Neck Pain - Three Things To Think Beyond MEDICINE

In the world of technology, the machines are becoming advanced and addictive up to a level that nearly 70% of your active daily time goes into it. Neck pain is as common as Low back Pain since both of them mainly originates from poor lifestyle and reduced physical activities. I see number of patients suffering from Bad Neck Pain and still keen on wanting an X-RAY or MRI scan because they really wants to see what has gone wrong with them. And the kind of reports which comes out after scans keeps them scared for life.

"So many studies have shown that Xray or MRI changes are normal after a certain stage of life even in people with NO PAIN"

Most people consider X-RAY or MRI Scan reports as their diagnosis further complicated by their doctors because they almost stamp the reports to be true. And you start believing in the terms like Cervical Spondylosis, Degeneration, Reduced disc space, loss of cervical curve etc.

What else can be done in 5 min checkup time with your doctor?

You can only prove me wrong if your doctor has examined you thoroughly and tried looking for reasons beyond what investigations are pointing towards. Remember, your reports always quote in the end " This is not a diagnosis, Please correlate clinically". A thorough checkup easily needs 30 min duration to carefully examine all possible reasons which may cause you pain. Identifying the source of pain is as important as your treatment so that you are not misguided towards ineffective solutions to your neck pain.

If you are wondering what else can cause you pain other than what your investigations had so far revealed, then read further down as this can be an eye-opener article for you.

My First question to you, if you have a NECK PAIN :

HOW bad you are with your sleep?

 

DO you feel stiff and painful with your neck in the morning?

 

DO you find your pain worse on the days when you do not sleep enough?

Your sleep quality is directly linked to pain and stiffness in the neck. Good sleep is almost like a restart to your body system ( including hardware- joints and muscles / software- mind and nervous system). Sleep helps recovering from all day stress which your body and mind has gone through. Minimum 7 hours sleep is the baseline for healthy sleeping time including minimum 2 hours of deep sleep.

My second question to you to observe carefully:

Does your pain aggravates from long hours of prolonged sitting at home or work? 

Do you think your bad posture is responsible for your pain?

Is your pain better on the days when you are active with less sitting?

From years doctors have blamed your poor posture for your neck pain. Blaming your bad posture is overrated as no one can sit in good posture for long as it requires enormous strength from the muscles to keep you upright nonstop.

If you do not move enough then even an upright sitting can trouble you equally.

"Your muscles need more blood to survive better"

Keeping yourself inactive for so long makes your muscles stressful and then it doesn't matter even if you try attaining a good posture. So it is not your posture which makes you suffer with strained NECK. Blame your long hours of sitting which reduces blood flow to the muscles and makes your joints feeling stiff.

My third and the last question you need to think about: 

Do you feel your mind gets stuck with thoughts making you worry constantly about random things?

Do you find increased neck pain on the days when your mind is overworked?

Does your neck pain has started giving you emotional response like crying, tensed, irritated etc?

Stress has started bugging our daily life and it has become almost epidemic. We all try to hide our disturbing thoughts and keep them alive in our mind. Generally we all are forgetting / hiding to share as we are scared of letting people know what we think. This huge collection of disturbing thoughts gives emotional response but also a physical response which we don't believe it can. Your neck pain can be an expression of stressful thoughts running in your mind (oh! sorry stuck in mind because running is still better).

If you have a bad disturbing neck pain even more so if it is chronic; you should consider the following factors which alone or in association of your diagnosis and treatment can help you recover better:

SLEEP, PHYSICAL ACTIVITIES AND STRESS

If you want to find more about your neck pain or looking for a solution to resolve your condition effectively, feel free to comment below or contact me on below mentioned details:

Regards,

Dr. Kunal Vashist, PT

MPT (ORTHO), Manual Therapy

Dry Needling Practitioner

Movement Specialist (USA)

Conservative Pain Management Specialist

Email id : kvashist.physio@gmail.com

Contact Number: 9968302757

More than physio... Clinics

Common Low Back Pain - Are You At RISK ?

