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Jun20
Treatment Of Hamstring Strain / Tendinopathy In Delhi, India - Removemypain
Hamstring Sprain / Tendinopathy
Hamstrings are a group of muscles present at the back of thigh. They extend from the sit bones in pelvis to just below the knee joint and play an important an important role is daily activities such as walking & running. The names of the individual three muscles included in hamstrings are semimembranosus, biceps femoris and the semitendinosus. These, work in opposition to the muscles in the front of the thigh (quadriceps) and the two group of muscles together stabilize movements of the knee and pelvis.

INCIDENCE
Hamstring injuries account for approximately 12–16% of all injuries in athletes. They are seen more commonly in sports that involve sprinting, acceleration, deceleration, rapid change in direction and jumping such as football, basketball, rugby and baseball. Runners, ballet dancers and older adults who do a lot of walking are also at increased risk. Reinjury rates are high and generally require more time away from the field. Although any injury for a sportsperson is painful, this one can be quite frustrating for both the sufferer and the treating physician.

SYMPTOMS
Symptoms vary depending on the severity of the problem. When the upper part of hamstrings is involved the most common symptom is deep buttock pain or irritation at the back of thigh (minor sprains) associated with tightness or cramping sensation. Pain can radiate down the back of thigh and is generally aggravated by physical activity such as walking, running uphill, high speed or long distance running, leaning forwards, squats and sitting on a firm surface for long duration. Morning increase in severity of pain is not uncommon in this condition. In the early stages pain may reduce after warm up and then recur after activity. This changes with time with the pain persisting throughout the day.

Partial or complete tear of hamstrings may present with severe stabbing pain, bruising with inability to weight bear or walk. Sciatic nerve is present close by and its irritation can cause pain to radiate further down the leg. In severe cases the tendon may completely tear away, often taking a piece of bone with it and this is addressed as avulsion injury.

RISK FACTORS & BIOMECHANICS
Muscle attaches to the bone with the help of a special type of tissue called tendon. To simplify, you can look at these as ropes tying the muscles to the bones. Injuries can involve the muscles or the area where the muscle transforms into the tendon (myotendinous junction) or the tendon itself. Generally the closer the injury is to the pelvis / sit bones the longer it takes to heal. Of the three muscles, biceps femoris is the most commonly injured one.

The hamstrings cross two joints and help to bend the knee and move the hip backwards (extension). They play an important role in propelling the body forwards as we move. Hamstring injury may occur by high speed mechanisms such as running or low speed mechanisms such as stretching. Sudden loading of muscle while it is stretched as while kicking a football is also a common injury mechanism.

The risk factors most consistently associated with hamstring muscle strain-type injuries are age, previous hamstring injury and quadriceps peak torque. As mentioned previously hamstrings and quadriceps oppose each another and it is not uncommon to see imbalance between the two groups of muscles with the latter being stronger. This is expressed as low hamstring to quad ratio which essentially means weaker hamstrings. Weak hamstrings can quickly turn into tight hamstrings and require hamstring to work harder which tires them easily. Tight, tired and weak muscles are predisposed to injuries. When the hamstring are injured, other nearby body muscles are called into action such as those in lower back and hip predisposing them also to injuries/ pain.

Risk factors foe hamstring injury can be classifies into modifiable and non-modifiable ones.

Modifiable risk factors

Volume of training and rapid variations
Muscle fatigue
Weak hamstrings
Repeated overloading with insufficient warm-up
Over striding during running or abruptly changing direction
Lower back, core and pelvis weakness or trunk instability
Prolonged sitting (work, cycling etc)
Biomechanical issues such as unequal leg length
Non-Modifiable risk factors

Previous hamstring injuries – most consistent risk factor with two to six times increased risk of recurrence. Most repeat injuries occur within two months of return to the sport but the risk remains elevated up to three times for an year after initial injury.
Age – teens and young adults are more likely to experience hamstring injuries as muscles do not tend to grow at the same speed as bones. Aging adults are also at a higher risk possibly due to reduced muscle cross-sectional area.
Genetics (collagen types)
HAMSTRING INJURY GRADES
Most hamstring injuries occur in the thick, central part of the muscle or where the muscle fibres join tendon. Muscle strains are graded from 1 to 3 depending on their severity

Grade 1 – or hamstring pull is most minor form and usually heals readily. Most patients with this are able to walk easily although may notice pain at the back of the leg after prolonged or quick walking.

