Chronic Back Pain: Top 5 Common Misconceptions

Chronic back pain is a condition that many people go through but too often overlooked or treated with wrong methods because of common misconceptions. Like other similar medical conditions, chronic back pain should be diagnosed and can be treated and managed, as long as these mistaken beliefs are out of the way.

1) Resting in bed helps to recover from back pain.

While resting in bed for 1 to 2 days is recommended to reduce stress on the discs of the spine and lessen the pain, any longer than that would backfire on the recovery. Long hours in bed would cause an increase in pain, muscle atrophy, loss in bone mineral and a higher risk of blood clots forming due to the lack of movement.

Contrary to popular beliefs, patients with chronic back pain should not rest for too long. On the other hand, doing back exercises regularly would strengthen the muscles and speed up recovery.

2) Only painkillers can help to relief pain.

Painkillers may be prescribed to help manage the pain for daily activities. However, without proper treatment, the condition does not get better. Physical therapy like ultrasound treatment and electrotherapy can help to reduce the inflammation and joint mobilization helps to decrease tension in the muscles. Other pain management methods include having a healthy diet, a better sleep routine and exercising.

3) The pain would go away with heat and back massage.

Heat and massage would help to manage pain for the short-term. But for chronic pain, the soothing effect wears off and the pain would be just as bad as before. This method is good if you just need a quick alleviation from acute pain. However, the condition would not get any better without appropriate treatment advised by the doctor.

4) Chronic back pain is a natural occurrence of aging.

Many people live with chronic back pain undiagnosed and untreated, thinking that the symptoms are due to aging. Back pain can happen to people of any age, with or without injury. In fact, those that go through chronic back pain at a younger age tend to feel less pain when they get older with proper treatment and exercise. Even though disc degeneration occurs between ages 35 and 55, it does not necessarily come with pain. Never ignore any kind of pain or discomfort and always get it checked.

5) If I have chronic back pain, I should not exercise.

Exercising helps strengthen the back muscles, giving a stronger support for the spine. Though vigorous exercises that add pressure on the back should be avoided, regular light exercises are good for long-term recovery.

Clubfoot: Treatment & Surgery

Clubfoot, also called Congenital Talipes Equinovarus (CTEV) is one of the most common non-major birth defects that infants are born with. The appearance of clubfoot is obvious – the foot is twisted inwards and sometimes in severe case, the toes are pointed upwards. It looks that way because the tendons are short and tight, pulling the foot towards the heel. Usually, because the muscles are not fully developed, the calf and foot look smaller than normal legs.

This condition has been around for a long time with more clubfoot boys than girls. Very often, both feet are affected. Newborns of parents that have clubfoot are at a higher risk of inheriting it. However, the cause of clubfoot is still unclear.

Diagnosis

Doing an ultrasound scan during the pregnancy may be able to detect clubfoot but it may not always be accurate since the infant’s bone may not be fully ossified yet. Once the baby is born, it would be easy to diagnose.

Treatment

It is important to start treatment right after diagnosis or the baby would grow up with the inability to walk flat on the foot. Non-surgical treatments like the Ponseti Method would first be used and it is usually effective. Only if conservative treatment does not fully correct the clubfoot or it recoils back to the position, then surgery would be considered.

The Ponseti Method:

This is a painless treatment which the foot is stretched back into alignment and held down in a cast. The cast covers the whole leg to maintain the foot in the position. Every week, the foot is manipulated into a new position and plastered again in a cast until it is nearly normally aligned.

About 6 weeks later of repeating this procedure, a minor operation may be recommeneded to release and lengthen the tense Archilles tendon in the hind foot. After recovering from the surgery, the baby needs to wear boots that come with a bar inserted in it for 3 months and at bedtime thereafter until they reach 4 years old.

Surgery:

If the treatment procedure is not followed regimentally or if the deformity is very severe, the Ponseti Method might not be enough and surgery is required to adjust the tendons, ligaments and joints. However, if the non-surgical treatment have partially corrected the foot, a less extensive surgery is needed. After surgery, it is crucial to maintain the foot alighment with special boots for a few years to prevent a recurrance which is highly possible.

