How to Cure Cervical Spondylosis Permanently

By Dr.Ravindra Patil

What is Cervical Spondylosis

Cervical spondylosis is a common, age-related disorder of the cervical spine that is located in the neck region. This condition is also known as neck arthritis or cervical osteoarthritis. With age, the cervical discs gradually face wear and tear resulting in the breakdown of the structure. The fluid present between the cervical discs is lost which makes the spine stiffer, leading to cervical pain. This results in changes in the bones, discs, and joints at the spine of the neck.

As a result of the fluid dehydration and degeneration of the discs and cartilage in the surrounding area, abnormal growth or spurs of bones called osteophytes can occur leading to the narrowing of the passage from where spinal nerves exit, causing a related condition called cervical spinal stenosis.

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What is Spondylosis?

Spondylosis is an umbrella term that is used to describe any degeneration of the spinal cord. Spondylosis symptoms involve acute pain in the neck and back in old-age. Cervical spondylosis is prevalent among middle-aged and elderly people.

Spondylitis vs Spondylosis

Spondylitis and spondylosis both affect the spinal cord but there is a basic difference between the two. The meaning of spondylitis is that it is the inflammation of one or more typical cervical vertebrae leading to pain in the spine. Cervical spondylosis mostly refers to any kind of degeneration of the spine. So, even though the effects of both the diseases might be similar, their origin and cause are completely different.

Symptoms of Cervical Spondylosis: What is the difference?

Cervical spondylosis symptoms can vary from person to person and the extent of cervical spine pain depends on the age of the affected person. Some of the common spondylosis symptoms are:

• Excessive stiffness at the neck leads to pain in neck
• Cervical spondylosis headache that may originate at the main cervical spondylosis pain areas
• Pain in the shoulder and arms
• Failure to properly turn the head around
• Grinding noise or sensation when trying to turn the neck
• Cervical pain is severe in the morning and at night before bedtime
• If cervical spondylosis leads to spondylotic myelopathy, the following symptoms may occur:
  • Abnormal tingling, numbness, and weakness in the arms, hands, feet, and legs
  • Lack of balance and coordination
  • Abnormal reflexes, random muscle spasms
  • Loss of control over urinary bladder and bowels

Causes of Cervical Spondylosis

Wear and tear of the vertebrae in the spinal cord causes degenerative spondylosis. Other causes are:

• Bone spurs or abnormal outgrowths of bones called osteophytes
• Dehydrated Spinal Discs
• Herniated Discs:
• Injury of the neck
• Stiffness of the Ligament
• Excessive Stress and Overuse

Risk Factors of Cervical Spondylosis

The greatest risk factor of cervical spondylosis is aging. Other risk factors are:

• Heavy physical actions like heavy lifting
• Poor posture in people who work at desk jobs
• Genetic factors and family history
• Smoking
• Being overweight and inactive

How to prevent cervical spondylosis?

• Avoid loading heavy objects on the head or neck. Do not sleep on a high-pillow.
• For people with desk jobs, maintain a proper posture
• Lean back your head once in a while.
• Swimming is considered to be a relaxed exercise for cervical pain
• Perform general physical activities.
• Do not be inactive for a long period of time, take exercise

Diagnosis of Cervical Spondylosis

1. Physical Examination

• Testing the reflexes of the patient and checking for the presence of muscle weakness and deficits in the sensory nerve function is done.
• Tests are done to determine the range of neck movement
• Overall walking movement is checked

2. Imaging Tests

• X-Rays
• CT Scan
• MRI Scan
• Myelogram

3. Nerve Function Tests

• Electromyogram (EMG) records the passage of nerve signals in the body by measuring the electrical activity of the nerves.
• Nerve Conduction Study – the speed and strength of the signals sent by the nerve endings in the body are checked.

Treatment of Cervical Spondylosis

Spondylosis treatments mainly focus on how to cure cervical spondylosis permanently, give pain relief and lower the risk of extensive damage to your vertebrae.

Physiotherapy

• Physiotherapy for cervical spondylosis is a great way for pain relief. A trained physical therapist can teach all the exercises for cervical spondylosis.
• Neck traction: it uses weights to help increase the space between the cervical joints and reduce the pressure forming on the cervical discs and nerve roots.