"IGNORANCE MAKES YOU SUFFER"

While starting to write this topic on risk assessment for low back pain, today I simply searched on google the statistics related to low back pain. It was really shocking to read nearly 80% of population suffer from low back pain at least once in lifetime. You know what it means that leaving just one or two in our family, we all suffer from low back pain. 

Isn't it very disturbing that pain has become such a closest partner for us to live with? Something is seriously going wrong with our bodies. How can it be so fragile that all of us are not so comfortable and pain free to live with. Moreover it makes us less productive and creative as we can't think or move without pain. 

I have categorized different expressions given by your back under pain. If you know the level of severity then you can easily take decision on what action your back pain needs at that moment. Remember it is the ignorance which makes you suffer.

Self Limiting Back Pain

For most people low back pain starts with a dull ache or a tiring sensation around the lower back which comes with physical exertion and goes away with rest. Normally this is a hint by the body that you have done something beyond your body can handle. This kind of pain is usually self limiting and goes away in couple of days or when your exertion days are over.

Acute Back Pain

The issue comes when you keep ignoring this discomfort and the pain becomes stronger or acute which also last longer even with rest. But again just being conscious of basic do's and don'ts things can be managed by adding self management like rest,  ice or hot compress and activity modification. This is an alert by the body to kind of look into your daily routine and work on changing the lifestyle. Mainly look into your daily activities somewhere you might be abusing your body by over exertion or just being too sedentary. Get your nutrition sorted because you become what you eat. Have you been  sleeping enough? Or is it difficult get a good deep sleep?

If at all your discomfort or pain is not getting over in 2 weeks, there is a need to see your physician or physiotherapist who can do a basic examination and rule out anything major. 

Acute Back and Leg Pain (Yellow Alert)

Sometimes the back pain is very disabling and doesn't allow you to work or do any activity. It can also radiate a sharp pain in your leg usually in one leg upto the ankle. This is the time when you should definitely seek a specialist help like an orthopaedic doctor or a specialized physiotherapist. They can diagnose the problem and start your treatment soon. Usually, the leg pain is coming due to compression of a nerve root from the spine primarily on the right or the left side. The nerve can get pinched because of a Bulging Disc, a small bony growth (osteophytes), a stiff or locked vertebral movement or a bad muscular spasm etc. Here I would say follow your doctor's advice rather thinking to self manage as things can get worse if you ignore.

Back Pain Emergency (RED ALERT)

There are certain emergency situations in back pain. In case you feel a sudden numbness or weakness in your leg or gives you a feeling of "dead Leg" or you can't control passing of urine or stool; this is the time where you should rush to the hospital and get emergency checkup done. Our spinal cord and spinal nerves is the only connection between Brain and the Body which helps us regulating sensation and movement control. Without such connection the body can go in paralytic mode where you may loose any conscious control over your body movements.


Year Long (Chronic) Back Pain



I see many patients coming with year long back pain along with an MRI or X-RAY in their hands. They want me to see what their report says about them. And like always my answer is I want to see what your muscles and joints want to tell me regarding you. As with chronic back pain investigations can be MIS-LEADING where we might treat what is even not bothering in the first place. Most chronic back pain is coming from poor body functioning along with contribution from mental health, nutrition, level of physical activities and Tolerance.

Having a Low Back Pain is not always about a pathology, a spinal disease or an injury to the content of Low Back. It can just be a predictor of your general health, your physical activity status or your fitness. Low back pain is very vast when it comes to diagnosing a problem there ranging from Muscular Spasm, Disc Prolapse, Sciatica, Lumbar stenosis, Spondylosis, Spondylo-listhesis, Vertebrae Fractures, Infections and Tumors. Without making you too much scared the biggest relief is most of these issues are rare. But yes majority of back pains are just a poor physical or mental health.

Just keep in mind that if your back pain is associated with:

• fever and chills

• constant back pain not linked to your movements

• continuous pain especially at nights 

• sudden abnormal weight loss along with back pain

Please contact your general practitioner as not all back pains are just physical.

