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Sciatica refers to a chronic pain that is felt at the base of the spine, the hip and buttocks, the leg and in the foot. When someone is suffering from severe sciatica, even a task like walking becomes difficult as the pain can be such that weight cannot be put onto the leg. These painful symptoms get their name from the sciatic nerve, the longest and largest nerve in the body. This nerve is as thick as a finger in parts, and travels from the base of the spine into the legs.
Those that suffer from sciatic nerve pain often find that it attacks in bouts. They may be pain free for several months, then experience a few days where the pain in considerable. Often those that experience sciatica will also experience lower back pain and upper back pain in the times when their sciatica is worse. Migraines and neck pain are also felt in severe cases.
There are differing potential causes of sciatica that have been identified by health practitioners. One identified cause of sciatica is a herniated disc. Between the vertebrae of the spine are discs which are made of soft, spongy tissue. Stress to the spine and back causes discs to bulge, placing pressure on the sciatic nerve. Damage to discs can be caused by things including bad ergonomics, sports injuries or other lower back injury.
During pregnancy, many women experience lower back pain and sciatic nerve pain. Pressure on the sciatic nerve is one of the most common causes of this pregnancy back pain. As the pregnancy progresses, shifts and changes in the body mean that the pressure on the body is increased which can in turn lead to back pain.
Other causes of sciatica can include:
Spondylolisthesis – a condition where vertebra in the lower part of the spine slip forward and onto a vertebra below
Nerve compression caused by accidents or injuries
Spinal stenosis – a narrowing of the spinal canal causing pressure on the nerve
Poor posture or body use.
Treatments for sciatica can include lower back pain exercises and therapies to improve overall muscle function and integration to take pressure off the sciatic nerve. Surgery has also been used to address sciatic nerve pain caused by damaged discs.
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A wide range of people especially between the age group of 35-55 years suffer from the problem of back pain. It is among the most common medical problems. It is necessary to understand the cause of your back pain for its proper treatment. Sometimes the problem of back pain is very difficult to treat so understanding the cause of the problem will help the patient in their recovery from back pain. In some cases the pain of the back may be severe and besides taking rests and all the precautionary steps the patient must contact to a doctor. The most common causes of lower back pain are sprains and strains.
The rip or tear of the muscles of the lumbar spine, despite their size and strength is called a muscle “strain”. Usually a strain is the result of a sudden force or a heavy load which is applied to the muscles before they are ready for activity. Within the muscle tissue, the muscle essentially rips along with the blood vessels. This may result into bleeding in the injured area. After 2-3 hours it produces pain. This tear in the muscle tissue is followed by certain symptoms like pain, swelling and muscle spasms.
It is associated with the over-stretching of one or more of the ligaments of the back. In this condition, the ligaments can be stretched beyond their natural integrity and in some cases they are completely tear. In some cases especially in motor vehicle accidents, both ligament sprains as well as muscle strains occur together.
There are some other causes also which result into the problem of back pain.
In this condition the disc bulges out from between two vertebrae. This condition is known as herniated disc as well as slipped disc. There are four types of disc herniation
1. Disc bulge or protrusion 2. Disc prolapsed 3. Disc extrusion 4. Sequestrateddisc
It is related with the narrowing of the spinal canal. It usually affects the people above the age of 50 years.
Osteoarthritis of the Spine
It is associated with the damage that causes wear and tear of the joints. It may affect single or many joints of the spine.
It is a condition in which one vertebra slips forward on the one beneath it. This condition may be due to many reasons like trauma to the spine or osteoarthritis of the spine or it may have been acquired from birth.
Some more causes are ankylosing spondylitis, osteoporosis and fractures of the lumbar spine, pregnancy and fibromyalgia.
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The title seems like quite a mouthful so let’s break this down into the components and look at just what minimally invasive mitral surgery actually is.
The mitral valve connects the left atrium to the left ventricle and it has the job of controlling the flow of blood, so it cannot flow back into the atrium when the lower ventricle contracts to expel the blood from the heart, and send it on its journey back around your body. The mitral valve itself is comprised of a connection between the two chambers which is open when blood flows from the atrium into the ventricle, but which must be closed when the ventricle then contracts. The opening is closed by means of two, parachute like leaflets which are attached to the inner wall of the heart by means of cords (known as chordata) – the force of blood being compressed and looking for a way out of the heart forces the leaflets to deploy and block the mitral valve opening.