Medications

Commonly administered medications for the treatment of Cervical Spondylosis are:

• Muscle relaxants
• Narcotics are used for severe neck pain
• Anti-seizure medications help to reduce pain caused due to damage of nerves
• Steroids: Used to reduce the occurrence of tissue inflammation and reduce pain
• Non-Steroidal Anti Inflammatory Drugs [NSAIDS]
• Antidepressants help in relieving severe neck and shoulder pain
• Certain homeopathic medicines also help

Home Remedies for Cervical Spondylosis

• Take enough rest
• Maintain a proper posture
• People who acquire spondylosis at an early age normally do so because of bad study habits
• Heat and cold treatment help provide relief and also works in relaxing the sore muscles of the neck and shoulders. Using a heating pack or a cold pack can be a good home remedy for cervical spondylosis
• Chiropractic manipulation that can help in order to control events of more severe pain due to cervical spondylosis. However the chiropractor must have the requisite skills of manipulating the neck
• Wearing a neck collar for cervical spondylosis helps limit movement and provides support for the neck and shoulders. However, these neck collars should not be worn for a longer period of time as it can cause muscle weakness.
• Several people opt for ayurvedic medicine for cervical spondylosis and Patanjali medicine for cervical spondylosis to cure their ailment

The Need for Cervical Spondylosis Surgery

Cervical spondylosis is not progressive even though patients might have to live with severe pain for long periods of time all their life as it is a chronic condition. Cervical Spondylosis Surgery is only advised by doctors in rare cases when other forms of treatment do not help to ease the pain. For people who suffer from a progressive loss of function in the arms, hands, and legs, surgery may be required to fix the defect at the source point. This is because any form of compression at the cord may result in permanent functional disability.

In cases of the surgery, the main goal is to remove the areas or sources that have been applying extra pressure to the spinal cord and nerve endings. Some extensive forms of surgery may also involve the insertion of implants or bone grafts to add stabilization. Doctors also perform a fusion of the degenerated discs as a cure for cervical spondylosis.

Road to Recovery and Aftercare

Cervical spondylosis is not uncommon among people who have crossed their 60s. Early diagnosis of this disease can help doctors recommend a conservative line of treatment to help ease the pain. Though this condition is not reversible, with proper care, home remedies, and lifestyle practices, patients overcome the stiffness and discomfort.

How to cure cervical spondylosis permanently?

This is a very difficult question to answer as has been mentioned, the treatment of cervical spondylosis is primarily aimed at pain relief cervical exercises by physiotherapy and medicines. Surgery in this condition is done only when there is a physical problem like a bone spur pressing on the spinal cord, or a herniated disc pressing on the nerves or a compressed disk ‘pinches’ a nerve or the spinal canal is narrowed, due to spinal stenosis. Samarth Neuro and Super-speciality Hospital in Miraj offers medical and physiotherapy treatment for cervical spondylosis. If required, surgery for cervical spondylosis can also be done at Samarth Hospital in Miraj, Maharashtra.

Spina Bifida Causes, Symptoms and Treatment

By Dr.Ravindra Patil

What is Spina Bifida?

Spina bifida is a birth defect in which an area of the spinal column doesn’t form properly, leaving a section of the spinal cord and spinal nerves exposed through an opening in the back. Spinabifida occurs in 1 per 2,000 live births.

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Myelomeningocele

The most common and serious form of spinabifida is called myelomeningocele, in which a part of the spinal cord and surrounding nerves push through the open bones (vertebrae) in the spine and protrude from the foetus’s back. In myelomeningocele, spinal cord and nerves protrude from the back in a sac that is exposed to the amniotic fluid. Continuous bathing of the fragile developing spinal cord in amniotic fluid over the course of gestation is thought to result in progressive neurologic injury.

Other types of spina bifida

Other types of spinabifida include myeloschisis, lipomeningocele and myelocystocele. Open neural tube defects such as myelomeningocele and myeloschisis are treatable by foetal repair. Closed neural tube defects such as lipomeningocele and myelocystocele are not treatable by foetal repair.

Causes of spina bifida

Myelomeningocele has genetic and micronutrient causes. Mothers who have had a baby with spinabifida have up to a 4 percent risk of recurrence in subsequent pregnancies.