Carefully assessing the low back problems and their timely management can give full recovery. Let me just put certain evidence based facts which we know today about back pain:

• Recovery rate for a back pain case is as high as 99%.
• Investigations have a low value as most back pains are due to poor function where early X-RAY or MRI doesn't give much information to help the treatment.
• Your pain has no relation to how bad or good is your disease. Each one of us has different pain threshold. To some people needle feels like a sword while others can take lot of pain easily.
• 80 - 90 % of low back pain sufferers can get better with lifestyle modification, optimal physical activities and rehabilitation (Exercises).
• Your mental stress is a major contributor to your back pain especially in chronic back pain.
• Conservative treatment with Active Physiotherapy has to be the number one choice of treatment. 
• People who do not recover in due course of time may need Injections or Surgery as per their doctor's advice but there is no other choice but to EXERCISE.

This article is an effort to create awareness regarding back pain in general public. Always talk to your physiotherapist and seek specific advice as every condition is as unique as you.

Feel free to comment or contact in case you need more information on this topic. 

Regards,

Dr. Kunal vashist,PT

Mpt (Ortho), Manual Therapy 

Dryneedling practitioner

Email ID : kvashist.physio@gmail.com 

Contact no. 9968302757

Benefits of exercise- Beyond weight loss

Exercise and weight loss has always been weighed together where the real aim for us is using exercise as a tool for weight loss.

Since ages dieting has been followed to create calorie deficit which is thought to be creating some reduction in body weight. Calorie deficit if combined with calorie burning has a tremendous effect on faster weight reduction. Numerous studies have shown  the role of combining exercises and good diet for effective weight loss.

There are studies to show that an intermittent fasting plan in a diet is way more effective than a long term strict diet routine alone. Whenever the body is challenged consistently it soon adapts to the routine and becomes less effective. Variation is the key to success as your body gives results when you challenge your metabolism (the rate of burning fuel by the body) and not allowing it to adapt with your routine. 

Similarly, when exercise is done uniformly your body soon adjust to the activities you do. And soon the weight loss becomes less effective. When you keep the body under challenge by variating your exercise routine from high to low and high again, the large metabolic changes occur. This variation makes the weight loss more effective and faster. This also makes your cardiovascular system work harder giving you benefits beyond just the weight loss. The most effective variation plan in exercise is HIIT (High intensity interval training) where your body performs high level of activity followed by short rest period and it goes on in a circuit create good strength and effective calorie burning.

Although I do not support HIIT until you do not improve your basic body strength. Human body is very intelligent as it can make you work without realizing the faults and it is too late by the time you experience something is wrong. It is good to identify your weakness and work on it to get a better balanced strength everywhere before you switch to HIIT. You need to get FIT before start HIIT.

Exercise should not just be a tool for weight loss as it has got numerous benefits. The aim behind losing the extra weight should be more than cosmetic appearance. Your extra weight is anyways a sign of bad lifestyle and poor health. Do you know why the weight which you lost with so much effort has a tendency to come back after some time? The reason is you never made permanent change in your lifestyle and eating habits. 

"The change which you want by doing something temporarily will work only temporarily".

In order to achieve good health, the change has to come in whole of you. You should be aware of the benefits coming from exercise and healthy life style. The real benefits of exercises are to control, cure and prevent lifestyle diseases and we have ample of evidence in researches for them.

Benefits Of Exercises Beyond Weight Loss

1. It can control, prevent and treat Hypertension or high blood pressure.
2. It can cure or control type 2 Diabetes.
3. Various cancer types can be prevented and even arrested from progression
4. It can make you live longer, stronger and independent.
5. It can keep you away from aches and pains.
6. It can delay or prevent surgeries.
7. It can counter chronic pain disorders.
8. It can simply make you HAPPIER and bring back the SMILE.

In case you want to know more about how you can make exercise as your RECOVERY TOOL kindly feel free to contact me through details mentioned below:

Dr. Kunal Vashist,PT

MPT (Ortho), Manual Therapy

Dry Needling Practitioner

Exercise and Rehab Specialist

MORE THAN PHYSIO

EMAIL ID : kvashist.physio@gmail.com

Contact No. 9968302757

WORLD BREASTFEEDING WEEK

Celebrating the World breastfeeding week (1st Aug-7th Aug)

Theme of the year: Empower Parents, enable breastfeeding- Now and for the future.

