Back Pain Articles

The sciatic nerve runs from the bottom of the spinal column down the back of your thighs to the lower legs and feet. If this nerve is compressed, the pain can be unbearable. Sciatic nerve pain could be the result of lots of circumstances, like a slipped disc, pinched nerves, age related constriction of the vertebrae, degenerative disc disease, and also bad posture. There are various forms of treatment for sciatic nerve pain that can give you some relief. Here’s a look at a number of of the more effective courses of action to reduce your sciatica pain.

Acupuncture: This age old Chinese technique for pain management has gained popularity with many of those who are experiencing sciatica. It is believed that acupuncture activates Qi energy, which helps to prevent pain. This will have to be done by a qualified practitioner.

Back Stretches: Stretching routines can assist to guide the back muscles to properly support the spine. The most effective stretches for sciatica nerve pain involve your back, neck and shoulders, hips, buttocks and hamstrings. These should be done slowly and each stretch should only be maintained for approximately 20 seconds so you don’t hurt yourself.

Cold and Heat Therapy: An ice pack can decrease the inflammation, numbness and pain associated with sciatic nerve pain or sore muscles. Heat helps to increase the flow of oxygen and nutrients to the painful region, and is best used when the extreme pain has decreased. Switching between cold and heat therapy offers the greatest results.

Hydrotherapy: Soaking in a hot tub gives relief to aching muscles and relaxes your body. Soaking for about 20 minutes to 2 hours helps reduce the pain attributable to sciatica. If remaining seated is too uncomfortable, taking a hot shower for approximately 20 minutes will work, but you will want to allow the water to accumulate in the bathtub to cover up your feet. This will warm the venous blood that proceeds from your feet throughout your body.

Reduce weight: Those who weigh more than they should will have to think about losing weight so as to relieve the strain on the spine.

Reflexology: You can perform this type of treatment on your own using your thumb or a reflexology tool. There are two reflex points on the feet, and if pressure is applied there for a minute or two, it alleviates the discomfort from the sciatic nerve.

Trigger Point Therapy: One more form of treatment that some people get good results with is to apply some force to the trigger point region for around 2 minutes with a ball or other firm object.

Exercise is an excellent approach to sciatica home treatment. Learn more about the causes and cures for this condition at the Sciatic Nerve Pain Treatment site.

Are you suffering from sciatic nerve pain (sciatica)? What are you using to relieve the pain, heat or ice? Many have the misconception, when it comes to sciatic nerve pain treatment, that heat is what will ease the pain. There are many opinions when it comes to sciatica treatment but, the rule of thumb to use, is to base the decision on the symptoms.

~If there is inflammation present which is indicated by swelling along with intense sharp pain then, ice is what you will want to use, just as you would with a sprain.

~If you are experiencing mild stiffness or are a little sore then this indicates that there isn’t a significant amount of swelling which means that heat will not worsen the pain and can help ease it instead.

Anytime you experience an injury or trauma to the sciatic nerve, it is best to avoid using heat for at least 48 hours to make sure there is no inflammation and that it doesn’t develop. Whenever you are in doubt, it is always best to avoid using heat! Heat may feel while you are using it but heat also increases inflammation if it is present. Since heat blocks the nerves sensory receptor it may feel good until you remove the heat then, because heat increases inflammation, the pain will be much worse.

After many years of trying to ease the sciatic nerve pain with heat and only feel more intense pain once I removed the heat, I decided to try ice. This is when Discovered the above to be true, ice really does work when you first experience sciatica, it doesn’t feel comfortable when applied but does ease the pain considerably.

As for any injury where inflammation and swelling are present most doctors will recommend application of ice packs to help reduce swelling and inflammation. Ice is one of the best anti-inflammatory measures you can take even though it may not feel comfortable. The short term discomfort of applying ice packs will be rewarded in long term relief of sciatic nerve pain.

Some precautions you should take when using heat or ice to avoid skin irritation or damage are, first always place a cloth between the heat or ice pack and your skin. Second Do not apply the heat or ice pack if you have applied a topical analgesic such as, Icy Hot, Ben Gay, Theragesic, Biofreeze, or any other, until the effects have worn off completely as this can cause skin damage as well as irritation.