Grade 2 – this is associated with more pain (often shooting type) and patients may struggle to walk / limp.

Grade 3 – represents more marked muscle tears including complete tears which present with more severe pain, swelling and difficulty weight bearing. These may require several months of rehabilitation.


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Jun13
Dr. Amod Manocha provides Diabetic Pain Treatment in Delhi at Removemypain
Diabetic Pain Treatment in Delhi
Diabetic Neuropathy where patients complain of a burning sensation most
commonly in the sole of feet, worst at night time
Infections such as Post heretic neuralgia, HIV
Persistent post surgery pain or trauma involving nerve damage
Drug induced neuropathy including that after chemotherapy/radiotherapy
Cancer related neuropathy
Post Amputation- Phantom limb pain
Central causes such as spinal cord injuries, strokes, multiple sclerosis
Complex Regional Pain Syndrome
Nutritional deficiencies
Screening questionnaires are commonly used in diagnosing neuropathic pain.
Investigations such as blood tests, scans, and nerve and muscle tests may
be requested to confirm the diagnosis or rule out other conditions. Depending
on the history, examination and investigation findings the pain condition is
diagnosed as possible, probable or definite neuropathic pain.

Dr. Amod Manocha - Pain Specialist Doctor in Delhi
Dr. Amod Manocha is the Head of Pain Management Services at Max Super Speciality Hospital, Saket. He is trained as a Pain Management Specialist and an Anaesthetist in the UK. He has over 13 years of work experience in the UK including working as a Chronic Pain Consultant in many UK hospitals. Dr. Manocha believes in multidisciplinary approach and providing evidence-based treatments at par with international standards. He is committed to providing quality care and believes in building long-term relationship with patients based on honest communication and keeping their interests foremost.


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Jun13
Neck Pain Treatment in Delhi by Best Neck Pain Specialist in Delhi - Dr. Amod Manocha
Neck Pain Treatment in Gurgaon
Neck Pain is a pain posteriorly anywhere between the skull base and thoracic spine. It is the largest cause of musculoskeletal disability after low back pain. Approximately two-thirds of the population will suffer from neck pain at some time in their life with high prevalence in middle ages. Fortunately for most people the acute pain resolves within days or weeks although in some it may reoccur or become chronic.

Neck pain may be a result of...

Local pathology
Whiplash (flexion-extension) injuries/ trauma
Be a part of a more widespread systemic problem such as ankylosing spondylitis, rheumatoid arthritis, fibromyalgia etc.
Be a result of referred pain from neighboring areas for example the shoulder joint

Neck pain usually has a multifactorial etiology -poor posture, neck strain/injuries, anxiety, depression and stress can play a role in magnifying the perceived pain. Quite often the diagnosis of simple or nonspecific neck pain is used implying postural and mechanical causes; this is contrary to other serious causes of neck pain such as fracture, tumour, infection etc.

Pain from upper neck can radiate towards the head leading to frequent headaches and that from the lower part of the neck can radiate to the shoulder, arm, chest wall and the scapula. Reduced neck movement along with localized areas of muscle tenderness known as trigger points are commonly observed along with pain.


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Jun06
Cervical Pain Treatment in India by Dr. Amod Manocha at Removemypain
Cervical Pain Treatment in India
Cervical radiculopathy or pinched nerve in the neck is a common problem. Irritation or compression of the nerves coming out of the spine can cause severe pain travelling (radiating) to the shoulders and arms. The arm pain is often more severe although the root of the problem lies in the neck. This pain can be associated with tingling, numbness, weakness in the arm and hand.

To understand a bit more about these pains it is essential to have an understanding of the anatomy of the neck. The neck or the cervical region consists of seven bones (vertebrae) stacked one above the other. There are labelled as C1-C7, where C stands for cervical and 1-7 are the numbers to identify the level being referring to. These vertebrae are separated from one another by discs which are like cushions allowing the spine to move freely.

Each vertebra encloses a hollow space which lines up with the space of the vertebrae above and below, running along the entire length of the spine. This hollow space is called the spinal canal and houses the spinal cord which is a thick bundle of nerves connected to the brain. Between every two vertebrae there are openings on the sides called the foramina. A pair of spinal nerves (one on each side) exit through these foramina and supply a specific part of the body for example the nerves coming out of the neck would go to the arm and hands. When these nerves are irritated, either inside the spine or as they come out of the spine, it leads to the pain being felt in the area supplied by the nerve and this explains when we get arm pain whereas the actual problem lies in the neck.

