Tuesday, December 25

Health - Pregnancy-related pelvic girdle pain

Home > Coping with Pregnancy-related pelvic girdle pain
Pregnancy-related pelvic girdle pain (PPGP) is a very common and universal problem. About 16% to 25% of women experience it at some point during pregnancy. In about five percent of women, PPGP is found to persist after childbirth up to two years. The pain and discomfort may start as early as the first trimester of pregnancy and gradually become severe as the trimesters progress. In some women it may begin as late as the last few days before giving birth. Informing the midwife, or obstetrician about the condition and early treatment can alleviate it.

The pelvic girdle is the largest part of our skeleton containing the pubic symphysis, and two sacroiliac joints. A net work of ligaments join these three joints giving them strength. We have to note that pregnancy-related low-back pain, sciatica, visceral or vascular origin syndromes are distinct entities which needs to be excluded before the diagnosis of PPGP is made. European guidelines recommended MRI scan for the differential diagnosis of PPGP in all stages.

Signs and symptoms during pregnancy

PPGP is associated with dull, stabbing, shooting or burning pain in pelvic girdle area during pregnancy. It may be spread over the general area of the girdle. It may also be localized either posteriorly close to the sacroiliac joints (hips and buttocks) or anteriorly to the symphysis pubis area (groin). Some of the symptoms are:
  • Inflammation of the joints in the pelvic girdle.
  • Tenderness in the pubic bone area.
  • Difficulty in standing on one leg.
  • Difficulty in lifting leg.
  • Difficulty keeping legs or knees apart.
  • Stooping backward when standing.
  • Difficulty in twisting, bending or squatting.
  • Pain may radiate to the legs.
  • Alteration of gait patterns.
  • Clicking sound or sensation from the pelvic girdle during movement. 
Depending upon stage of pregnancy and the severity of the condition, the symptoms may vary from individual to individual.

Pelvic girdle pain in pregnancy - possible causes

The exact causes leading to the development of this syndrome are unclear. Etiological implications may be multifactorial conditions during pregnancy like hormonal changes, bio-mechanical factors, trauma, metabolic changes and genetic factors. The release of pregnancy hormones, structural and postural changes in pregnancy, gait changes, weight of the growing baby and changes in the center of gravity can all add to the development of PPGP. Having PPGP in a previous pregnancy predisposes the person to have pelvic girdle pain in subsequent pregnancy.

Any change during pregnancy in the activity of the muscles in pelvic girdle, hips (hip abductor and hip extensor), lower back, abdomen, ankle (ankle plantar flexor) and pelvic floor can cause this condition. Remodeling of soft tissues, cartilage and ligaments over time or due to pregnancy by bio-mechanical and hormonal factors can also contribute to development of this discomfort.

Treatment for pregnancy related pelvic girdle pain

Many treatment options like exercises, exercises in water, physiotherapy, chiropractic manipulations, medication, educational interventions, acupuncture, use of mobility aids, and intensive multidisciplinary bio-psycho-social rehabilitation treatment are available. For very severe debilitating cases during pregnancy surgical treatment (fusion surgery) is considered. The available treatment options during pregnancy are limited by the presence and the potential hazards to the fetus.

Coping with pelvic girdle pain in pregnancy

Self care and management can to a great extend contribute in the alleviation of the distressing condition.
  • Take care to have sufficient rest.
  • Avoid lying on your back.
  • Lie on your side with a pillow between your knees to keep hip joints aligned.
  • Avoid sitting slumped.
  • Be active within the pain limits.
  • Avoid strenuous activities.
  • Avoid weight bearing activities.
  • Avoid climbing stairs.
  • Wear flat shoes.
  • Avoid twisting, bending or squatting.
  • Take small steps while walking.
  • Avoid any action or movement with knees apart.
  • As far as possible Keep the knees together.
  • Avoid stressing the joints.
  • For getting into bed, sit on the edge keeping the knees close together and lie down on your side by simultaneously lifting your feet.
  • Do the reverse of it when getting out of bed.
  • While shifting position in the bed keep the knees together.
  • Avoid moving your knees apart.
  • Avoid standing on one leg.
  • Avoid carrying a baby on one hip during pregnancy.
  • Consider wearing hip support.

With the increase in clinical awareness of pregnancy related hip girdle pain syndrome and multidisciplinary medical approach there are significant improvements in the treatment and management of this multifactorial syndrome.