Spina bifida symptoms

The myelomeningocele lesion can occur at any level on the developing spine, but most are found in the lumbo-sacral region. Depending on the lesion’s location, myelomeningocele may cause:

• Bladder and bowel problems (incontinence)
• Sexual dysfunction
• Weakness and loss of sensation below the defect
• Inability to move the lower legs (paralysis) and other cognitive impairments
• Orthopaedic malformations such as club feet or problems of the knees or hips
• Generally, the higher the defect is located on the spine, the more severe the complications.

In many cases, the brain develops an Arnold-Chiari II malformation, in which the hindbrain herniates or descends into the upper portion of the spinal canal in the neck. This herniation of the hindbrain blocks the circulation of cerebrospinal fluid, causing hydrocephalus (accumulation of fluid in the brain), which can injure the developing brain. Ventricular shunting (placement of a thin tube into the ventricles of the brain) is used to drain fluid and relieve hydrocephalus.

Hindbrain Herniation and Ventricular Shunting

Ventricular shunting is done to treat hydrocephalus. It involves placement of a thin tube into the ventricles of the brain to drain fluid and relieve hydrocephalus. The other end of the tube is usually put in the peritoneum [abdomen] of the patient for continuous drain.

Evaluation and diagnosis of spina bifida

As with other birth defects, most myelomeningoceles are discovered by routine ultrasound evaluation between 16 and 18 weeks into the pregnancy. Sonographic features suggestive of myelomeningocele include a cystic mass anywhere on the spine. Abnormally high alpha-fetoprotein (AFP) will support the diagnosis.

Other evaluation methods for suspected spinabifida are:

• High-resolution level II ultrasound — to confirm the diagnosis and determine the location of the lesion, and to assess for any other birth defects such as club feet
• Ultrafast foetal MRI — to confirm presence of the Chiari II malformation and to screen for evidence of any other neurologic abnormalities
• Foetal echocardiogram — to determine any problems with the heart
• Amniocentesis — to confirm the presence of elevated amniotic fluid alpha-fetoprotein (AFAFP) levels and acetylcholinesterase (AChE), which indicate open neural tube defects
• Maternal serum alpha-fetoprotein (MSAFP) test — to confirm elevated AFP levels in the mother’s blood

After evaluation, a multidisciplinary team works together to review test results, confirm the diagnosis, explain spina bifida treatment options and potential outcomes, and answer all the patient’s questions.

Treatment

The two main spina bifida treatment options are foetal surgery during pregnancy or surgery on the baby right after birth.

Deciding whether prenatal or postnatal spinabifida repair is appropriate is influenced by several considerations, including gestational age, the level of the myelomeningocele lesion on the spine, presence of the Chiari II malformation, and a number of important maternal health factors.

Spina bifida surgery after birth

If postnatal spina bifida surgery is recommended or selected, your pregnancy is monitored and a caesarean delivery is planned at 37 weeks.

Traditional spina Bifida treatment takes the form of surgical repair 24 to 48 hours after birth. Your child will undergo general anaesthesia. A paediatric neurosurgeon removes the MMC sac, if one is present, and closes the surrounding tissue and skin over the defect to protect the spinal cord. After surgery, your baby will receive care in the Neonatal Intensive Care Unit (NICU).

Spina bifida surgery before birth

Because spinal cord damage is progressive during gestation, prenatal repair of myelomeningocele may prevent further damage. Scientific studies have demonstrated that prenatal repair can offer significantly better results than traditional postnatal repair.

• It reduced the need to divert fluid from the brain using ventricular shunting
• Reduced the incidence or severity of neurological effects such as impaired motor and sensory function of the legs
• Improved mobility and improved the chances that a child will be able to walk independently
• Reversed the hindbrain herniation component of the Arnold-Chiari II malformation

Foetal surgery for spinabifida is a complex and challenging procedure, requiring the most expert, comprehensive care for both mother and foetus. The surgical team’s level of experience and all aspects of care surrounding the operation are of paramount importance.

If your unborn baby has been diagnosed with myelomeningocele, the surgery is performed between 23 weeks and 25 weeks of gestation.

Spina bifida prognosis

Rarely, children can die due to complications associated with Chiari II malformation or hydrocephalus. Many patients require shunts (85 percent), and 45 percent of shunts develop complications within one year.

Follow-up care

Children operated for spina Bifida require comprehensive long-term follow-up, from the time of repair through adolescence. It is team work of a paediatrician, nurse, social worker, physical therapist, neurosurgeon, orthopaedic specialists, urologist and genetic counsellor.

