1. What are the common causes of backache?Common causes of backache are
a) Physical labor performed incorrectly
b) Sitting in wrong or awkward positions
c) Wearing high-heeled shoes
d) Poor posture
e) Weak abdominal or back muscles
f) Being overweight
More serious causes of back pain include:• Spinal tumours, infections, or fractures
• Neurologic disorders affecting the spine
• Sciatica—Pain travelling along the sciatic nerve, felt in the thigh, buttocks, calf, and foot
2. How can backache be prevented?a) Lose weight. Extra kilos, especially around the waist, increase stress on the lower back.
b) Don’t smoke. Smoking can interfere with blood circulation to the lower back.
c) Reduce stress. Economic worries, family pressures, and fatigue can cause back spasms or tense muscles. Exercise is an excellent way to relieve stress.
d) Walk short distances instead of driving. Climb a few flights of stairs instead of taking the elevator.
e) Choose a sport that is easy on your back such as walking, swimming, or cycling in an upright position.
There are times when immediate medical attention is required . f) Most back pain resulting from minor strains can be resolved with simple analgesics and simple home treatment. If the pain gets better then probably it was due to muscle spasm and will not require further treatment.
g) See your doctor if any of the following problems occur within a few days of your back injury:Pain that keeps you from moving, Pain that runs down a leg or goes into an arm, Night pain that keeps you from sleeping, Pain that increases after a few days rest, Pain that does not lessen after rest and basic home treatment.
h) Seek immediate attention from your doctor if you have any of the following:Difficulty controlling your bladder or bowel movement, Loss of sensation in the rectal area, Pain following a fall or impact to the back, Severe leg pain down both legs, weakness,tingling, numbness, or inability to move, Pain that is steadily increasing over several hours, Chills, fever, or night sweats, Difficulty with balance or coordination.
3. How can I self treat my backache?a) Analgesics – simple pain killers like paracetamol, diclofenac or brufen might be helpful
b) Treatment without drugs-
Ice- For a day or two, apply ice or a cold pack for about 20 minutes at a time, three or four times a day. Heat - If ice has not relieved the pain after 2 or 3 days, apply moist heat. Wrap a hot water bottle in a towel or take a warm shower. * Apply moist heat about 15 to 20 minutes, two or three times a day. Bed Rest- Staying in bed more than a few days can cause supporting back muscles to become weaker some movement is necessary to heal properly.
4. What are some useful back excercises?If you suffer from an acute back injury- Perform stretches in a smooth motion and hold
the position for a few seconds; do not bounce or jerk while stretching. Do these stretches and exercises after a day or two of rest, if rest is necessary. Get your muscles ready for activity by
stretching. This reduces the tightness in muscles and provides them with more blood flow. You may experience some discomfort when doing these exercises. If the discomfort increases and remains the following day, consult your doctor.
Press-Ups 1. Lie on your stomach with your legs straight and feet together. 2. Prop up your upper body with your forearms.
3. Push upward while keeping your pelvis on the floor.
4. Hold for five seconds.
5. Gently lower yourself to the floor. Remember to keep your forearms in contact with the floor at all times.
6. Repeat five times
Backward Stretch 1. Stand upright.
2. Place your feet a shoulder width apart.
3. Place your hands on your lower back.
4. Lean backward while keeping your neck straight.
5. Lean further back until you feel a slight stretch in your back.
6. Hold for a count of five.
7. Return to the upright position.
8. Repeat three or four times.
Lower Back and Hip Stretch 1. Lie on your back with knees bent and feet flat on the floor.
2. Press your lower back onto the floor.
3. Grasp one knee with both hands and pull toward your chest keeping your head on the floor.
4. Keep the other knee bent and foot on the floor.
5. Hold for a count of ten.
6. Return to starting position.
7. Repeat with the other leg.
8. Repeat ten times on each leg for three sets.
Pelvic Tilt 1. Lie on your back.
2. Bend your knees at a 90-degree angle.
3. Tighten stomach muscles and buttocks.
4. Slowly push your lower back downward.
5. Hold your back in this position for five seconds.
6. Slowly return to normal and relax.
7. Repeat five times.
Good Body Mechanics Can Protect Your Back
a) Getting out of bed. 1. Roll on your side and push your body up with your arms.
2. Bend your knees and lower your feet to the floor.
3. Use your legs to lift your entire body.
b) Sleeping. 1. Sleep on a firm, comfortable mattress.
2. If the mattress is too soft, insert a board under the mattress for firmness.
3. Sleep on your back with a pillow under your knees or on your side with a pillow between your bent knees.
4. Sleep on a contoured pillow (with a shallow curve for the head) to help keep your neck and spine aligned during sleep.
c) Getting into a vehicle. 1. Use the door to help you sit.