When applying heat or ice you should only apply it for twenty minuets once every two hours, once an hour if pain is severe but, to help avoid skin damage try to do it every two. hours. It will take time to feel the heat or cold through a cloth so, wait until you actually feel the heat or cold before you start timing.

If you suffer from impaired circulation or decreased skin sensitivity due to, diabetes, nerve damage, or anything else that causes reduced blood circulation, consult a doctor before applying ice or heat.

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Sciatica is a common problem that people can sometimes experience. It is the term used by the medical community for pain, numbness, or weakness that is in the leg. However, despite what many believe, it is not a medical condition, but rather the result of a medical condition that you may already be experiencing. The cause is from pressure being applied to the sciatic nerve or nerve damage in the area.

For some people, the symptoms can only feel like tingling. For others, it can be pain or even a burning feeling. Those who suffer from severe sciatica are not able to move at all when the pain strikes. Commonly, it only happens on one side of the body, in one leg. The pain can be felt in the hip or back of the leg. Some individuals have even reported feeling the pain in the sole of their foot.

Your doctor can figure out if you have sciatica from several different types of tests. This can involve MRIs, blood tests, or x-rays. This can also involve tests that reflect on your range of motion. In example, someone that is suffering from the ailment may have problems bending their feet down or may reflect weak reflexes. There can also be weakness in the bending of the knees.

If the condition is treated before the nerve damage has the chance to worsen, there is a good change that the individual can recover completely. Other times, full recovery might not be possible and may leave the individual with a loss of motion. Pain can also become more consistent and prolonged. For this reason, it is important to get the problem diagnosed fairly soon.

Treatments can depend on what is causing the damage and lack of function to the sciatic nerve. In the best cases, treatment is non surgical and the patient recovers very quickly, but this is dependent on the severity of the problem. In cases where the nerve damage may be caused by something applying pressure to the nerve, surgery is required to ease some of the symptoms. Medications or injections can also be prescribed to help treat the pain and stop some of the inflammation in the nerve area itself.

Another common treatment is physical therapy. This helps to promote muscle strength and improve range of motion with the individual. This in addition to other types of therapy can help the individual to recover at a faster rate while allowing them to regain some of their lost movement and function. However, the doctor may also recommend other options such as changes to the way you work at your job or suggestions for different ways to work if you are often standing or sitting.

Prevention really depends on how severe the damage to the nerve truly is. Something that may work as a preventative measure for one individual may not work as well for another individual because of the differences in severity. Methods for prevention are better discussed with a doctor that can create specific solutions for individuals based on the severity of their own needs.

Truthfully, to have the best results regarding treatment of sciatica, the problem needs to be diagnosed fairly soon. If the individual even suspects that it could be a possibility, they should go to the doctor for an examination and diagnosis. If nerve pain is allowed to continue without examination and treatment, the nerve damage can worsen. Allowed to worsen too long, the condition might not be repairable.

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Pregnancy comes with an assortment of aches and pains, but a number of women are plagued by an even more excruciating condition during pregnancy: sciatica. When the baby’s head presses against the sciatic nerve, which is a nerve that travels down the spine, into the pelvis, and down the upper leg, this extremely painful condition is produced. The result is usually numbness or pain in the woman’s back, many times going down into their buttocks and thighs.

Most of the time, women have to deal with sciatica when they are in their second or third trimester because that is when the head of the baby is the biggest and is able to press down more. This condition is something that the woman will generally have to deal with until the birth of the baby, as its position, which is causing the pain, will likely not change until birth. The hormonal changes of pregnancy, that allow the ligaments and tendons to loosen in preparation for the birth of the baby, will actually exaggerate the condition. There is a higher probability that pressure will be exerted on the sciatic nerve, thanks to the instability in the pelvic and back area, that is produced by the loosening of the body’s tendons and ligaments.