References:
1. Wu W, Meyer O, Uegaki K et al. 2004. Pregnancy-related pelvic girdle pain, 1: terminology, clinical presentation and prevalence. Eur Spine Journal Epub 13: 575-589 
2. Vleeming A, Vries HJD, Mens JMA et al. 2002. Possible role of the long dorsal sacroiliac ligament in women with peripartum pelvic pain. Acta Obstetrica Gynecologica Scandinavica 81: 430-436 
3. Nikolaos K Kanakaris, Craig S Roberts and Peter V Giannoudis. Pregnancy-related pelvic girdle pain: an update BMC Med. 2011; 9: 15. Published online 2011 February 15.

Image source: http://en.wikipedia.org/wiki/File:Illu_pelvic_girdle.jpg
License: Public domain.
Current topic on health tips:
Coping with pelvic girdle pain during pregnancy.

Wednesday, December 12

Back pain - Chronic low back pain - Treatment and management

Home > Back pain - Chronic low back pain - Treatment and management
Lower back pain is a common health problem and nearly 80% of adults experience it at some point in their life. Low back pain is a skeletomuscular disorder and it is considered chronic if it persists for more than twelve weeks. Without proper treatment the pain tends to become chronic.

Most of the causes of chronic low back pain (CLBP) are neuromusculoskeletal disorders like wrong posture, sprain in the lower back muscles, strain of soft tissues, slipped disc (herniated, or ruptured disc), sciatica ( sciatic neuritis) degenerative discs, spinal stenosis, fractures, trauma, skeletal irregularities, scoliosis, kyphosis, lordosis, osteoarthritis and osteoporosis.

Chronic lower back pain treatment options

The options are physical, medical, and surgical methods. The focus is on causative factors, relevant pathoanatomy and pain generators and their alleviation and removal. Generally the options are non-invasive methods like initial rest, medication and exercise. In the case of traumatic injury, structural damage or structural irregularities surgical options may be resorted to.

Bed rest for chronic LBP

Immediate bed rest for less than two days helps in the lessening of chronic pain and inflammation. However bed rest for longer period does not have increased benefits. Prolonged bed rest can be counterproductive. In fact prolonged bed rest can have deleterious effects by weakening the supportive muscles and leading to progressive hypo mobility of joints and prolonged recovery.

Physio-therapeutic treatments

Physiotherapy comprises a mixture of any of the methods like interferential treatment, laser, lumbar supports, shortwave diathermy, therapeutic ultrasound, hot/cold packs, traction, transcutaneous electrical nerve stimulation (TENS), massage and mobilization Though there may be marginal momentary reduction in low back pain there are no long term positive effects and advantages.

Exercise treatment

Exercises aimed at strengthening, endurance and flexibility
show lasting improvement in chronic low back pain reduction and function. These exercises do not require expensive training equipment. Muscle strengthening, muscle conditioning, aerobic, flexion, Alexander Technique and McKenzie exercises may be tried as per the preference of both the patient and therapist.

Chiropractic spinal manipulation and spinal mobilization

Manual treatment comprises spinal manipulation and spinal mobilization  The spinal manipulation is small amplitude high velocity thrust technique. It is usually a rapid movement beyond the movement range of the affected back joint. The patient has no control over the manipulation and the technique is prone to complications if done by persons lacking expertise.

Spinal mobilization is use of passive low-velocity movements to give mobility to a joint. Excluding movements that would further strain the lower back, mobilization within the limits of low back pain aids recovery. Mobilization techniques show improvement in pain reduction, motor activity and sympathetic nervous system activity. As the patient has control over the movement, this technique is considered as far safer to manipulation technique.

Pharmacological treatments for chronic LBP

Non Steroidal Anti Inflammatory Drugs (NSAIDs) are widely prescribed for their pain-killing potential and also for their anti-inflammatory action. The side-effects of NSAIDs are gastrointestinal complications like irritation, gastric ulcers and intestinal bleeding. Some NASIDs like rofecoxib have serious long-term effects like increases cardiovascular risk. Hence for long term use individual case has to be monitored.

Noradrenergic and noradrenergic-serotonergic antidepressants have been found to be moderately effective in reducing chronic pain in CLBP patients and quite effective when used as co-medication with NSAIDs. In patients with kidney diseases, glaucoma, chronic obstructive pulmonary disease and heart failure antidepressants should be avoided. Pregnant patients with chronic pain should not be given antidepressants without closely monitoring their health.