The corrected clubfoot would not appear completely normal as the calf and foot usually remain slightly smaller and do not function as well as a regular foot. Nonetheless, the child would be able to walk, run and wear regular shoes without any pain.

Pelvis Fractures: Cause & Treatments

The pelvis consists of a series of ring-like structure of bones located at the lower end of the trunk. There are three ones supporting the side of the pelvis namely the ilium, ischium and pubis. Ligaments and tendons join the pelvis to the sacrum located at the bottom of the spine, creating a bowl-like cavity just below the rib cage. On each side is the acetabulum, a hollow cup serving as the socket for the hip joint.

Many digestive and reproductive organs are located within the pelvic ring as well as large nerves and blood vessels passing through it. The pelvis acts as an attachment point for muscles reaching into the legs up into the trunk of the body. With all these important structures running through the pelvis, a fracture can be serious and life threatening.

Causes

The group of people most susceptible to pelvis fracture are those heavily involved in sports. Very often, a muscle is pulled and these may go undetected. Such undetected pulls might be avulsion fractures of the pelvis due to sudden muscle contractions. In avulsion fracture, a small piece of bone from the ischium located at the hamstring muscles region is broken and torn away by the muscles. This fracture however do not render the pelvis unstable. Most pelvis fractures can also be caused by high impact forces such as those sustained during a motor vehicle accident or falls from great heights. Depending on the impact and height, such injuries can be deadly.

Nonsurgical treatment

Nonsurgical is usually administered for stable fractures such as the avulsion fracture mentioned above. Stable fractures will heal on their own without the need for surgery. However, the patient will need the assistance of a walking aid such as a crutch or walker for at least three months while the bones heal. To lessen pain, doctors may prescribe painkillers. Due to the significant reduced amount of movement and prolonged periods of inactivity, blood-thinners may also be prescribed to reduce the chances of blood clot formation.

Surgical treatment

Pelvis fractures resulting from trauma are life threatening due to extensive bleeding and surgery is inevitable. An external fixator may be used to stabilise the pelvic area while the surgeon performs surgery. The external fixator has long screws that are drilled into the pelvic bones.

A pelvis fracture will heal well if treatment is administered in a timely manner. Some patients may walk with a slight limp months after surgery due to damage to the muscles surrounding the nerves. However, this is only temporary. In serious cases, patients may suffer from impaired mobility or even sexual dysfunction due to damage to nerves and organs.

Muscle Strains in the Thigh: Symptoms & Prevention

A muscle strain refers to a muscle pull or tear and it is an extremely common injury in people who are active in sports. There are three sets of strong muscles in the thigh: hamstring muscle located at the back of the thigh, quadriceps muscles located at the front and adductor muscles located on the inside. The hamstring muscle and quadriceps muscle works in tandem to allow extension and flexion of the leg while the adductor muscles help to pull the legs together. The hamstring and quadriceps muscle are at higher risk for muscle strains as they cross both of the hip and knee joint. Additionally, they are involved in high speed activities such as running and sprinting.

Symptoms

A person experiencing muscle strain in the thigh may hear frequent popping sounds due to the tearing of the muscles. The onset of pain is sudden and intense. The area surrounding the thigh will also be tender to the touch and swelling will be visible. The thigh muscle will be weak and in serious cases, inability to use the muscle.

Treatment

Swelling and localised bleeding can be easily managed by applying ice packs to the affected area. After swelling has lessen, heat pack can then be applied. However, heat pack should not be applied if swelling is still present as this will increase swelling and pain. Nonsteroidal anti-inflammatory drugs such as naproxen or ibuprofen should be taken to reduce pain and facilitate movement. PRICE technique comprising of Protection, Rest, Ice, Compression and Elevation should be performed. The strained thigh should be protected from further injury. The thigh should then be rested and all activities should be stopped with immediate effect. The thigh should be iced every 20 minutes to relieve pain and reduce inflammation. Small bags of frozen peas are extremely handy tools. At the end of the day, the thigh should be compressed using elastic bandages or thigh guards. It should also be elevated to allow fluid to drain off.

This is followed by gentle resistance exercises to align the scar tissues formed during the healing process. Aligning the scar tissues help to enhance the tensile strength of the thigh muscles. Resistance bands are handy tools to help improve muscle function and reduce the risk of a recurrent injury. Once the core strength is regained, a return to functional activities will then be possible. Compression shorts or thigh supports will help to further strengthen the thigh.