We all know that breastfeeding is a very natural process, but the pity is that at today’s date there is a need to promote breastfeeding. When we all know that nature has given the wonderful power of nurturing the baby through breastfeed then why we are trying to interfere with it and leading toward artificial feeds. Why the introduction of honey, ghutti etc is there to such small babies when it’s world-wide known fact that it can be dangerous for them. Do you really think that providing that ghutti through one of your family member will transfer that person’s qualities to the baby?



Are we really living in 21st century?

My idea is not to offend anyone here but I am trying to find the reasoning. We should think before we do anything instead of just blindly following the unnecessary rituals or beliefs which can put our little one’s health on risk.
Now the question that might come to your mind is what to do in case if someone can’t breastfeed. So the answer is have you seen any animal’s baby having artificial feed; similarly our baby also has a right on mother’s milk only and

"THERE IS NO SUCH MOTHER WHO CAN’T BREASTFEED HER BABY"

It’s the Biggest MYTH and the challenge in INDIA is to break that myth.

Yes it’s true that breastfeeding can come across various challenges like delayed milk supply, sore nipples, heaviness etc. but believe me all this is temporary and the only thing which is required to overcome all the challenges is RIGHT INFORMATION AND RIGHT ADVICE at the RIGHT TIME. So here comes the role of family who should be patient and supportive enough to encourage breastfeeding rather than giving substitutes like formula feed or bottle feed; role of partner who can support the mother with various things like burping the baby, swaddling, swaying or cleaning the baby at times to give the adequate rest to mother.

Government is also spending lot of money to create awareness about early initiation and exclusive breastfeeding till 6 months, creating breastfeeding rooms, provision of maternity leaves till 6 months –Why?






So that we have enough resources and time to give a healthy and happy life to our munchkins

.

To establish a successful breastfeeding work on 3T’s:

Timing: Early initiation of breastfeeding is very important; do not delay it. As soon as you get the baby start feeding.

Techniques: Right positioning and latch as half of the problems come because of the wrong holding.

Trials: Breastfeeding works on demand and supply so give enough time and multiple trials; as practice makes you perfect.

Last but not the least; do not hesitate to seek for help of a lactation consultant as this is her domain to give you the correct guidance and clear myths from realities.


So once again MARK my words:

Every woman can feed her child naturally; you just have to find a way and when there is a will; there is Always a way.

Thank you

Dr Kavita Mehta (PT)
Lactation consultant and a proud mother of 3 year old Son.

For any queries reach out at kavita.mehta@fortishealthcare.com/kavita.physio@gmail.com

Know About Your MYSTERIOUS Neck Pain

Muscular aches and pains are becoming common day by day. Almost all of us face some issues with our muscles and joints as we cross our student life and enter professional life especially if work involves lot of screen time and sitting. 

During school days, kids are forced to sit long hours for studying in the classes as well as at home or tuition but they can still get away from pain as the body can take and forget muscular stress easily. Muscular health is also better at that time because your body is mobile, agile and undergo short periods of high activities like running, indoor or outdoor games etc. As a child your carefree attitude does help in keeping physical and mental stress under control. In addition the body weight is well under control which helps you moving faster. 

With time you enter professional life and then you are bound to do a sitting job in front of laptop or computer for long hours. Gradually work and family do add up some stress to life as you want to perform better in both. That carefree attitude is gone by the time you enter professional and personal maturity. When you move less, you hamper your mobility and your strength declines due to long hours of physical inactivity. Decrease in muscular strength and mobility is just the adaptation of your body towards reduced physical activities. 

Long hours of inactivity, stress and poor diet altogether increases your body weight disallowing you to remain agile the way you were during your early childhood. The collective response from your body is aches and pains gradually becoming unresolved and chronic. 