Depending on the location of the lesion and outcome after surgery, follow-up care may also include:

• Clean intermittent catheterization
• Bowel management
• Lower extremity bracing
• Physical therapy evaluation and guidance to outside physical therapists and early intervention
• Pressure sore management
• Referral to appropriate psychosocial and financial resources
• Consultation with other subspecialties including ophthalmology, nephrology, nutrition and feeding specialists, and plastic surgery

The Spina Bifida team works closely with each child’s primary care paediatrician and school, and helps families access appropriate community services. Ongoing follow-up is critical when it comes to improving outcomes and advancing treatment for patients with myelomeningocele.

Spina Bifida can lead to a variety of social and emotional challenges and lifelong quality-of-life issues. Hence proper diagnosis during pregnancy is essential.

Spina bifida occulta

Spina bifida occulta is the mildest type of spinabifida. It is sometimes called “hidden” spinabifida. In this birth defect, there is a small gap in the spine, but no sac comes out of the back. The spinal cord and the nerves usually are normal.

At Samarth Neuro & Super Speciality Hospital in Miraj, we are dedicated to providing expert care, ensuring the well-being and quality of life for individuals facing this condition.

Lumbar Spondylosis

By Dr.Ravindra Patil

It is a painful condition of area of the lower back above the buttocks. But first let us understand each term clearly. Let us see ‘Lumbar’ means and what ‘Spondylosis’ means.

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What is ‘Lumbar’ Spine?

It refers to that part of the spinal column which has five vertebrae and is located at the lower back but above the buttocks. Painful conditions occur in the lumbar spine because it carries the weight of the upper body and is prone to many stresses and injuries during routine work and severe hard exertions.

Understanding spondylosis

Spondylosis refers to the development of age-related arthritis that affects the spine. More specifically, it involves a number of different degenerative issues that affect the disks and joints of the spine. It may occur in any part of the spine, from the neck to the back to the lower back. In this article we focus on the lower back or the ‘Lumbar’ region. Hence we call it Lumbar Spondylosis.

Why does spondylosis occur? Over time, disks between two vertebrae [called intervertebral disks] may become dehydrated and become compressed, meaning their height is reduced as a result of dehydration. Thus, they provide less cushioning and can actually “crack,” which can lead to herniation. Herniation means a part of our body protrudes out of a normal or an abnormal opening.

Similarly, the cartilage in the spine’s joints can wear down, resulting in the formation of bone spurs.  

These arthritic changes can not only cause pain in the back but can also lead to a narrowing of the spinal canal (also known as stenosis), which may compress nerves. Nerve compression causes symptoms like pain and numbness, which slowly increases with the passage of time. Later there may be loss of vital functions like bladder and bowel control. Individuals with spinal stenosis may have neurologic symptoms in their extremities, such as numbness, tingling, or weakness radiating into their arms or legs. Loss of bladder or bowel control may lead to further complications. 

What causes spondylosis?

The most common cause of spondylosis is the cumulative joint stress that occurs as people age. It predisposes them to osteoarthritis, a common form of arthritis typically associated with progressive “wear and tear” on joint cartilage. 

Spondylosis may also arise as a result of previous trauma to the spine. For instance, patients who:

• Have had car accidents, falls, or other spinal injuries
• Play competitive sports
• Perform strenuous physical activity at work
• Have had a previous neck or back surgery

The lumbar region is most affected by spondylosis because of its exposure to mechanical stress.

What are the risk factors for spondylosis?

The risk factors for spondylosis include the following:

• Age 60 or older
• Osteoarthritis affecting other joints
• Physically demanding jobs that may require heavy lifting or bending
• High-level athletics
• Neck or back injury
• Previous spine surgery
• Obesity
• Smoking
• Physical inactivity

What are the symptoms of lumbar spondylosis?

Many with spondylosis do not have pain or neurologic symptoms. Some people may experience symptoms. They are:

• Neck or back pain that worsens when coughing or sneezing
• Decreased flexibility in and range of motion of the neck or back
• “Clicking” sounds from the spine
• Pain radiating from the lower back into the legs
• Numbness, tingling, or weakness in the arms or legs
• Unsteady gait
• Muscle spasms
• Headaches
• Bladder or bowel dysfunction in severe cases

How is spondylosis diagnosed?