Sadly, there isn’t a method that will keep a woman from getting sciatica while she is pregnant. It is thought, though, that those who are more healthy and are in better physical condition are at less risk for sciatica. The reason for this is that healthier women have better muscle tone, making it easier for them to support the pregnancy weight and give them better range of motion if they do damage the sciatic nerve.

If an expectant mother has sciatica bad enough, her doctor might give her a prescription, but a lot of physicians try to treat sciatica without medication. If it is severe, the doctor will usually put the mother on bed rest, have her get a deep tissue massage, and put heat and ice on the area alternatively.

Making some lifestyle modifications can help as well. You will experience greater pressure on the nerve if you tend to slouch, so be sure to stand up straight. To ensure even weight distribution, low heeled or flat heeled shoes are recommended. Sleep with a pillow between your knees, on a flat surface, such as the floor or a very firm mattress. To ease your discomfort when arising from bed, you should first roll yourself over onto your side, and then swing your legs over the side of the bed before you get up. Many times the sciatic nerve is hurt when people get out of bed the wrong way, so be sure to take care. It is also helpful to walk, swim, stretch, and have a prenatal massage to relieve the pain of sciatica.

Exercise is an excellent approach to sciatica home treatment. Learn more about the causes and cures for this condition at the Sciatic Nerve Pain Treatment site.

What is Sciatica? Sciatica is a constant pain that is felt along the sciatic nerve; it runs from the lower back down to the feet. It controls the muscles to the legs and provides feeling to the thighs, legs and bottoms of the feet. Sciatica occurs most often in people between the ages thirty through fifty. It usually is caused by repetitive use type of conditions, such as sitting for long periods of time, or normal wear and tear. It is rarely caused by an acute or traumatic event.

The pain from sciatica can be sometimes debilitating and it can get so bad it can be difficult for one to sit, walk or even sleep. Some people experience tingling, while for others it is just a dull pain. Occasionally it can be a burning type of feeling. Pain from the sciatic nerve is usually caused by the nerve being pinched or irritated in the lower back or lumbar spine. The nerve then gets inflamed and causes a variation of symptoms that can wreak havoc with one’s lifestyle.

The most conservative type of treatment for sciatica is the application of ice. I recommend to my patients to lay flat with two pillows under the knees and apply ice to the lower back on the side of involvement for fifteen minutes. This can be repeated up to every hour if necessary. It is important not to apply the ice for more than twenty minutes at a time because this can aggravate the condition. Applying ice to the source of the problem will decrease the inflammation of the nerve and subsequently decrease pain. Although this may be a temporary solution, it does offer some relief.

Manipulation of the spine to relieve the pressure on the nerve has been demonstrated in studies to be one of the most affective treatments for sciatic pain. Manipulation is the best place to start when someone has sciatic nerve pain. It is a non-invasive, drug-free treatment option. The goal of manipulation is to realign the spinal bones taking the pressure off the nerve. When the nerve pressure is alleviated one often finds great improvement with decreased pain and inflammation.

Other very effective, conservative option is a good exercise program. There are many exercises available, but these are the ones I have used in my clinical experience to be most effective. The first exercise is laying flat on your back with your knees bent. Squeeze or flex you buttocks pressing toward the ceiling. Hold this position for a count of ten and slowly return to the neutral position. Repeat this four times. Starting at the neutral position, bring each leg to your chest with both hands one at a time. Follow this by bringing both knees to the chest, bringing your head up again holding for a count of ten and returning slowly to the neutral position and do this four times. A third exercise is laying on your stomach and arching backwards with your elbows on the floor moving from a neutral position to a comfortable flexed position arching backwards as much as you can but stopping if back or leg pain worsens. The fourth exercise is on your hands and knees, pushing your back up toward the ceiling then pushing it to the floor, (this is often called the cat stretch). These exercises should be initiated slowly and if there is any pain or discomfort, to stop before you have pain. I would recommend doing these exercises two to three times a day.