Neck pain is usually very common in these conditions and can interrupt with your healthy living. It doesn't seem like an emergency but it doesn't allow you work peacefully also. By the time you realize neck pain is a problem it is too late as your body gets well adapted to your current way of living. It is so natural for all of us to find an instant cure but I wish we had such an approach to deal with it. A prolonged neck pain is a consequence of multiple changes mentioned in initial paragraphs of the article which your body has acquired in so many years. A permanent solution is reversal of at least some of those changes which definitely doesn't happen instantly. 

You do not have neck pain because a particular spinal vertebrae or spinal joint has reduced space or degenerated or damaged. You have pain because you do not move functionally well as a whole. Medicines have a very limited role in treatment of neck pain. In fact anything which does not improve how you move or sit through out the day, might not help in long term when it comes to joint and muscles health.

The current evidence based information about neck pain management is as follows:

• X-Rays are not so informative in describing the source of neck pain.

• MRI is an investigation of choice but should be used very carefully as it can pick up issues which are irrelevant for your pain. Also the reporting can act as a nocebo, creating new area of pain which you never had or can delay your recovery as you might get relatable anxiety and fear-avoidance behavior leading to reduced activities.

• Electrotherapy like TENS, IFT or Diathermy doesn't have supporting evidence in treatment of prolonged neck pain.

• Therapeutic Ultrasound can provide deep tissue heat and micro-massaging effect in case of acute pain for some days but does not qualify as a treatment for neck pain.

• Wide use of mechanical traction device for neck pain has been stopped by many western countries because of associated consequences and negligible results.

• Manual (Hands-On) techniques like mobilization, manipulation and massages via osteopathy or chiropractic techniques have some effect in initiating recovery but only gives you short term relief.

• Postural Correction is also over-rated as you tend to force your weaker muscles in order to sit upright. And that conscious effort will last only for couple of minutes the moment you get busy with other things around you.

• Stretching is helpful in temporarily DE-Stressing the muscular tension and helps in regaining the range of movement.

• Strengthening the weaker muscles can help in sustaining the correct posture for long time as it reduces the stress on postural muscles. Strength training in full range of movement can help with improving your neck motion as well.

Feel free to connect with me and discuss a lot more in detail about various types of neck pain and their solutions.

Dr. Kunal Vashist,PT

MPT (Ortho), Manual Therapy

Dry Needling Practitioner

kvashist.physio@gmail.com / 9968302757

Find me on FACEBOOK Page : More Than Physio

ARTHRITIC KNEES - DO YOU NEED SURGERY?

Long time ago, knee pain used to be an old age problem where people who suffered were very few and even lesser population getting knee replacement done. But now there is a dramatic shift in number of people facing the knee arthritis and number of surgeries being performed. Moreover, the age at which these arthritic changes occur has reduced. The changes in the knee seen at around or over 55 years of age are now been observed as low as at 30 years of age. 

I consider early knee arthritis similar to premature graying of your hair. Just imagine why do you get grey hair. The reasoning starts with you might be getting older but if it is early then you might be stressed, too much in the sun, not sleeping enough or not eating healthy and may be some genetics. 

Similarly, Osteo-Arthritis of knee is a term for inflammation of old age knees. But in early knee arthritis, overloading of joints (especially if your muscles are weak), stress, poor diet or disturbed sleep can disturb your metabolism to deplete calcium from the bones and put your knees under abnormal load and may result in early and faster degeneration. Rheumatism or gout can also eat up your knee joint and make it degenerate early. Last but not the least, a previous injury with unresolved inflammation or infection can lead to early arthritis. The only difference is it is not affected by your genes. Even reduced Vitamin D3 levels in blood can cause degeneration of the joints because it is linked to your bone strength. So either it is simply that you are getting older or you are causing it with bad lifestyle as mentioned above.

I feel this early arthritis of the knee is a major concern because with the speed we are replacing the knees, soon we will have a major population with metallic knees.  The world will soon have a workforce of "not so natural" knees.

Are the replaced knees good for your health? I think when your knees are damaged enough to make you stop enjoying life it becomes necessary to undergo knife chopping but only if it is a promising procedure. The question is not whether surgeries are good or bad, it is about whether you need it and if no then what can you do to avoid it.