If the mitral valve fails to operate properly, blood can flow back into the atrium and this is known as “mitral regurgitation” which may result in pooling of blood in the heart, leading to the formation of blood clots. Blood clots are the cause of strokes and may also lead to other serious cardiac episodes, both of which may be fatal.
In addition, the mitral valve may become thickened and restrict the supply of blood or enflamed which affects the structures allowing the valve to operate. This is known as “mitral stenosis”.
Mitral valve disease may result due to bacterial infection or other underlying cardiac disease but the majority of patients who suffer the condition acquire it as a result of hereditary factors and it is common to find the disease running in families.
Traditionally, surgery was open heart which involves a large scar due to the chest incision and “rib cracking”; the spreading of the ribs to expose the heart to allow the surgeon to operate. This procedure results in considerable pain levels, extended stays in hospital and post-operative recovery periods though the surgery has extremely high levels of success in both immediate results and long term prevention of the recurrence of the disease.
Medical advances in technique and technology have led to the development of minimally invasive surgery. By minimally invasive, we mean that there is less cutting and internal intervention; in simple terms it means smaller incisions and less intrusion into the chest cavity while seeking to handle only those organs and tissues which need the surgeon’s attention. Some techniques involve the use of robotically assisted instruments to provide for greater precision and control when handling the specific tissue and structures which are the subject of the surgery.
Minimally invasive techniques require a much higher degree of surgical skill and expertise and there are additional risks associated with using these techniques though the success rates are still very high. In addition, there are benefits to using the procedures because they result in reduced pain for the patient and much shorter stays in hospital and recovering from the surgery. There is also much less scarring and incisions are made at other locations on the body which result in operation scars being far less visible which makes for a far better cosmetic effect.
Lower back pain is one of the most common causes of job-related disability and why some people miss work. It is also the second most common neurological ailment in the United States, second only to headache. In fact, approximately 80% of adults in Western countries have, at some point, experienced lower back pain.
For some fortunate people, pain in the lower back may be resolved by itself or with the aid of medication within two to four weeks. However, there are some cases of lower back pain that may last for more than a few weeks, during which case the condition is termed as “chronic” and “progressive,” meaning it can only grow worse over time.
Moreover, 60-80% of those patients who suffer their first episode of lower back pain may experience recurring pain within one year.
According to current research, there are certain muscles in the back that work to stabilize the spine. When the spine or the back suffers an injury, these muscles are reflexively inhibited or shutdown. Worse still, these muscles do not spontaneously recover, and this is true even if patients do not feel pain and are able to return to normal activity levels.
As a result of the inhibition of these muscles, called lumbar multifidi and the transversus abdominus, lower back pain occurs. However, there are steps you can take to prevent the same thing from happening to you.
Lower Back Pain and Physical Therapy
One way to prevent the inhibition of the lumbar multifidi and transversus abdominus is through a series of physical therapy exercises.
Designed to strengthen the muscles of the lower back and keep the spine healthy, these physical therapy exercises may range from back stabilization exercises to muscle strength development and several wide variety of techniques.
In addition, a physical therapist may also recommend such methods as heat therapy, ultrasound, massage, mobilization, and education about posture and body mechanics in order to prevent lower back pain from recurring.
Some of these methods will be discussed later on. You will also find some practical self-help tips provided by experts to help you avoid lower back pain or prevent the condition from worsening.
However, before we head on to learning how lower back pain is treated through physical therapy, it is important that we first understand what causes lower back pain.
Lower Back Pain: CAUSES
There are actually many types of back pain, but the most common is pain in the lower back. Why? You might ask. The reason is simple: you carry most of your weight in the lower back. Thus, it is highly likely that a person would suffer pain in that area.
There is no definitive cause of lower back pain. Sometimes, the causes of the condition are so complex that it is difficult to pinpoint just a single one.
However, physical therapists and other healthcare professionals have observed that lower back pain is often a result of strained back muscles and ligaments due to any of the following activities:
Sudden awkward movement
We could all be guilty of the above activities. We may not suffer any back pains now, but it is likely that as we get older and the degree of inhibition of the back muscles as a result of these activities increases, back pain becomes a very distinct possibility.
In addition to these common activities, lower back pain may also result from specific conditions, such as:
Herniated disk (when the disk material presses on a nerve)
Sciatica (when a herniated disk presses on the sciatic nerve. The condition causes sharp, shooting pain through the buttocks and the back of the leg.)
