Prevent back pain.

Prevent back pain.

Some simple exercises you can do at home to help prevent or relieve back pain.

·         Wall slides – stand with your back against a wall with your feet shoulder-width apart. Slide down into a crouch so that your knees are bent to about 90 degrees. Count to five and then slide back up the wall. Repeat five times.

·         Leg raises – lie flat on your back on the floor. Lift each heel in turn just off the floor while keeping your legs straight. Repeat five times.

·         Bottom lifts – lie flat on your back on the floor. Bend your knees so that your feet are flat on the floor. Lift your bottom in the air by tightening your stomach muscles while keeping your back straight. Repeat five times.

Preventing back pain:

Preventing back pain:

Keeping your back strong and supple is the best way to avoid getting back pain. Regular exercise, maintaining good posture and lifting correctly will all help.

If you have recurring bouts of back pain, the following advice may be useful:

·         Lose weight – too much upper body weight can strain the lower back.

·         Wear flat shoes with cushioned soles: as they can help reduce the pressure on your back.

·         Avoid sudden movements: which can cause muscle strain.

·         Try to reduce any stress, anxiety and tension: which can all cause or worsen back pain.

·         Stay active – regular exercise, such as walking and swimming is an excellent way of preventing back pain.

Exercise:

Exercise is both an excellent way of preventing back pain and of reducing it. However, if you have had back pain for more than six weeks, you should consult a healthcare professional before starting any exercise programme.

Exercises such as walking or swimming strengthen the muscles that support your back without putting any strain on it or subjecting it to a sudden jolt.

Activities such as Yoga or pilates can improve the flexibility and the strength of your back muscles. It is important that you carry out these activities under the guidance of a properly qualified instructor.

Below are some simple exercises you can do at home to help prevent or relieve back pain.

·         Wall slides – stand with your back against a wall with your feet shoulder-width apart. Slide down into a crouch so that your knees are bent to about 90 degrees. Count to five and then slide back up the wall. Repeat five times.

·         Leg raises – lie flat on your back on the floor. Lift each heel in turn just off the floor while keeping your legs straight. Repeat five times.

·         Bottom lifts – lie flat on your back on the floor. Bend your knees so that your feet are flat on the floor. Lift your bottom in the air by tightening your stomach muscles while keeping your back straight. Repeat five times.

At first, you should do these exercises once or twice a day, before gradually increasing to six times a day, as your back allows.

These exercises are also useful for warming up your back. Many people injure their back when doing everyday chores at home or work, such as lifting, gardening or using a vacuum cleaner. Warming up your back before starting these chores can help prevent injury.

Posture:

How you sit, stand and lie down can have an important effect on your back. The following tips should help you maintain a good posture.

Standing

Stand upright, with your head facing forward and your back straight. Balance your weight evenly on both feet and keep your legs straight.

Sitting:

Make sure you sit upright with support in the small of your back. Your knees and hips should be level and your feet should be flat on the floor.

Some people find it useful to use a small cushion or rolled-up towel to support the small of the back. 

If you use a keyboard, make sure that your forearms are horizontal and your elbows are at right angles.

Driving:

Make sure that your lower back is properly supported. Correctly positioning your wing mirrors will prevent you from having to twist around. Your foot controls should be squarely in front of your feet.

If you are driving long distances, take regular breaks so that you can stretch your legs.

Sleeping:

Your mattress should be firm enough to support your body while supporting the weight of your shoulders and buttocks, keeping your spine straight.

If your mattress is too soft, place a firm board (ideally 2cm thick) on top of the base of your bed and under the mattress. Your head should be supported with a pillow, but make sure your neck is not forced up at a steep angle.

Lifting and handling:

One of the biggest causes of back injury, particularly at work, is lifting or handling objects incorrectly. Learning and following the correct method for lifting and handling objects can help prevent back pain. You should:

·         Think before you lift – can you manage the lift? Are there any handling aids you can use? Where is the load going?

·         Start in a good position – your feet should be apart, with one leg slightly forward to maintain balance; when lifting, let your legs take the strain – bend your back, knees and hips slightly, but do not stoop or squat; tighten your stomach muscles to pull your pelvis in; do not straighten your legs before lifting as you may strain your back on the way up.

·         Keep the load close to your waist – keep the load close to your body for as long as possible with the heaviest end nearest to you.

·         Avoid twisting your back or leaning sideways, particularly when your back is bent – your shoulders should be level and facing in the same direction as your hips; turning by moving your feet is better than lifting and twisting at the same time.