All about Ankle Splinting

Ankle splints are used to stabilise injuries to the bones of the ankle until the patient can be professionally attended to by an orthopaedic surgeon. It is also used to immobilise the ankle joint following an injury before the surgery date in order to prevent further injuries. Patients who have splinted their ankles will often be referred to a specialist within 3 days.

Anatomy of ankle joint

The ankle joint is a hinged synovial joint that allows plantar flexion and dorsiflexion. When the range of motion of the joint is considered, the ankle joint becomes a complex universal joint. This complex joint will allow movement of more than 100°, making it extremely flexible. Protecting this joint is the anterior and posterior ankle capsular ligaments which are relatively thin.

Preparing for ankle splinting

Ankle splinting is fairly painless and can be tolerated without the need for anaesthesia. However if the patient is suffering from immense discomfort during the splinting process, anaesthesia may be used depending on the severity:

  • Nerve blocks will temporary provide pain relief by blocking nerve signals to the brain. This is done by injecting a substance into a nerve.
  • Procedural sedation acts by administering sedatives to induce a state where the patient is still conscious but will not have any feeling.

Tools required

The tools involved in ankle splinting are fairly simple:

  • Stockinette
  • Undercast padding
  • Fiberglass splint
  • Bandage
  • Sterile water
  • Medical scissors
  • Disposable sheets
  • Bandage tapes

After splinting

Postsplinting care is important to ensure complications are reduced to the minimal. The patient should adhere to rest, ice and elevate the injured limb. If any numbness is experienced or the limb is turning purple, the patient needs to go to the nearest emergency department as this mean that the bandage is too tight and is restricting blood flow. At all times, the splint must be kept clean and dry to prevent infection. If the area feels itchy, the patient can use a pen to scratch the inside of the splint for itch relief. However, using such tools might injure the skin and cause an unwanted infection. After 3 days, the patient will be scheduled to see a specialist who will advise further.

Complications

Despite proper techniques, complications may still arise but they are rare:

  • Thermal burns may result from the exothermic reaction when the plaster solidifies. If any intense pain is experienced, the patient should remove the plaster immediately.
  • Contact dermatitis may occur if the patient is sensitive to the chemicals that are used in the splinting process.
  • Decreased range of motion will result as the area is immobilised and simple actions will be restricted.

Spinal Stenosis: Cause & Symptoms

Spinal stenosis is the result of the narrowing of free spaces in the spine. This will cause extra pressure to act onto the spinal cord and the nerves running through it. In majority of the cases, spinal stenosis affects the lumbar spine. This will eventually cause pain along the legs and make walking a difficult task to accomplish.

Causes

There are many different possible causes for spinal stenosis:

  • As we grow older, our soft connective tissues such as the tendons and ligaments will start to harden and thicken. When this happens, spurs will start to develop and some may make their way into the spinal canal. This will result in the damaging of the vertebrae and cause the facet joints to wear and tear. Eventually, this will cause the narrowing of the lower spine.
  • When one of the many vertebrae slips over another, this will cause congestion and narrow the spinal canal.
  • Spinal tumour. Spinal tumours are abnormal growth of soft tissues that will cause inflammation of the spinal canal. White blood cells will rush to the site and cause an overgrowth of new tissues. This will eventually result in the narrowing of the spinal canal.
  • Accidents especially high impact ones may shatter or dislocate the spine, causing small bones to impinge onto the canal.

Symptoms

Patients suffering from early stages of spinal stenosis often have no symptoms. Symptoms will develop slowly over time and may include:

  • Pain in the back
  • Burning pain at the buttocks
  • Numbness in the legs
  • Loss of feeling in the feet
  • Loss of sexual abilities
  • Loss of bowel or bladder control
  • Pain and weakness of legs

The pain in the legs are usually due to inefficient circulation of the blood. Leg pain will usually go away with rest but patients with spinal stenosis will get persistent leg pain despite resting. Narrowing of the spine will also cause nerve impingement, resulting in important nerves to be deprived of the abilities, leading to incontinence.