CAUSES
The main causes of pressure or irritation of the nerves in the neck include

Disc problems such as bulging of discs can press on nearby nerves
Age related wear and tear/degeneration. This can cause narrowing (stenosis) of the openings between the vertebrae and pressure on the nerves as they exit the spine
Instability of the neck. Loss of normal spinal alignment can cause compression of nerves
Other causes. Less common causes include infection, tumours and fractures
Cervical radiculopathy is seen more commonly in middle-aged people and injury, poor posture can further contribute to this. In younger age groups this problem is majorly due to ruptured disc or injuries.

SYMPTOMS
Pain from a pinched nerve may be felt in both the arm and the neck or may be limited to just the neck or arm. Although the root of the problem lies in the spine, the symptoms may be felt in the area where the nerve that is irritated travels such as the shoulder, the arm, or the hand. By looking at where the symptoms are, the pain specialist can usually tell which nerve is involved. Symptoms include:

Burning, sharp, squeezing, aching or electric shock like pain
Tingling or pins and needles sensation in the arm or hand
Numbness or loss of feeling in arm or hand
Shoulder, arm or hand weakness
Increased pain travelling down the arm with neck movements such as looking up towards the ceiling (extension) or on turning the head


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Jun06
Chronic Headache Pain Treatment in Delhi at Removemypain by Dr. Amod Manocha
Chronic Headache Pain Treatment in Delhi

Headache is a common problem. Fortunately a significant proportion of headaches can be managed by commonly used painkillers. In certain types of headaches prophylactic agents are used to reduce the frequency of attacks. However, there still remains a subgroup of patients with difficult to manage headaches despite all measures. For this subgroup pain clinic offers interventions and multi-disciplinary input, over and above the traditional approach of using painkillers. Multi-disciplinary approach helps in addressing concomitant magnifiers/ triggers such as anxiety, depression, altered sleep cycle, medication overuse, life style and poor posture.

In clinical practice, an overwhelming majority of headaches are either a tension-type headache, migraine, cluster headache or medication overused headache. Extra cranial sources of headaches such as nerves, joints and muscles can be easily missed. The term Cervicogenic Headaches is used for headaches originating from cervical spine pathology or surrounding soft tissues. Examples include neck facet or Atlantoaxial joint pathology, headaches secondary to third occipital nerve, supraorbital neuralgia, and occipital neuralgia, sternocleidomastoid and trapezius muscle spasms. These types of headaches may be accompanied by neck pain, stiffness and are commonly undertreated.

Facet Joint Injections & Radiofrequency ablation
Headaches originating from facet joints are more commonly observed in the elderly and after whiplash injury (flexion/extension injuries). Clinical diagnosis is often difficult as the features overlap with other types of headaches. Diagnostic injections can help identify the pain generators in such cases. Pain originating from these joints can be felt in the base of the skull, neck, upper back, mid-back and shoulders. Please follow the link to Facet joint injections to find out more on this treatment.

Third Occipital Nerve Block and Radiofrequency
The third occipital nerve originates from the cervical spine and supplies sensation to a joint in the neck (C2-3 zygapophyseal joint) and a small area at the back of head. This nerve or the joint it supplies can be a source of headaches localised to the back of head on one side. Sometimes the headache can spread towards the top of the head. This occurs more commonly after whiplash injury.

A diagnostic block involving injection of local anaesthetic close to the nerve can help determine if this nerve is the source of your headache. This is performed under x ray guidance. If the diagnostic test is positive then radiofrequency ablation of the nerve can provide long lasting relief.


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May30
Back Pain Treatment in Delhi From Pain Specialist in Delhi Dr. Amod Manocha
Pain Specialist in Delhi
In simple words, low back pain can be defined as pain experienced in the bottom region of spine (between lower margins of ribs and the gluteal folds). It may remain localised to back or radiate to the legs.

Sciatica is a term used for pain radiating down from the lower spine to the legs. Most common cause of sciatica is irritation or compression of the nerves as they exit the spine on their way to the legs. It may be accompanied by numbness, tingling and weakness in the distribution of the affected nerve.

