The optic nerve that connects the eye to the brain is too sensitive to reconstruct successfully.The cells in your eye come in different shapes. Rod-shaped cells allow you to see shapes, and cone-shaped cells allow you to see color.You blink about 12 times every minute.Your eyes are about 1 inch across and weigh about 0.25 ounce.Some people are born with two differently colored eyes. This condition is heterochromia.Even if no one in the past few generations of your family had blue or green eyes, these recessive traits can still appear in later generations.Each of your eyes has a small blind spot in the back of the retina where the optic nerve attaches. You don’t notice the hole in your vision because your eyes work together to fill in each other’s blind spot.Out of all the muscles in your body, the muscles that control your eyes are the most active.80% of vision problems worldwide are avoidable or even curable.Who knew your eyes could be so amazing and complex? Make sure to give them the attention they deserve by seeing your VSP doctor for a comprehensive eye exam every year.

Neuralgia: Types and Treatment Options

Dr. G P Dureja, Spine and Pain Specialist
Pain in a nerve pathway is quite sharp and shocking. As a result of stimulating the pain receptors, pain is triggered. But there are abnormal conditions when the nerve endings are irritated and damaged, resulting in neuralgia. The term is a combination of two words- ‘neuro’ that relates to nerves and ‘algesia’ implying pain sensitivity. For a person affected by neuralgia, the pain is more of a burning sensation, which can occur in any region. Generally, the face and neck are common regions. In certain cases, diseases like diabetes or multiple sclerosis or infections as shingles are common causes leading to this problem. Types of neuralgiaIdeally, neuralgia can be classified into two types depending on the pain location:   Central: Where the condition begins in the brain or spinal cord, andPeripheral: Where the origin is the peripheral nervous system, consisting of the     nerves and ganglia.Neuralgia treatment however, depends on the kind of pain one is experiencing. For a better idea, PNS neuralgia has certain subdivisions as the following:Trigeminal neuralgia: If the pain is from the trigeminal nerve, there is acute pain felt as a shock or burning sensation or something pressing against the skin.Atypical trigeminal neuralgia: Usually this pain is felt in the cheeks, jaws, eyes, temples or forehead and jaws as an electric shock sensation. Contrary to the typical one, this pain also extends across the scalp and neck.Occipital neuralgia: Better known as Arnold’s neuralgia, here the pain sensation is confined to the neck, back of the head and behind the eyes.Post-herpetic neuralgia: The pain is of a variable degree in this vase which can range from mild to even severe. Commonly called shingles, this condition is a result of herpes varicella virus that follows herpes zoster outbreak.    Glossopharyngeal neuralgia: This is a rare disorder where the pain occurs near the tonsil and its surrounding regions like the throat or the back of the tongue.Diagnosis and TreatmentOptions for Neuralgia treatment are quite a few in number. Some are enlisted as under:Medications: Some common medicines that can be used to relieve the pain of this condition include:  Anti-seizure medicationsOver the counter pain relievers (aspirin, ibuprofen) Antidepressants   Topical creams (capsaicin)Nerve blocks: These are injections meant for particular nerves or nerve groups so that inflammation and pain is reduced significantly.It is difficult to treat neuralgia, but now with the advancements of medicine, we can definitely help in improving the quality of life.