·         Keep your head up – once you have the load secure, look ahead, not down at the load.

·         Know your limits – there is a big difference between what you can lift and what you can safely lift; if in doubt, get help.

·         Push rather than pull – if you have to move a heavy object across the floor, it is better to push it rather than pull it.

·         Distribute the weight evenly – if you are carrying shopping bags or luggage, try to distribute the weight evenly on both sides of your body.

Physical therapists' advise:

Physical therapists' advise:

·       Don't under prescribe exercise for older adults.

·       Don't prescribe bed rest for people with acute deep vein thrombosis once they're properly medicated.

·       Don’t use continuous passive motion machines for people who have had knee replacements.

·       Don't use whirlpool baths for wound management.

Neck Pain: Getting a Diagnosis

Neck Pain: Getting a Diagnosis

If you do seek help for neck pain from a physician, your evaluation will include a medical history, a physical examination, and, if needed, imaging tests. During the physical exam, the doctor will likely measure your reflexes, range of motion, sensation, strength, and muscle and nerve function in your neck, arms, and legs.

If pain is the only symptom, and it does not radiate beyond your neck, imaging studies are usually not necessary. In this case, the pain is likely temporary and requires no invasive treatment. However, for people with a traumatic injury, rheumatoid arthritis, or a physical exam that does not pin down the cause of the pain, imaging studies may be needed. Imaging tests include x-rays, MRI scans, and CT scans. Further options may include electromyography and nerve conduction tests to assess the combined function of the muscles and nerves. People with intense pain that lasts for months may need further evaluation to rule out cancer.

Neck Strength Training Improves Quality of Life:

Strength training may help improve the quality of life in women with chronic neck pain, a recent study suggests.

Researchers randomly assigned 180 women with chronic neck pain to take part in either a strength­training program three times a week for one year, an endurance­training program three times a week for one year, or a single session on neck stretching exercises. Women in the strength­training group performed high­intensity isometric neck strengthening exercises with an elastic band. The endurance­training group performed lighter dynamic neck muscle training.

At one year, women in both exercise groups reported significantly better quality of life compared with baseline. Women in the strength­-training group had the greatest improvement. Women in the neck-­stretching group had slightly lower scores at the end of the study.

These findings suggest that regularly performing neck exercises may help improve quality of life for chronic neck pain sufferers. If no treatable cause of your neck pain has been identified, ask your doctor to refer you to a physical therapist, who can design an appropriate program.

Range-of-motion exercises and massage also can be helpful for neck pain. A physical therapist can teach you appropriate neck stretches and exercises for the shoulders and upper back to help ease neck pain and prevent future episodes. Your doctor or physical therapist may also instruct you on how to correct detrimental aspects of your posture or the setup of your office.

If two weeks of conservative treatment do not alleviate the pain, muscle relaxants, ongoing physical therapy, or spinal manipulation (chiropractic) may be recommended. Another treatment option is a cervical traction device, which uses a system of weights and pulleys to help relieve pressure on the neck. The device is available at surgical supply stores.

For individuals whose neck pain appears to be caused by stress or depression, stress-management techniques, antidepressant medication, or both are often useful. In addition, your doctor may prescribe corticosteroid medications (either oral or injected), which can help reduce inflammation.

Even people with disk herniation or mild spinal stenosis should be treated first with conservative measures if the pain does not radiate beyond the neck. If no treatment has relieved the neck pain after eight weeks or if imaging studies indicate serious structural problems, you may need to consult with a spinal surgeon.

Surgery involves relieving pressure on the spinal cord or the pinched nerve. Up to 90% of people who undergo surgery for neck pain experience significant pain relief.

Long-term back pain Treatment:

 Long-term back pain Treatment:

If you have had back pain for more than six weeks (known as chronic back pain), your GP will advise you about which painkillers to take and recommend the treatments listed below:

·         Exercise - usually take the form of a group class supervised by a qualified instructor. The classes may include exercises to strengthen your muscles and improve your posture, as well as aerobic and stretching exercises. NICE recommend a maximum of eight sessions over a period of up to 12 weeks.

·         Manual therapy - there are different types of manual therapy including manipulation, mobilization and massage, usually carried out by chiropractors, osteopathos orphysiotheraoists (chiropractic and osteopathy aren't widely available on the NHS). NICE recommend a maximum of nine sessions over a period of up to 12 weeks.

·         Alexander technique - teaches you how to eliminate unnecessary muscular tension from your body. It aims to make you aware of any bad postural habits that you have while sitting or standing, as well as any inefficiencies in the way you move. You'll learn how to improve the balance and alignment of your body.