Spinal stenosis (when the space around the spinal cord and nerve roots becomes narrow. This is caused by arthritis and bone overgrowth, the pain resulting from when a nerve gets pinched in the narrow space.)
Spondylosis (a type of arthritis affecting the spine due to degenerative changes brought on by aging)
Spondylolisthesis (when one vertebra in the spinal column slips forward over another)
Lower Back Pain: TREATMENT
The treatment of lower back pain depends on several factors, including the specific type of lower back pain (whether it is chronic or acute) and the purported cause.
For instance, acute lower back pain is commonly treated with pain relieving drugs, such as analgesics, or some forms of exercises that can help relax the muscles.
On the other hand, chronic back pain or one that lasts for more than two weeks and is progressive may be caused by some underlying condition, during which case the treatment plan may consist of resolving the underlying condition to treat the back pain.
Lower Back Pain and Physical Therapy Exercise
Physical therapy exercise is one of the most common methods of treating lower back pain. In fact, many home remedies for lower back pain consist of exercise, because the general theory is that if you remain active, you remain healthy. This is true in most cases.
However, for purposes of this article, the exercises featured here will be those that are practiced by physical therapists to treat patients with lower back pain.
Generally, in physical therapy exercises, the exercise program for back pain should encompass a set of stretching exercises, strengthening exercises, and low impact aerobics. Read below for more on these exercises:
The back of a person is composed of the spinal column and contiguous muscles, ligaments and tendons. All these are designed to move in consonance with each other so that any limitation in the range of motion in any of these components of the back result in back pain.
Stretching for lower back pain specifically targets soft tissues, such as muscles, ligaments and tendons, found in the back and around the spine. By stretching, the spine and soft tissues are mobilized, increasing motion and thus, relieving pain.
There are many kinds of stretching exercises employed by physical therapists. One is the Hamstring Stretching Exercise which works to relax tight hamstrings, a common symptom of lower back pain. This exercise is said to help decrease the intensity of lower back pain among sufferers.
Physical therapists generally use two forms of strengthening and back pain relief exercises, usually depending on the specific condition of the patient. These are the McKenzie exercises and dynamic lumbar stabilization exercises. However, the two forms of strengthening exercises may also be combined should the therapist find it appropriate to do so.
Named after a physical therapist in New Zealand, McKenzie exercises are primarily extension exercises that could help reduce pain generated from the disc space and also may help reduce the symptoms of herniated disc by reducing pressure on a nerve root.
For acute pain, the McKenzie exercises should be done frequently, at least once every two hours. In addition, patients are advised to avoid flexing their spine when exercising.
-Dynamic Lumbar Stabilization Exercises
Using this back exercise technique, the first thing that a physical therapist does is to look for the patient’s “neutral” spine. This refers to the position that allows the patient to feel the most comfortable.
Afterwards, when the patient is in that position, the back muscles are then exercised in order to “teach” the spine how to stay in this position.
Performing these exercises on a regular basis can help strengthen the back muscles and keep the spine well-positioned.
Low Impact Aerobic Exercises
The purpose of low impact aerobic exercise is to recondition the back. Patients who undergo reconditioning of the back through low impact aerobic exercise will have fewer episodes of lower back pain.
In addition, whenever an episode of lower back pain does occur, the pain is less intense and lasts only for a short period.
Another benefit of low impact aerobic exercise is that patients tend to stay functional that is, they can continue with their regular work and carry on with recreational activities. In contrast, patients who do not undergo low impact aerobic exercises typically experience the gradual loss of their functional abilities.
For low impact aerobic exercises to achieve their desired results, they should be continuous. This will increase the heart rate and keep it elevated as well as increase the production of endorphins, which are pain fighting hormones released by the body.
Here are some examples of low impact aerobic exercises that you may want to try in order to lessen or reduce lower back pain:
One of the simplest forms of aerobic exercises, walking is generally considered as very gentle on the back. To get the maximum benefit from walking as a form of low impact aerobic exercise, walk two to three miles three times per week.
This form of aerobic exercise is less painful on the back since there is lower impact produced. This is beneficial for patients with lower back pain who may find walking too painful.
Sometimes referred to as aquatherapy, water therapy is simply doing exercise in the water. The buoyancy works to provide effective conditioning at the same time stress on the back is reduced.
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