There are many nutritional aspects to sciatic nerve pain you may not be aware. A diet that is pro-inflammatory i.e., one that is rich in meat, dairy and shellfish, will give more inflammation to all nerves. An anti-inflammatory diet consists of fruits, vegetables and fish. This is one of the most powerful ways to treat the symptoms of inflammation and stop pain.

The nutritional protocol that I found to be most effective in treating sciatic nerve pain are turmeric, tulsi and rosemary. These powerful herbs have been studied and found to greatly lower inflammation. Boswellia is an herb that is a specific anti-inflammatory. This is especially helpful for arthritic patients. Bromelein is a plant enzyme found in pineapples and has powerful natural anti-inflammatory effects. I prefer to take this with papain as well, it is essential that you take it on an empty stomach to really get the benefits of the anti-inflammatory nature. Ginger is a wonderful herb that offers pain relief. You can steep fresh ginger in boiling water and use it as a tea or make a juice with it. Evening primrose oil, black currant oil, or borage oils contain the essential fatty acids Gammalinolenic acid. These omegas will powerfully reduce the inflammatory process and take down the inflammation on the sciatic nerve.

There are many ergonomically beneficial positions that will improve sciatic nerve pain no matter the cause. It is an important part of your treatment to improve your posture and use your body correctly. Good posture allows the use of the body without strain on muscles, joints, ligaments, and internal organs. Good posture must be considered in all activities: sitting, standing, resting, working, playing and exercising. It is simply not a matter of “standing tall”.

In the resting position, it is beneficial to lay flat on your back with two pillows under your knees or lay on your side with a pillow in between your knees. Avoid positions like sleeping flat with no pillow, on your stomach or lying on your stomach with one knee bent up. This will result in a ’swayback’ condition. Some simple things, such as getting up and down from bed, to get into bed it is best that you sit on the side of the bed bring both arms to one side, lower your side to the bed keeping your knees bent at forty five degrees, then pull your feet into bed. Remain on one side or roll on the back. Getting up from the bed it is best to roll on your side push with the hands to the sitting position keeping knees bent and swinging legs over the edge of the bed. When sitting, stay away from a chair that is too high, as this will increase swayback. When sitting, the knees should be higher than the hips as this will flatten the lumbar curvature. Avoid slouching on a chair with feet on an ottoman because this can strain the lower back. When traveling in a car the seat should be close to the steering wheel and use a small pillow for proper lumbar support. When standing, it is recommended to place one foot on a stool or shelf and after a short time switch to the other foot, this will cause the lumbar curve to flatten and ease the pressure off the lumbar spine. When lifting, do not bend at the waist. Bend the knees and carry the object close to the body. When bending, bend at the knees and push your buttocks out rather then flexing at the waist.

My final tip on stopping sciatic nerve pain is to drink plenty of water. A dehydrated body is one that will struggle to heal. It is important to drink at least six to eight glasses of water per day to keep the body well hydrated and to flush toxins built up from resulting muscle spasms of the pain and inflammation. Water will also hydrate the disc. Between your spinal bones are intervetebral discs that dry out as we age the more we can keep them hydrated, the less degenerative arthritis will occur in the spine. This is also the reason we get shorter as we age is each little disc between the vertebrae dry out, or desiccate then subsequent height loss will occur.

If you follow these simple steps for stopping sciatic nerve pain, you will go a long way in preventing any pain in the future and avoid any harmful pharmaceutical side effects or painful surgical intervention. Remember, an ounce of prevention is worth a pound of cure.

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Human populations are ageing across the world, particularly in developed countries such as the USA, Europe and Japan, with some developing countries such as China set to follow them over the next decades. This will place a large burden on physiotherapy and medical services as countries struggle to cope with steadily increasing levels of osteoarthritis (OA), an age-related degenerative condition. OA is responsible for significant levels of medical expenditure, disability, pain and work loss and provision of services such as joint replacement will be a challenge. Quality of life improvements after medical interventions vary but for joint replacement are some of the highest of all medical procedures.

Hip replacement has a long history but the 1960s saw its development into a reliable procedure, with modern developments making it a predictable and very successful treatment for hip osteoarthritis.