·         Acupuncture - an ancient Chinese treatment where fine needles are inserted at different points in the body. It's been shown to help reduce lower back pain. NICE recommend that an acupuncture course should include a maximum of 10 sessions over a period of up to 12 weeks.

These treatments are often effective for people whose back pain is seriously affecting their ability to carry out daily activities and who feel distressed and need help coping.

Nerve root blocks:

A nerve root block is where a steroid or anesthetic is injected into your back. If your back pain is caused by a trapped or inflamed nerve in your spinal column, the injection can help relieve the pain in your back, plus any associated leg pain.

To be effective, the injection needs to be made at exactly the right place in your back, so the procedure will be carried out under X-ray and CT- guidance.

Facet joint injections:

It is also possible to have anesthetic or steroid injections in the facet joints. The facet joints are the joints that connect one vertebra to another so that your spine is kept aligned. The joints are sometimes affected by arthritis. Facet joint injections are not always effective at relieving back pain.

Antidepressants:

If the painkillers do not help, you will probably be prescribed tricyclic antidepressants (TCAs), such as amitriptyline. TCAs were originally intended to treat depression, but they are also effective at treating some cases of persistent pain.

If you are prescribed a TCA to treat persistent back pain, the dose is likely to be very small.

Counseling:

If the treatments described above are not effective, you may be offered counseling to help you deal with your condition.

While the pain in your back is very real, how you think and feel about your condition can make it worse. Studies have shown that people who have had CBT later reported lower levels of pain. They were also more likely to remain active and take regular exercise, further reducing the severity of their symptoms.

Surgery:

Surgery for back pain is usually only recommended when all other treatment options have failed.

Surgery may be recommended if your back pain is so severe or persistent that you are unable to sleep or carry out your day-to-day activities. The type of surgery will depend on the type of back pain you have and its cause.

For example, a procedure known as a discectomy may be used if you have a prolapsed disc. The discs are the circular, spongy tissue between the vertebrae that help cushion your spine. A prolapsed disc is where the hard outer membrane of the disc is damaged, causing the soft, jelly-like fluid inside to leak out.

A discectomy involves removing the damaged part of the disc through an incision made in your back. It is now possible for surgeons to carry out the procedure using a very small incision and a microscope or magnifying lenses to find the damaged disc. This minimizes the amount of trauma to the surrounding tissue, reduces the pain and discomfort in the affected area and results in a smaller scar.

Spinal fusion surgery is a less common surgical procedure where the joint that is causing pain is fused to prevent it moving.

As bone is living tissue, it is possible to join two or more vertebrae together by placing an additional section of bone in the space between them. This prevents the damaged vertebrae irritating or compressing nearby nerves, muscles and ligaments, and reduces the symptoms of pain.

Spinal fusion is a complicated procedure and the results are not always satisfactory. For example, you may still experience some degree of pain and loss of movement following surgery.

Before you agree to have surgery to treat back pain, you should fully discuss the risks and benefits of the procedure being recommended with your surgeon.

Other treatments:

A number of other treatments are sometimes used to treat long-term back pain. However, they are not recommended by the National Institute for Health and Care Excellence (NICE) due to a lack of evidence about their effectiveness. They include:

·         low level laser therapy – where low energy lasers are focused on your back to try to reduce inflammation and encourage tissue repair

·         interferential therapy (IFT) – where a device is used to pass an electrical current through your back to try to accelerate healing while stimulating the production of endorphins (the body’s natural painkillers)

·         therapeutic ultrasound – where ultrasound waves are directed at your back to accelerate healing and encourage tissue repair

·         transcutanious elecrcal nerve stimulation(TENS)– where a TENS machine is used to deliver small electrical pulses to your back through electrodes (small sticky patches) that are attached to your skin; the pulses stimulate endorphin production and prevent pain signals travelling from your spine to your brain

·         lumbar supports – where cushions, pillows and braces are used to support your spine

·         traction – where a pulling force is applied to your spine

·         injections – where painkilling medication is injected directly into your back

Treating back pain:

Treating back pain:

 

Treatments for back pain will vary depending on how long you have had the pain, how severe it is and your individual needs and preferences.

Short-term back pain:

Most cases of back pain that last no longer than six weeks can be treated with over-the-counter painkillers and home treatments.

Painkillers:

Paracitamol is effective in treating most cases of back pain. Some people find non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, more effective. A stronger painkiller, such as codeine, is also an option and is sometimes taken in addition to paracetamol.