Now carefully read this paragraph to know your answers. Knee arthritis means the pain and stiffness generated in your knee due to inflammation caused by loss of cartilage (Lubricant inside the knee) and wear-tear of joint surface as well. At early age when you show the signs of arthritis, there is loss of cartilage but doesn't mean its fully gone. The knee can become completely healthy as there is only some loss of lubrication that means your bones are still not touching each other directly. The reason behind your pain is something more than what your doctor told you or the X-Rays are showing there. 

The first thing I usually notice in knee pain is that within 72 hours of pain the muscles stop working efficiently and shows weakness on examination. And if your pain has now become chronic, you can easily judge how much your muscles have become weaker. And when you try walking with knee pain, there is subconcious adjustment in the way you walk to avoid pain, which may lead to abnormal functioning of your Lower Back, Hip or Ankles. So there is a gross weakness and imbalances in the whole body. All these changes may lead to more pressure on your affected knee causing more or unresolved pain. The knees are mainly survived by strong thigh muscles, ligaments and healthy cartilage along with healthy lower back and muscles of HIP and ANKLES. 

If only knee cartilage has got some injury there are many other structures to keep you moving pain free. All you need to do is following a suitable exercise regime supervised or crosschecked by a concerned health expert (in this case your Physiotherapist), working on healthy diet in order to control your weight and regular walks if or when you become painfree. This change will not only help your knee pain but also work on saving your knees from further damage. 

Remember, if you can prevent it you don't need to cure it. please feel free to comment here if there are related questions in your mind.

REMEDY FOR UNRESOLVED PAIN

Any pain lasting for more than 12 weeks is generally considered as Chronic Pain. This means whether the injury is traumatic or non traumatic, it should or must heal within 6-12 weeks at maximum. If you do not help yourself to get better within this time frame, you are basically channeling your nervous system to adapt to the painful sensation given by the local tissue damage.

Poor Diet, Lack of Sleep, Emotional or physical stress, lack of physical activity, your boss and colleagues, family and friends. all of this can affect your pain to become good or bad. Many things are not in our hands but anything from the list above which you can change to help your self should be tried. Hence, your lifestyle modification is a big term where you have to consider anything which influences your pain. Just remember self help is the better help. The change starts from YOU and the rest will follow. A doctor or Physiotherapist can give you the path to recovery but you need to proactively participate and reach to the goal of pain-free life.

Long standing pain generates a threat to your normal body movement and you start avoiding them which in turn makes the joints and muscles unhealthy. There is a sub-conscious fear in moving all the time and the brain and body kind of pre-decide that this particular movement will cause pain. Inability to move freely along with fear of pain increases the neural and chemical response in the brain to make you feel sick all the time. In such conditions, medicines usually don't work or mask your pain very temporarily.

What you need to do at this stage is to come out of threatening painful memory  through controlled pain-free movements (Pain free activities). Resting at this time is not a correct choice but being careful to not create too much pain is. I believe any activity or exercise causing pain more than 20 % is a good sign to step back or stop that activity. Doing ice compression as a therapy can work very well if and when pain increases. At times you need pain modulation procedures like Manual therapy, Massage, Dry Needling / Acupuncture or even taping to facilitate pain free movements. Once you get better with pain, simultaneously start loading your damaged tissues via exercises which mainly includes strengthening against gravity or resistance. 

In the beginning, you may find some discomfort in doing strengthening exercises but that is a normal response to tissue loading rather than any damage which you might think is happening. But tissue loading capacity will increase you will start feeling stronger and active with your earlier painful movements. In my opinion, it will take from 6 weeks to 6 months, where decent muscle strength will build up and you will reach to your pre-injury level of fitness.

Since, chronic pain involves memory of local tissue damage, nerves which conducts painful sensation to spinal chord and the brain at the center, there are social and psychological factors which can variate your pain on daily basis. I always tell my patients that the part of brain which responds to chronic pain is also responsible for your emotions. So, it is very natural for emotions to make you feel pain and vice a versa. You definitely feel emotionally stressed on the days when it is painful or when you are emotionally stressed your pain increases. Anything which disturbs the chemistry of your brain will disturb the pain also.