In surgery the degenerative joint is excised and artificial components of alloy steel and plastic are substituted. The hip joint ball is removed and the socket cored out in preparation, the new ball and stem is inserted into pressurized cement in the femur and the new cup is pressed into cement in the socket. The two materials, steel alloy and ultra high density polyethylene, ensure very low friction in the joint similar to the original and contribute to low wear and long life of the joint.

Conservative treatment is always instituted initially but if the joint degeneration becomes severe then joint replacement is the remaining option. The surgeon removes the osteoarthritic joint surfaces and replaces them with new components which are made of steel alloy and ultra high density polyethylene. The ball of the hip is replaced by a metal ball and stem and inserted into pressurized cement in the femoral canal. The plastic socket is pushed into the cement in the prepared socket to complete replacement of the two surfaces. Using the two materials, very slippery plastic and highly polished metal, ensures very low joint friction and a long functional life under load. The physiotherapist will review the patient’s medical notes for their post-operative instructions and medical status and then assess the patient’s respiratory and lower limb function.

The patient continues with buttock, hip flexion, quadriceps and foot exercises regularly to encourage normal limb muscle function and help circulation. They take regular analgesia to reduce pain and assist in their ability to mobilise. Once safe they can mobilise independently at least three times a day to have a walk, go to the toilet and wash and dress. Sitting is encouraged as long as the chair is not low and they are not permitted to put their legs up when sitting.

Physiotherapists routinely teach and correct patients’ gait after hip replacement to improve joint movement, muscle strength and a normal walking pattern. On getting a patient up initially the physio will teach the “step to gait”, instructing the patient to place the crutches forward at first, place the operated leg between the crutches then following it by stepping to it with the unoperated leg. This technique is steady but slow and used when safety is key, and the next progression is to a “step through gait” where the unoperated leg then moves through past the operated leg into a more normal gait. The most advanced gait sees the operated leg and the crutches moving together at the same time and gait approaching normal.

Once they return for their follow up appointment at six weeks after operation patients have often achieved a good gait, reasonable hip strength and returned to some activities of daily living. The physio may advise a stick if they are unsteady, slow or older, and they can gradually regain their previous abilities provided they observe the precautions to prevent hip dislocation:

* Avoid crossing the legs in sitting.

* Weight bearing on the leg and rotating the body weight is unwise.

* Don’t flex the hip suddenly or above 90 degrees, such as by sitting in a low chair, sitting down too fast, crouching or leaning forward quickly to the feet.

* If an infection develops, for example chest, teeth or bladder, then the doctor should be informed as infections can settle in an artificial joint.

Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about Physiotherapist, back pain, orthopaedic conditions, neck pain, injury management and physiotherapists in Edinburgh. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.

Osteoarthritis is a time related joint degenerative condition, the incidence rising rapidly with age, making it the commonest arthritic condition in the world. It develops in various joints in the human body and in some people it particularly affects the large weight-bearing joints of the hip and the knee. As the joint surfaces deteriorate the joint becomes painful, crunches, loses range of motion and becomes difficult to walk on. When conservative measures are not helpful, such as physiotherapy, analgesics, walking aids and weight loss, then knee replacement is considered.

Total knee replacement is one of the most successful medical technologies with the highest quality of life improvements of any medical intervention, a distinction it shares with total hip replacement. Knee replacement has matured from an experimental procedure of uncertain long-term outcome to a predictable and very common operation with very good results at ten years or more. As western populations age knee replacement is overtaking hip replacement as the most commonly performed joint replacement.

Metal and plastic components are inserted to replace the degenerative joint surfaces of the knee. In knee replacement these consist of four items:

* The metal femoral insert to replace the lower end of the femur which is the top half of the knee.

* The metal tibial insert to replace the tibial surfaces, the lower half of the knee.

* The plastic insert, made of ultra high density polyethylene, is placed between the femoral and tibial inserts.

* The patellar button is also of plastic and placed on the back of the kneecap to replace that surface.