2. Grasp the steering wheel for support when seated, and slowly swing both legs into the car.
3. If you use a seat pad or back support, secure it to the seat to prevent slippage.
d) Getting out of a vehicle. 1. Use the steering wheel as leverage to help pivot your lower body out of the car.
2. If possible, slowly swing legs out of the car at the same time to prevent twisting your back.
3. Use the door for support as you raise your body with your legs.
e) SittingWhile sitting at work or at home, try to maintain good posture.
1. Keep your knees at a 90-degree angle.
2. Keep your feet flat on the floor or on a footrest.
3. Use a back support or a rolled up towel to support the normal curvature of your lower back.
4. Keep your ears, shoulders, and hips in a straight line perpendicular to the floor.
5. Bend your elbows at about 90 degrees, with your wrists parallel to the floor.
6. Allow your arms to rest on the soft armrests of a chair.
This will also relieve some compression on your lower back. f) Lifting. 1. When lifting, keep the object close to your body.
2. If the object is on the floor, widen your stance (slightly outside of shoulder width) and bend only at the hips and the knees.
3. Keep your back in its normal arched position while lifting.
4. Do not lift by bending forward and using your lower back.
5. Do not twist while you are lifting.
6. Take a breath and breathe out as you exert yourself during the lift.
7. Tighten your stomach muscles and begin the upward lift by using your legs.
8. If you are carrying the object, be sure to keep it close to your body and maintain a straight spine.
- 5. What kinds of pain is treated at the pain clinic?All types of pain are treated. Conditions treated include acute and chronic low back pain, acute and chronic neck pain, arm and leg pain, herniated discs, arthritis, muscle pain, fibromyalgia, headaches, reflex sympathetic dystrophy, shingles, diabetic neuropathy, tendinitis, joint pain including hips, shoulder and knee, as well as cancer pain.
- 6. What is an epidural injection? Epidural refers to the space outside the dura or covering of the spinal cord and inside the spinal canal. This space runs the length of the spinal cord. Epidural injections provide diagnostic data and pain relief by delivering local anesthetic and steroid into the spinal area on the surface of the spinal column. The steroid serves as an anti-inflammatory agent.The procedure is done under fluoroscopy (X-ray) guidance so your doctor can better target the direct source of your pain.
- 7. Why is it done? An epidural injection may be done to confirm a specific diagnosis and/or decrease pain and inflammation. In general, epidural injections are recommended to provide pain relief and enable patients to progress with their rehabilitation. Epidural injections may be an effective nonsurgical option for common conditions such as lumbar disc herniation, degenerative disc disease, and lumbar spinal stenosis.
- 8. How long does the procedure take? The procedure approximately takes 2 hours. You will have to arrive one hour before the procedure. The actual procedure time is usually fifteen minutes. The remainder of the time will be spent in the recovery room.
- 9. Is the procedure painful? The procedure does involve an injection so you may feel some discomfort. Local anesthetic is used. You may feel some warmth as the fluid is injected. You may also experience some of your typical pain.
- 10. When will the pain relief take effect? You may experience numbness and/or relief from your typical pain for up to 6 hours after the injection. This is due to the long-acting anesthetic injected. Your usual symptoms may then return and may possibly be worse than usual for a day or two. The beneficial effects of the steroid injection usually begin in 2 to 3 days or may take as long as a week.
- 11. What are the risks of this procedure? Generally speaking, this procedure is very safe. However, as with any procedure, there are risks, side effects, and the possibility of complications. The most common side effect is pain, which is temporary. There is also occasional bruising. There is a slight possibility of infection, either at the site of injection or in the deeper tissue. This could require the use of antibiotics, either by mouth or intravenously. Additionally, if the infection is severe it could require hospitalization and further management. In these procedures it is possible to get close to a nerve root, and this would cause a slight increase in pain with possible radiation into the limb. It is very unlikely, but there could be permanent nerve damage. Very rare complications may include bone injury from repetitive steroid intake, reaction to the injectant (anaesthetic or steroid material) causing respiratory or cardiac compromise as well as seizures. Steroid medications have rarely been associated with hip or arm (bone) damage, and this has usually been with high doses or prolonged use. This remains a rare complication.
12. What are the instructions to be followed before the procedure?Please stop aspirin, blood thinning medications and nonsteroidals. If you are taking any other blood thinner, notify your doctor. This medication must be discontinued prior to an injection and requires permission from the doctor prescribing it.
• Do not eat or drink 2 hours prior to the procedure. You may take routine morning medications with a small amount of water.
• You may be requested to obtain laboratory work and an EKG prior to your procedure. This will be discussed and ordered, if necessary, at the pre-procedure appointment with your doctor.
• For your safety, you must have a responsible adult to drive you home.