Spinal stenosis have no unique signs nor symptoms and will worsen over time. Although x-ray results look promising, there is still uncertainties. The best method to manage lumbar spinal stenosis is to understand the disease better and to strengthen the back by engaging in strengthening activities daily.

Bunions: Cause & Treatments

Bunions are bony humps that form at the base of the big toe. When this happens, the big toe will curve towards the other toes and cause the base of the toe to push towards the first metatarsal bone. It usually occurs at a joint and the entire body weight will be acting on it. This will result in tremendous pain and discomfort.

Causes

As we grow and develop, more pressure is acting on the foot due to the need to support the body’s entire weight. Therefore, it gets worse as age increases. Bunions is hereditary and will run in the family due to the fact that foot type and shape is hereditary. In some cases, bunions will develop with existing medical conditions such as arthritis. Women are also at a higher risk of suffering from bunions due to the fact that most women wear tight and ill-fitting high heeled shoes, pushing the foot bone into awkward positions for long periods of time.

Non-surgical treatment

Non-surgical is targeted to reduce pressure on the big toe and provide pain relief.

  • Wearing wide and comfortable shoes with sufficient space for toes to wriggle. The insoles should also provide good arch support.
  • Custom made orthotics will help to distribute the body’s weight equally throughout the foot and reduce any unnecessary pressure acting on the big toe.
  • Pain relief medication will provide instant pain relief for patients and bring down the swelling.
  • Ice is a cheap and effective method to reduce swelling and provide pain relief.

Surgical treatment

If non-surgical treatment does not provide adequate pain relief, daily activities such as walking can be severely hindered. In such cases, surgery may be the only option left. The main aim of bunion surgery is to straighten the curved toe bone and provide pain relief.

  • Bunionectomy is a bunion specific surgery and involves removal of part of the affected metatarsal head.
  • Osteotomy involves the cutting of bones located in the toe to prevent bone spurs from sticking out and re-alignment the soft tissues around the toe joint.
  • Resection arthroplasty is reserved for more serious cases and involve the removal of bone located at the end of the first metatarsal joining the metatarsophalangeal joint.

As the saying goes, prevention is better than cure. A good pair of footwear is often all that is needed to prevent one from getting bunions. Selecting a pair of functional shoes over one that is aesthetically pleasing is a much sensible choice.

Femur Shaft Fractures (Broken Thighbone): Cause & Treatments

Our femur is the strongest and longest bone in our body. Due to the high strength, an extremely large force is necessary to cause any fracture. These situations can include a high speed car crash and this is the most common reason for such fracture. A force that is beyond the normal limits of the femur will result in a fracture. The long and straight part of the femur is called the femoral shaft and when there is a break along the femoral shaft fracture, it is known as a femoral shaft fracture.

Causes of a femoral shaft fracture

Femoral shaft fractures usually occur in young people due to the type of activities they engage in. Most youngsters engage in high impact activities such as wakeboarding, football and racing. The most common reason is an automobile accident resulting in a car crash. Other less common causes can be an accidental fall from a certain height or even a simple fall in people of a higher age group. This is due to their weakened bones or existing medical conditions such as osteoporosis.

Treatment

Non-surgical treatment

Non-surgical treatment is meant for patients who do not have a displaced femoral shaft fracture. In cases like this, treatment will involve the usage of walking aids such as crutches or walker with the foot in a protective brace or splint for a period of time. However, most femoral shaft fractures will require surgery to properly heal.

Surgical treatment

Surgical treatment is needed for those who have displaced femoral shaft fractures and this will usually involve the realignment of the bones. Metal pins and screws will be placed into the bones located above and below the fracture site to properly hold the bone in the proper position to facilitate healing. It is a temporary treatment and will provide adequate stability until the patient is ready for stage 2 of the surgery – intramedullary nailing. A metal rod will be inserted into the marrow canal of the femur to hold it in its proper position. It is then screwed to the bone at both ends. The bone fragments will also be cleaned and joined together with the femur using screws and metal plates.

Patients suffering from a femur fracture should seek prompt medical attention as ignoring such symptoms will cause more damages to the femur and prevent healing of the fracture altogether, leading to a lifetime of instability and pain.