The components are fixed in place using cement which acts as a grouting material rather than sticking anything. Knee replacement surgery causes weakness of the knee muscles, pain, inflammation and joint swelling, all important problems which the physiotherapist needs to treat promptly. Physios in hospitals often use Cryocuffs to provide cold therapy and compression which reduce the knee effusion and the post-operative pain. Analgesia is encouraged regularly and the physio teaches muscle activation of the quadriceps and knee flexion hourly to get the joint moving. Restoring the muscle control of the knee and gaining joint range of movement is the initial goal of the first few day of therapy.

Once the operation has been completed the physiotherapist must treat the consequences of the operation to ensure a successful outcome for the patient. Surgery causes pain, swelling, inflammation and muscle weakness and much of the early physiotherapy is targeted towards this. Initially the physio can use a Cryocuff, a refillable pressure cuff fitted closely to the knee, to reduce the swelling and to provide cold therapy over an extended period, reducing the pain and facilitating muscle action. Taking the painkillers regularly and static quadriceps exercises are encouraged hourly to re-establish muscular knee control and gentle knee flexion exercises to get the knee range of movement going.

Next the physiotherapist assesses the patient for suitability for their first mobilisation, checking the operation note, the patient’s medical observations and the condition of the legs themselves. The operated knee has to have enough stability to safely weight bear, as an epidural can cause profound loss of muscle power and prevent safe mobilisation until the drugs wear off. The patient is mobilised into standing by the physio with an assistant and encouraged to walk a small distance with elbow crutches or a Zimmer frame for more elderly persons. Operative protocol usually encourages normal weight bearing through the new knee as this helps restore normal patterns of muscular activity and improves circulation.

Outpatient physiotherapy aims to restore normal muscle power and function, joint range of motion and regain functional abilities. Initial exercises include knee hangs for full passive extension (very important for normal knee function), inner range quadriceps to restore active extension to full range and knee flexion to increase range. Resisted flexion over the edge of a bed helps the quadriceps relax by reciprocal inhibition and allows increases in flexion range. This can be manually resisted by a physio or performed against a spring or Theraband. Massage to the scar area is also useful to mobilise the scar and free up the tissues.

Further rehabilitation is more likely to take place in the gym, concentrating on functional activities such as moving from sitting to standing and step ups and strengthening work with Theraband and the gymnastic ball. Work on range of motion will continue using resisted exercises and static bicycling and patients can usefully work on proprioception using the wobble board and other balance related activities. Proprioception is the normal ability of a joint to sense its position in space and this is very important for normal activity and safe walking. Normal gait patterns are encouraged and abnormal patterns corrected.

Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about Physiotherapy, back pain, orthopaedic conditions, neck pain, injury management and physiotherapists in Gloucester. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.

Knee injuries and the management of post-operative knee conditions require physios to apply cold therapy to the joints to control knee effusions and pain. This is difficult to do with traditional methods but the Aircast Cryocuff is a flexible and efficient device to achieve effective cryotherapy and compression.

Knee injuries are very common in sports and vigorous activities and their acute physiotherapy management is very important for a good outcome and a speedy return to normal activities. Typical knee injuries and conditions managed by physiotherapists include meniscal tears (cartilage tears), medial collateral ligament damage, lateral collateral ligament damage, anterior cruciate ligament tears, patellar dislocation, total knee replacement and capsular injury.

The knee is the largest synovial joint in the body and when the joint is damaged it responds by becoming inflamed, increasing the metabolic rate of the tissues and secreting large amounts of synovial fluid into the joint. This can lead to a knee effusion, a large and tight swelling of the knee, at times called “water on the knee”. An effusion can be painful in itself and it inhibits normal muscle function, thereby interfering with muscle action and joint recovery.

Normal methods of applying compression and cooling have several difficulties:

* It is difficult or impossible to provide both at once

* Applying ice to the knee does not provide effective cooling in many cases

* Ice application carries the risk of ice burn by overcooling the skin

* Long periods of cooling are difficult to maintain

* Cooling is difficult to keep up over long periods

* Cooling cannot easily be done whilst mobilizing.