13. What are the post procedure instructions ? Your activity level following your injection should be at the following levels:
Day of Injection:We recommend no new activities. You should rest on the day of the procedure. You can participate in all previous activities, but do this at a level of 25% of your usual effort. Avoid sustained sitting or standing and alternate your positions on a regular basis (about every 20 minutes).
Day 2:25% to 50% of your usual activity level.
Day 3: Up to 75% of your usual activity level.
Day 4:After Day 4, activity is unrestricted as tolerated.
• Diet:Return to your normal diet as tolerated.
• Medications:Resume aspirin and other anticoagulants the first day after the injection. Resume your other medications as per your physician’s previous directions.
• Should you have fever, chills, drainage, excessive swelling or redness from the injection site, bladder or bowel dysfunction, or change in sensation or musclestrength, please contact immediately.
• The bandage may be removed after 24 hours.
• You may use ice compresses over the injection site – 20 minutes on, then 20 minutes off. Repeat this cycle as required. If using a gel pack, make sure a towel or piece of cloth is placed between the cold pack and the skin. Do not apply the cold packs to the numb areas following injection.
• Common side effects following the procedure include: Decreased pain and possibly some numbness for 4 to 8 hours due to the local anesthetic.
Pain at the injection site. A small amount of bleeding at the injection site.
If a steroid medication was used during the procedure, possible side effects include facial flushing, insomnia, and occasionally a low-grade fever.
All of the side effects listed should disappearwithin 1 to 3 days after the procedure.
- 14. What is Radiofrequency Nerve Ablation?Radiofrequency is a way of interrupting pain sig-nals. An electrical current produced by radiowaves is used to heat a small area of nerve tissue, thus decreasing the pain signals from that region. A small needle is inserted into the area where you are experiencing pain. Using live X-ray the doctor will guide the needle to the target area. An elec-trode is then inserted through the needle and radiofrequency current is sent through the electrode to the tissue causing the tissue to heat.
- 15. Who is a candidate for Radiofrequency Nerve Ablation?Prior to the Radiofrequency nerve ablation, the source and location of your pain need to be determined through a series of diagnostic blocks/injections on several areas of your back. Once the source and location have been established,and other conservative injections have failed Radiofrequency may be an option.
- 16. Will the procedure hurt?The doctor will use local anesthetic to numb the area to be treated, and the patient should experience minimal discomfort throughout the procedure.
- 17. How long does the procedure take?The total procedure time will only take on an average 30 minutes.
- 18. Can my pain be cured?Your back or neck may remain painful for about 1-4 days after the procedure. This is usually caused by muscle spasms and residual effect of the nerve being ablated. After this period you will begin to feel the pain relief, which can last anywhere from 9 months to 2 years. The nerves will eventually regenerate and additional procedures may be required
- 19. What is Ozone ? Ozone is a gas that normally exists in the atmosphere and is produced by the effect of UV rays of sun’s light on the oxygen.Medical ozone is the mixture of oxygen and ozone,in variable concentrations according to how it is applied.
- 20. How does Ozone work? When Ozone is injected in the inner disc space (nucleus pulposus),there is a production of antioxidant enzymes. These neutralize the toxic materials present inside the inner disc space and cause shrinkage of the disc. Further,Ozone dissolves in the water in the disc and affects the proteoglycans which are the building blocks of the disc causing them to shrink thus reducing the disc volume and lessening the pressure on the nerves.
- 21. Is Ozone therapy safe? Ozone injections have been found to be an extremely safe form of treatment and are currently employed in Europe as the first treatment of choice in disc herniations. The treatment is by and large free from any side effects .
- 22. What is Ozone discectomy? It is a procedure used to relieve back and leg pain by the injection of ozone in and around the disc.
Benefits of Ozone discectomy? There is:
o No cutting
o No scarring
o No general anaesthesia
o No hospital stay(day care procedure)
o Shorter recovery time
o Very short absence from work
Who should consider it ? Patients with :
o Very severe back, leg and or arm /shoulder pain due to disc herniation
o Pain that has not responded to 4 weeks of conservative treatments(rest, pain medications, physical therapy)
o Herniated lumbar or cervical disc confirmed by MRI or CT scan.
Who should not consider it?Patients with :
o Back pain where the disc appears normal by MRI/CT scan
o Cancer or other spinal tumours
o TB or other spinal infections
o Severe spinal stenosis due to degenerative changes in the spine and the discs
o Spondylolisthesis (2nd or 3rd degree)causing spinal instability
What is the course after the Ozone treatment? Bed rest advised for the first 48 hrs
10-15 min walk advised from day 3
Full activity with the exception of vigorous activity from day 6
Forward bending and lifting of weight not allowed for 4 weeks
Spinal exercises to be started only after 3 weeks and after consulting the doctor