Globally low back pain (LBP) is one of the leading causes of disability. LBP is an important cause of limitation of activities, absence from work with resultant economic implications. In industrialised countries lifetime prevalence of non-specific low back pain is estimated at 60–70%.Despite the high incidence and intensive research into this area, pain generators are not easy to identify and the diagnosis Nonspecific Low Back Pain is used commonly. This is different from situations where a specific cause such as fracture, infection, neoplasm etc. responsible for pain generation can be identified.

Potential Sources & Causes
Back pain can originate from numerous sources and some of the common causes include

Disc herniation (Slipped Disk), degenerative disc disease
Facet and Sacroiliac Joints
Muscle and ligament sprains/injuries
Narrowing of spinal canal- Spinal Stenosis
Spondylolisthesis
Fractures, trauma
Autoimmune diseases
Infections


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May23
Neck Pain Treatment Gurgaon by Pain Specialist in Gurgaon Dr. Amod Mancoha
Neck Pain Treatment in Gurgaon

Neck Pain is a pain posteriorly anywhere between the skull base and thoracic spine. It is the largest cause of musculoskeletal disability after low back pain. Approximately two-thirds of the population will suffer from neck pain at some time in their life with high prevalence in middle ages. Fortunately for most people the acute pain resolves within days or weeks although in some it may reoccur or become chronic.

Neck pain may be a result of...

Local pathology
Whiplash (flexion-extension) injuries/ trauma
Be a part of a more widespread systemic problem such as ankylosing spondylitis, rheumatoid arthritis, fibromyalgia etc.
Be a result of referred pain from neighboring areas for example the shoulder joint

Neck pain usually has a multifactorial etiology -poor posture, neck strain/injuries, anxiety, depression and stress can play a role in magnifying the perceived pain. Quite often the diagnosis of simple or nonspecific neck pain is used implying postural and mechanical causes; this is contrary to other serious causes of neck pain such as fracture, tumour, infection etc.

Pain from upper neck can radiate towards the head leading to frequent headaches and that from the lower part of the neck can radiate to the shoulder, arm, chest wall and the scapula. Reduced neck movement along with localized areas of muscle tenderness known as trigger points are commonly observed along with pain.


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May16
Sport Injury Treatment in Delhi by Pain Specialist Doctor in Delhi - Dr. Amod Manocha
Sports Injuries Prevention

Overuse and trauma are two common factors responsible for sports injuries. Both intrinsic (such as age, fitness level, muscle strength etc) and extrinsic factors (such as equipment, environment, type of activity etc) play a role in injuries.

Prevention of injuries may involve changing of training schedule, gear, training, practicing environment and style and many other factors. Primary prevention deals with prevention of an injury whereas secondary prevention is about prevention of re occurrence of injury. As "Prevention is better than cure," here are some tips that can help you prevent sports injuries. Whilst most of these may seem like common knowledge, you would be surprised by how many injuries can be avoided by following these tips.

Tip 1: Understand the importance of physical conditioning and know your limits
This factor is often overlooked by amateurs who easily succumb to temptation and overindulge. It is easy to get carried away when you return to sports after a long time. Knowing ones limits, gradually increasing the intensity and duration of training can help in injury prevention. Regular exercise is an effective way to energize your body and keep fit. On the other hand aggressive training beyond ones capabilities and the resulting overuse, fatigue, poor judgment makes injuries more likely.

Be mindful of old injuries and listen to your body. Warning signs such as joint pain, tenderness, and swelling are reasons to re-evaluate your technique and routine.

Tip 2: Invest in the right sporting gear
This includes every essential bit of equipment required for playing a particular sport, starting from the right shoes to the protective equipment such as helmets, gloves, protective pads etc. Right gear not only protects you from injuries but can also enhance your performance.

Tip 3: Warm and stretch your muscles
Warmed up muscles are less prone to injuries and overlooking warm-up sessions can cost one dearly. Warm up raises the core body temperature and gears up the body for the intended exercise. It helps by increasing the blood flow to muscles improving the muscle efficiency, range of motion and stretching the muscles being used in particular sports. Stretching to the point of tension (not pain) helps to reduce stiffness and improve flexibility, thereby reducing the chances of injury.

Warm up may be general or specific to the intended sport. The right exercises would vary depending on the sports. Starting the sport at a slow pace can be helpful. If you closely observe your sporting idols, you will always see them warm up prior to any game.