Cooling is always thought to be the main aim, but however as research has shown that management of the acute knee should start with compression instead, pain and inflammation reduction is an important part of the treatment so cold is important too.

The Aircast Cryocuff

The Aircast Cryocuff is a cryotherapy and compression device, designed to be easy to use and to be portable, used in managing post-injury and post-operative inflammation in knees and other joints. The Cryocuff has three parts:

* The Water Bucket. This water/ice reservoir is a plastic cylinder with a lid and guidance markings inside the bucket for the proportions of ice and water to fill for optimal use of the device. The lid is screwed on securely to avoid leakage and the contents can be remixed by simply turning the whole assembly upside down a few times.

* The Hose. The hose from the reservoir to the cuff is insulated and allows rapid clipping and unclipping to and from the cuff.

* The Cuff. This is the business end of the device. It is a wraparound cuff designed to fit the contours of the knee and comes in three sizes.

Application of the Cryocuff by a Physiotherapist

The size of the cuff needed for the patient is measured by the physio 6 inches above the kneecap and then the cuff is fitted snugly to the knee and firmly attached with the Velcro straps. It is important to start with the cuff deflated or the benefits of compression of the Cryocuff will not be forthcoming.

Now the bucket is filled with cubed ice and cold water in the right proportions and the top screwed on firmly to prevent leakage. The hose is clipped to the cuff by pushing the connector into the cuff clip and then the bucket and hose assembly is held up above the knee, allowing the cold water to flow into the cuff by gravity. How high the physiotherapist holds the bucket and for how long has some effect on the tightness of the filled cuff.

The cuff stays cold for an hour or so and the patient can disconnect it from the hose and get on with normal life as able. To change the water the hose is reconnected to the cuff and the bucket put below cuff level to refill the bucket from the cuff, and then the bucket is turned over a few times to remix the water and ice. The process is repeated from the beginning, allowing the compression and cooling to be maintained continuously as the bucket water mixture remains cold enough for 6-8 hours before replenishment.

Jonathan Blood Smyth is the Superintendent of Physiotherapists at an NHS hospital in the South-West of the UK. He writes articles about back pain, neck pain, and injury management. If you are looking for physiothrapists in Southampton visit his website.

Years ago, I was an insurance adjuster. I handled claims for large farm labor companies in California and I was the worker’s compensation adjuster. When people were injured, they heard from me. I learned what happened and I paid them their disability benefits and also paid for all of their medical bills. I estimate that over the 3 1/2 years that I adjusted claims, I paid for at least 150 lower back disc surgeries. The average cost of these surgeries was $60,000. I would routinely authorize $10,000-$12,000 bills to be paid directly to the main surgeon. Some of these surgeries would last 3-4 hours and sometimes up to 8-10 hours. I had one surgeon who used to do 2 surgeries per day.

In order to perform 2 surgeries per day, office staff including nurse practitioners and physician assistants are the ones who see the patients before and after surgery. This kind of impersonal service is what is required to make $20,000 per day. At that rate, is the focus on the patient or finances of the office and surgeon?

I believe that most surgeons are well-meaning, honest individuals who want to help their patients. But, as my dad used to say, ‘When you’re a hammer, before long, everything looks like a nail.’ I think most surgeons simply get caught up in seeing and scheduling their patients for the treatment that they perform. Very little thought is actually given to alternatives and potential side effects of the treatment.

After seeing hundreds of patients have surgery, when I was an adjuster, I quite my job with the aim of trying to help some avoid the surgeries they were recommended. I went to chiropractic school in order to help the very people I was seeing suffering. While some recover after having surgery, most end up the same or worse than when they started; at least 50% of all surgery cases I’ve seen have failed and lead to devastating outcomes.

A neurosurgeon once told me when I was an adjuster, that there is no such thing as a one-time surgery. All backs that undergo surgery will need further and additional surgery in the future as the operated zone of the spine becomes weakened and other areas around it are damaged over time. Thus, by doing one surgery, the surgeon is ensuring his future surgeries as most people go to the same surgeon again since the surgeon “knows my back.”