Opioid are short-term treatment for pain and disability in chronic low back pain. Weak opioid are prescribed only for short-term treatment as there is the risk of development of dependence and addiction. To avoid addiction, slow release opioid can be given.

Muscle relaxants like benzodiazepines are used for the short-term reduction from pain. However they have the side effects like allergy, addiction, drowsiness, dizziness and impaired liver function in the long run.

Capsicum pain plasters have capsaicin from chilli peppers which reduces low back pain. Hence application of capsicum pain plasters is an effective short-term treatment for CLBP.

Surgical treatments

Surgery for pain reduction is resorted to when all other conservative treatments have become ineffective in reducing of pain.
Surgical treatments for chronic low back pain include lumbar microdiscectomy, discectomy (involving partial or complete excision of an intervertebral disk), laminectomy (removal of portion of the vertebral bone called the lamina), foraminotomy (performed to reduce the symptoms of nerve root compression), disc replacement surgery or spinal fusion.

Spinal fusion surgery is considered in case of degenerative disc disease, facet joint degeneration or spinal instability and it aims at obtaining solid fusion of two or more affected vertebrae to give stability. As spinal fusion surgery has high rate of complications it may be performed only if the CLBP persists for more than two years and also in case of failed conservative treatments and severe pain.
 

Other alternative treatments

Back school is a combination of education and skill program aimed to lower the chronic LBP. There are some short-term positive results. However there may not be any long-term benefit.
Brief educational interventions to promote self treatment by the patient can be given by the physiotherapist or physician to reduce disability and sickness. Brief educational interventions should provide reassurance and positive messages that encourage the patient to return to normal activities.
Cognitive-behavioral treatment methods are effective for chronic pain, functional status and behavioral outcomes.
Intensive multidisciplinary biopsychosocial rehabilitation treatment program consisting of combination of physical, pharmacological, vocational, and behavioral components are very effective in alleviating the chronic LBP and improving the functionality, especially in patients who have failed mono-disciplinary treatment options.
Neuro-Reflexotherapy has been effective in the treatment of chronic low back pain. Short-term treatment can be taken up to lower chronic pain.
Percutaneous electrical nerve stimulation (PENS) are effective in reduction of chronic low back pain.


Image source:
http://en.wikipedia.org/wiki/File:Lumbar_region_in_human_skeleton.svg
Image author: LadyofHats Mariana Ruiz Villarreal
License: public domain

References:
1.http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm
2.Karjalainen K, Malmivaara A, van Tulder M, et al. Multidisciplinary biopsychosocial rehabilitation for subacute low back pain among working age adults. Cochrane Database Syst Rev. 2003;(2):CD002193.
3.http://www.musculoskeletalnetwork.com/pain/content/article/1145622/1507555
4.http://www.backpaineurope.org/web/files/WG2_Guidelines.pdf


Current topic in Daily Health News & Tips:
Chronic low back pain - Treatment

Saturday, December 1

Skin care in winter - Coping with dry skin in winter

Home > Winter skin care - Coping with dry winter skin
Skin becomes dry in winter months and if proper care is not taken it may lead to painful cracks, bleeding and infections. The primary cause of dry skin in the winter is the dehydration of the stratum corneum layer of epidermis and the decrease in the production of sebum. In winter conditions even people with healthy skin can develop dry dermal conditions and as for persons already having dry skin, eczema, dermatitis, contact dermatitis, seborrhea and psoriasis the problems will aggravate.

In winter weather the humidity (moisture in the air) tends to be low and moisture from the skin is removed at a faster rate leading to dry condition. In cold weather people tend to use room heaters which further dry up the low-moisture air in the room. To address this problem sufficient care must be taken to prevent loss of moisture from the skin as well as to additionally moisturize it. Following a regular skin care regimen we can tide over the winter months smoothly.

Hydration by drinking fluids in winter

Fulfilling our body's water requirement takes care of skin moisturizing to a great extend. A normal individual requires up to one liter of water per day for every twenty kilos of body weight. Persons consuming insufficient water tend to become chronically dehydrated. In such situation they are likely to have dry skin. In winter, even if we do not feel thirsty, we must drink sufficient water and fluids to hydrate our body, to avoid constipation and to remove toxic wastes from the system. Fruit juices give nutrients required for care of healthy body and skin.