 

All about Electrodiagnostic Testing

Our body possess a huge ability to generate electricity and it is through this ability that allows us to achieve good health. The electricity that is generated will send important signals from all parts of the body to the brain and provides a source of instantaneous communication. These electrical signals are created by the nerves and instructions are sent to the muscles to carry them out. However, signals can easily be affected due to diseases or injuries. The presence of pain and numbness in different parts of the body can help doctors to diagnose the exact cause of injury and this is what electrodiagnostic testing is all about.

Electrodiagnosis employs the science of electrophysiology, using electrical pulses to study neurophysiology. There are two separate parts in this test: testing the nerves and testing the muscles. Both tests will evaluate the ability of both nerves and muscles to function as a single entity unit. This test will allow narrow down the list of possible causes of pain and weakness.

Nerve conduction studies (NCS)

NCS is done in conjunction with its muscle counterpart. The main purpose is to determine if a particular nerve is functioning properly. It is done by placing sensors over nerves in both the hands and legs and stimulating it with electrical pulses. Patients will experience a warm and itchy sensation similar to suffering from an ant’s bite. Through this test, doctors will be able to evaluate the performance of the nerves and to identify which nerves are not performing well. A healthy nerve will conduct electricity at an extremely fast rate up to 200km/h whereas a damaged nerve will have a much lower conduction rate.

Electromyography (EMG)

EMG on the other hand analyses the electrical activity in muscles. When a muscle is in use, it will be buzzing with electrical signals as the muscle attempts to communicate with different parts of the body. Likewise when it is not in use, it will be electrically quiet. Unlike NCS, EMG will cause slight discomfort to patients as small needles are inserted to monitor and record electrical activities. The wires will be connected to a small TV that will broadcast these electrical signals. After the test, the needles will be removed and this will cause further trauma to the area, resulting in bruises in the following days.

Electrodiagnostic tests are pretty accurate due to the advancement of medical technology and devices. However, it is only able to identify whether the nerves are functioning properly and it is unable to identify the cause of pain.

Causes and Symptoms of Compartment Syndrome

Compartment syndrome is a serious medical condition that occurs when excessive pressure builds up from within the body. This is usually due to conditions such as bleeding or swelling following an injury, causing blood to gush to the injury site. This unusually large pressure will constrict blood vessels and decrease blood flow, depriving cells from getting adequate amounts of oxygen and nutrients. Compartment syndrome is classified into acute and chronic cases. In acute cases, it is an emergency and is often caused by injury requiring immediate medical treatment to prevent permanent damages. In chronic cases however, it is usually caused by repetitive motions and is not an emergency.

Causes

Acute compartment syndrome

Acute compartment syndrome is usually due to a severe injury such as a high impact car accident or sports injury. It is also the most common form of compartment syndrome and will develop rapidly over hours.

Acute compartment syndrome can also develop after injuries including:

  • Fractures
  • Bruised muscle
  • Crush injuries
  • Prolonged compression of a limb after prolonged period of unconsciousness
  • Surgery to blood vessels of an arm or leg
  • Blood clot(s) in a blood vessel in an arm or leg
  • Anabolic steroid usage
  • Constricting bandages
  • Extremely vigorous exercises


Chronic compartment syndrome

Chronic compartment syndrome develops over a longer period of time and is usually caused by exercises such as running, swimming or cycling. It usually involves the lower body core muscles such as the gluteus maximus muscles, thigh and calf muscles. It may cause cramps during exercising but will go away once the activity is stopped.

 

Symptoms

Acute compartment syndrome

The symptoms for acute compartment syndrome is usually pain when the affected muscle is stretched. Usually, the pain will be much more intense that pain from the injury and a burning sensation could be felt. The affected muscle will able be tight and stiff and at times, numbness can be felt.


Chronic compartment syndrome

Symptoms of chronic compartment syndrome include aching or cramping in the affected muscle within a half an hour of the exercise starting. The symptoms will usually go away with rest and muscle functions will remain normal. There might also be visible muscle bulging and moving the foot might be difficult.

Compartment syndrome is a medical condition that cannot be prevented. However, early diagnosis and treatment will help to prevent many of the complications and patients must be aware of some of the most common symptoms.