Tip 4: Use the right technique and follow the rules of the game
Correct techniques to play a sport are defined to minimize the chances of injuries and maximize your performance. The same can be said about the rules of the game. Incorrect overzealous manoeuvre can predispose one to injuries and hence the importance of concentrating on the precise technique. One example which I can quote as I commonly see this in my clinic is back injuries due to incorrect dead lift technique. Often that temptation to add the extra 5kgs compromises the technique predisposing one to injuries.

Selecting the appropriate surface for sports is equally important especially for repetitive activities such as running, jumping where the impact force on the body is magnified by 3- 12 times. Impact force on hard surfaces is much higher increasing the injury chances.

Tip 5: Cool down
Cooling down is another injury prevention technique that helps to return the heart rate, breathing, and blood pressure to the pre-training levels. It can also help to limit the post exercise muscle soreness and flush out toxins produced during the training.

Tip 6: Adequate recovery
Adequate recovery is essential no only for avoiding injuries but also for the full training effect. Inadequate recovery can lead to tiredness, lethargy, mental fatigue and impaired performance. Adequate recovery includes warm down sessions, re stand sleep, psychological and nutritional advices.


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May02
Dr. Amod Manocha is The Pain Specialist Doctor in Delhi, Pain specialist in Gurgaon, Best Pain Specialist in South Delhi - Removemypain
Dr. Amod Manocha - Pain Specialist In Delhi and Gurgaon

Dr. Amod Manocha is the Head of Pain Management Services at Max Super Speciality Hospital, Saket. He is trained as a Pain Management Specialist and an Anaesthetist in the UK. He has over 13 years of work experience in the UK including working as a Chronic Pain Consultant in many UK hospitals. Dr. Manocha believes in multidisciplinary approach and providing evidence-based treatments at par with international standards. He is committed to providing quality care and believes in building long-term relationship with patients based on honest communication and keeping their interests foremost.


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Jul20
Physical Therapy for Low Back Pain Relief
The goals of physical therapy are to decrease back pain, increase function, and teach the patient a maintenance program to prevent future back problems.
Common forms of physical therapy include:
1.Passive physical therapy (modalities), which includes things done to the patient, such as heat application, ice packs and electrical stimulation. For example, a heating pad may be applied to warm up the muscles prior to doing exercising and stretching, and an ice pack may be used afterwards to sooth the muscles and soft tissues.
2.Active physical therapy, which focuses on specific exercises and stretching. For most low back pain treatments, active exercise is the focus of the physical therapy program.
Exercise Benefits for Low Back Pain:
Lumbar spine (low back) stability is largely dependent on the supporting abdominal (stomach) and low back musculature. The abdominal muscles provide the initial stabilizing support through their ability to generate pressure within the abdomen which is exerted posteriorly on the spine, thus providing an anterior support column (from the front of the spine). The low back muscles stabilize the spine from the back and lead to posterior support. The bony spine and discs are surrounded by muscles, and the stronger these specific muscles are, the less stress is placed on the discs and joints of the spine. The patients should develop a 'belt' of muscle around their spine.
Key Aspects:
In this section, we have briefly listed the key aspects of the role of physiotherapy in management of lower back pain.
1.Advice and early activity There is significant evidence to prove that encouraging early movement in case of lower back pain is one of the most significant aspects of treatment in this condition.
2. Mobilization or Manipulative physiotherapy This aspect concentrates on promoting mobilization of the specific affected area. The approach of manipulative physiotherapy is used to target the specific point of pain for the purpose.
3. Specific stabilization exercises In this aspect of physiotherapy, stress is laid on improving the strength and stability of the muscles which have been weakened due to the lower back pain.
4. General exercises and stretches A series of properly structured exercises and stretches are usually carried out in context of the patients individual condition and cause of the lower back pain.
5. Ergonomic advice Since work-related hazards account for more than 65% of lower back problems, physiotherapists also concentrate on providing accurate ergonomic device, guiding the patient on using the appropriate infrastructure at work to avoid and cure lower back pain.
6. Postural guidelines This aspect of physiotherapy focuses on guiding the patient about the correct postural habits and ways to maintain accurate posture to avoid lower back pain.
Contact your Physiotherapist for more detailed and case specific treatment.


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