As drinking aerated soft drinks is found to dehydrate our body, it better to reduce their consumption. Alcohol and caffeine present in alcoholic beverages and coffee have diuretic effect and remove water from the body. Hence their consumption must be avoided for care of dry skin. Alcohol and nicotine (smoking) are found to constrict capillaries and cut down blood supply to body organs, including skin.

Nutritional care of dry skin in winter

To have a healthy body and skin we should take care to eat healthy balanced food. During the winter when the skin has to face the dry conditions, any nutritional deficiency will have adverse effect on stratum corneum hydration, sebum secretion and desquamation process.

The food we eat must be balanced containing all the required nutrients. Our food must contain complete protein having all the essential amino acids. To achieve this we have to include protein rich food of both plant and animal origin. To stop aggravation of dry winter conditions, sugar, sugar preparations, sweets and soft drinks must be avoided. Take care to avoid saturated fats. Polyunsaturated and monounsaturated fats must be consumed in moderation.

However our food must contain sufficient quantities of essential fatty acids like omega-3 fatty acid and omega-6 fatty acid available in olive oil, vegetable oils, fish and fish oil. Sufficient soluble and non-soluble fiber containing food must be consumed to ease bowl movement and avoid constipation. Constipated material in the bowl release toxins which can affect the skin causing it to become dry and acne prone. Our food must also contain micro nutrients like dietary minerals and vitamins. Any deficiencies can cause dermal problems especially during dry winter.

Skin cleaning and bathing in winter

For protection from dry winter conditions use chlorine free water for bath. Do not have more than one bath a day and make the bath as short as possible. Do not use hot or cold water for bath as it will cause dry skin; use lukewarm water. You can think of massage with olive oil or body oil before bath to lock in moisture.

Take care not spend more time in bathing. Long exposure to water removes the protective natural sebum layer. Use mild soap of PH 7 or less. Alkaline soaps remove the acidic protective layer and dehydrate the skin. After bath dab the skin dry and apply moisturizer to lock-in moisture.

Cleansing, moisturizing and exfoliating dry winter skin

Prefer cosmetics containing natural, organic and herbal ingredients like aloe vera, olive oil, honey, jojoba oil, calendula, oatmeal, tea tree oil, beeswax, and almond oil.

Clean your skin daily preferably before going to bed with alcohol free cosmetic milk, cleaning lotion or cleansers to remove the accumulation of grime, stratum corneum debris and remnants of makeup. Cleansing also opens up and cleans the pores.

Take care to apply moisturizer twice a day to lock in moisture. It is preferable to apply moisturizer soon after cleansing. Please note that your hands, feet and nails require moisturizer as they often come in contact with water. Try wearing hand gloves, when prolonged contact with water is required.

Hair also requires protection from being getting dry and suitable moisturizer and conditioner like olive oil can be used. Chapped lips are common in dry winter conditions and moisturizing lip balm can be applied regularly to protect them. Licking the chapped lips must be avoided as this aggravates the condition.

Exfoliating once a week helps in skin rejuvenation. The skin debris get removed of their own in younger persons during desquamation process. As one ages the desquamation may not be complete and exfoliation will help in removal of dead skin and grime clinging on.

Careless use of cosmetics can flare up the dry winter skin condition. Take care not to use any skin care product containing harsh chemicals. Avoid using chlorinated water for cleaning as chlorine will make the skin further dry by removing the natural moisturizing oils and moisture.

Protection and care of skin from environment in winter

Even if it is winter take care to protect yourself from exposure sun by using umbrella, sun protective clothing and wide brimmed hat. Take care to use sunscreen of SPF 20 or more on exposed parts of the body when going out or getting exposed to sun. In longer exposures take care to apply sunscreen every two hours. Take care to avoid exposure to cold winds and rain. Cold winds dehydrate the skin. Drenching in rain and using swimming pool also removes the protective natural oil from the skin. If room heaters are used in winter take care to install a room humidifier to counter dry conditions.

Treatment and care of skin ailments

If you are affected by skin ailments like itch, rash, eczema, dermatitis, seborrhea and psoriasis consult a dermatologist to treat them. In dry winter the conditions if proper care is not taken the ailments can worsen and lead to many complications.

Current topic in Daily Health News & Tips:
Coping with winter dry skin and skin care for winter