In practice, as a chiropractor I have helped literally hundreds over the past 10 years avoid surgery even when they have been recommended for surgery by surgeons. Conservative chiropractic and physical therapy can work wonders are removing the cause of the need for surgery. Rather than cutting open the spine and removing a bad disc; chiropractic and physical therapy can help the disc to heal and reabsorb the herniated portion taking pressure off the nerves and removing the pain.

While no treatment or modality of any kind works 100% of the time, starting with the least invasive and moving your way up is the most prudent method to ensure long-term health and vitality of your spine. Going for the most invasive, most expensive and most damaging choice first is irresponsible and disrespects the research and knowledge the medical community has.

Unfortunately, when you can make $20,000 per day the best interest of the patient and their health becomes blurred.

Find out how to avoid back surgery through natural means and avoid all of the possible side effects and catastrophic problems associated with surgery. If you’d like to learn more about how to avoid back surgery visit our website.

The wrist-hand complex is a highly complicated tool which allows for the precise use of the hand and its very important role in human function, with the wrist a vital link in this process. The shoulder and scapula allow crude arm positioning, the elbow allows the distance from the body to be varied, the forearm sets the angle at which the wrist will be positioned and the wrist finishes off the last detail of hand positioning. As the joints get closer to the hand the smaller and more precise their movements.

The wrist itself is positioned between the forearm and the hand and consists of eight small bones known as the carpal bones which are arranged in two rows and situated in between the ends of the radius and ulna and the metacarpal bones. The metacarpals run from the furthest row of carpal bones down towards the knuckles to join the finger bones. As the metacarpals are narrow and run almost parallel to each other this gives them the ability to flatten themselves out to make the hand wide or to curl themselves up to aid grasping, a very useful ability.

This tight grouping of carpal bones endows the wrist with a large range of movement of 360 degrees in a conical shape facing forward. They are able to make individual and group movements to improve the precise positioning of the hand, fingers and thumb. Even though the arrangement is a little untidy the two rows of bones do line up with more or less two bones at the end of each metacarpal separating this from the forearm. The large number of in-line joints created with this arrangement allows a high degree of adaptability and precision of movement.

The manoeuvrability of the thumb is one of the most amazing parts of the function of the hand. The “opposable thumb” that humans possess and which apes do not is one of the defining characteristics of precision movement and control. The metacarpal of the thumb on the outside of the hand is not inline with all the others but rotated inwards, having the ability to rotate further inwards to allow the end of the thumb to participate in grasping with one of the fingers. The thumb has a very specialised joint at the junction of the metacarpal and carpal, allowing the specialised movement.

The movements of the carpal bones can be in unison in small amounts as they move together to allow a movement to occur. As the hands move small amplitudes of movement occur between the individual carpal bones and the carpal rows. The metacarpals are able to rotate around their long axes which allows the palm to be curled into a cupped position. As the palm moulds round to assist gripping it also allows the fingers to align so that they can effectively grip at the correct angle. Any loss of the accessory movements of the carpals and metacarpals can reduce the ability of the hand to function adequately.

Using the hands very heavily such as in gripping and holding heavy objects, hauling ropes or operating heavy machinery can adversely affect wrist function. The longitudinal forces which are generated across the wrist are very high as the hand grasping power is applied, compressing the carpal bones between the forearm and the metacarpals. The carpal bones can then suffer a reduction in the accessory movements possible between them. If the wrist is forcibly extended this may dislodge the lunate bone, one of the wrist bones, forwards and cause pain.

The commonest reason for the wrist to be extended forcibly is a FOOSH or a fall on the outstretched hand, which can result in a Colles fracture which involves the last inch of the radius and ulna near the wrist. The fracture, commonest in older females, is the most obvious part of the overall injury which results also in wrist sprain and soft tissue injury. Five to six weeks will be enough to heal the fracture but there may be weakness, pain and difficulty with use in the hand for a longer period, partly related to a upset in the inter carpal movements.

Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about physiotherapy, physiotherapy, physiotherapists in Manchester, back pain, orthopaedic conditions, neck pain and injury management. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.