If you also experience muscle spasms in your back, your GP may recommend a short course of a muscle relaxant, such as diazipum.

Painkillers can have side effects, some can be addictive and others may not be suitable, depending on your state of health. Your GP or a pharmacist will be able to give you advice about the most appropriate type of medication for you.

Hot and cold treatments:

Some people find that heat – for example, a hot bath or a hot water bottle placed on the affected area helps ease the pain.

Cold, such as an ice pack or a bag of frozen vegetables, placed on the painful area is also effective. Do not put the ice directly on to your skin because it might cause a cold burn. Wrap the frozen pack in a wet cloth before applying it to the affected area.

Another option is to alternate between hot and cold using ice packs and hot compression packs or a hot water bottle. Hot compression packs can be bought at most larger pharmacies.

Sleeping position:

Changing your sleeping position can take some of the strain off your back and ease the pain.

If you sleep on your side, draw your legs up slightly towards your chest and put a pillow between your legs. If you sleep on your back, placing a pillow under your knees will help maintain the normal curve of your lower back.

Relaxation:

Trying to relax is a crucial part of easing the pain because muscle tension caused by worrying about your condition can make things worse.

Research suggests that people who manage to stay positive despite the pain tend to recover quicker and avoid long-term back pain.

Read more about relaxation tips to relieve stress.

Keep moving:

Most experts now agree that staying in bed, lying down or being inactive for long periods is bad for your back.

People who remain active are likely to recover more quickly. This may be difficult at first if the pain is severe, but try to move around as soon as you can and aim to do a little more each day.

Activity can range from walking around the house to walking to the shops. You will have to accept some discomfort but avoid anything that causes a lot of pain.

There is no need to wait until you are completely pain-free before returning to work. Going back to work will help you return to a normal pattern of activity, and it can often distract you from the pain.

Exercise and lifestyle

Try to address the causes of your back pain to prevent further episodes. Common causes include being overweight, poor posture and stress.

Regular exercise and being active on a daily basis will help keep your back strong and healthy. Activities such as walking, swimming, and yoga are popular choices.

The important thing is to choose an enjoyable activity that you can benefit from without feeling pain.

TRIGGER FINGER-02

TRIGGER FINGER:

Treatment

Initial treatment for mild or infrequent symptoms of trigger finger include rest, avoiding or modifying those activities that caused the inflammation, and the use of a nonsteroidal anti-inflammatory drug (NSAID) 

Treatments depend on the severity of the symptoms. At-home treatments include:

• taking a break from repetitive activities for four to six weeks 
• wearing a brace or splint to restrict motion and rest the hand
• applying heat or ice to reduce swelling 
• placing the hand in warm water several times throughout a day to relax the tendons and muscle
• gently stretching the fingers to enhance range of motion. 

Medications may help relieve inflammation. Anti-inflammatory medications include:

• ibuprofen 
• naproxen
• prescription strength anti-inflammatory
• steroid injections

If medications and at-home treatments don’t work, a doctor may recommend surgery. Surgery for trigger finger is done on an outpatient basis. After an anesthesia shot, a surgeon makes a small cut in the palm and then cuts the tightened tendon sheath. 
As the tendon sheath heals, the area is looser, helping the finger move more easily. Surgery risks include infection or ineffective surgery. 
Surgery recovery can take anywhere from several weeks to six months. A doctor may recommend physical therapy exercises to relieve post-surgery stiffness.

In severe cases that do not respond to injections and the finger or thumb remains in a locked position, surgery may be required to relieve the symptoms. A local anesthetic is used for the surgical procedure performed on an outpatient basis. An incision is made by a surgeon in the palm of the hand at the base of the affected finger or thumb to relieve the constriction of the tendon. Recovery may take up to four weeks.
Sometimes physical therapy of the hand is required after surgery to regain good use.







Alternative treatment:

Treatment should begin when a person starts having difficulty moving the fingers. If started early, non-invasive measures have a good chance for success. Alternative treatments include acupuncture to facilitate healing and microcirculation, pulsed ultrasound, and myofascial release work for the affected area

Prognosis:

At least half of cases can be cured non-surgically. The key to successful treatment is early intervention. A mistake people make is trying to work through the pain. Diabetics have a higher incidence of the condition and are sometimes left with a disability.

Prevention:

Taking frequent breaks from a repetitive activity will do much to prevent the condition. Depending on the intensity, that may mean a 10-minute break every hour from the repetitive activity. The break should be spent stretching the hands and arms and generally moving around.
dense of the condition and are sometimes left with a disability.