A person can be diagnosed with lumbar spondylosis by a medical history, physical exam, and reviews of diagnostic tests. When providing your medical history, it is important to share any history of spinal injuries or previous surgeries. Physical activity information must also be shared.

Your doctor will observe your walking ability and assess the range of motion of your spine to determine if you have any pain or stiffness. Palpation of the neck and back can also help identify the location of any tenderness associated with spondylosis. Your neurologic function will also be evaluated, including your sensation, strength, and reflexes. Special tests may also be performed to check for any signs of nerve impingement (from a disk herniation, for example). 

Finally, imaging studies like X-rays, computed tomography (CT scan), and magnetic resonance imaging (MRI) may also be used to identify any arthritic changes in the spine. Lab tests may also be useful for ruling out more concerning diseases, such as an infection or cancer.

Differential Diagnosis

When a patient is suffering from low back pain, there are a lot of other possible diseases that have to be considered and ruled out:

• Rheumatoid arthritis
• Excessive exercise pain
• Ankylosing Spondylitis
• Coccyx Pain
• Spinal Masses
• Infection
• Discitis
• Lumbar Compression Fracture
• Mechanical Low Back Pain
• Overuse Injury

Lumbar Spondylosis’s degeneration can influence spinal alignment, potentially exacerbating pre-existing Spinal Deformities, emphasizing the need for comprehensive diagnosis and treatment.

How is spondylosis treated?

Different treatments are available to treat spondylosis, depending on the type and severity of symptoms. 

Treatments for milder spondylosis include:

• Activity modification, such as avoiding activities that cause pain
• Medications, such as non-steroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen and Diclofenac or Paracetamol
• Hot/cold compresses, massage, and traction
• Physical therapy, such as strengthening and flexibility exercises and ergonomic education
• Spinal injections, such as an epidural around nerves and facet joints

In more severe cases, surgery might be the best course of action. It may involve the following procedures:

• Decompression (laminectomy, discectomy), which involves the removal of bone spurs, disk herniations, and arthritis to relieve compression of the nerves and address neurologic symptoms
• Fusion, which is the formation of bone across adjacent vertebral bodies to stabilize the spine and relieve pain

Other Surgical treatment for Lumbar Spondylosis

• This surgery is used to relieve pain associated with a compressed nerve in the spine.
• Disk replacement.
• Interlaminar implant.
• Physical Therapy Management
• Educating the patient: may include reviews of lumbar anatomy, explanations of the concept of posture, ergonomics and giving appropriate back exercises.

Other non-surgical treatment modalities include

• Lumbar Back Support: Can be beneficial for patients suffering from chronic LBP. It occurs to limit spine motion, stabilize, correct deformity and reduce mechanical forces. There is no consensus if it may function as a placebo or really improve pain and functional ability.
• Special type of taping is done on the back to prevent moment in certain directions, but again it is thought to give more of a placebo effect of pain relief.

Clinical Bottom Line

Lumbar spondylosis can be described as a degeneration of the lumbar vertebrae.

• It is a form of low back pain and is an important clinical, social, economic and public health problem affecting the worldwide population.
• It is a disorder with many possible causes and many definitions.
• Clinical diagnosis of lumbar spondylosis is done by MRI, CT, SPECT and X-ray and a general examination of the spine.
• Mild cases are managed with medicines.
• Severe cases need surgery.
• The physical therapy has an important role, and may include lumbar traction, manipulation of the spine, massage therapy, TENS, back school and Lumbar back supports.
• The choice of therapy depends on the individual wishes and the surgeons advice.

Lumbar Spondylosis’s degeneration can influence spinal alignment, potentially exacerbating pre-existing Spinal Deformities. This complexity was underscored when a patient, who had tumours in his spine twice, faced a critical situation. Here, surgical navigation emerged as a crucial factor in saving him. This advanced technique seamlessly complemented the comprehensive approach discussed earlier, highlighting the intricate nature of spinal health management.

Outlook for people with spondylosis?

Fortunately, most individuals with spondylosis will not experience symptoms and may never even realize that they have arthritis in their spines. However, for those who experience pain or neurologic changes due to nerve compression, safe and effective treatments are available.

Vertigo and Dizziness

By Dr.Ravindra Patil

Dizziness

Overview

Dizziness is a term used to describe a range of sensations, such as feeling faint, woozy, weak or unsteady. Dizziness that creates the false sense that you or your surroundings are spinning or moving is called vertigo. Dizziness is one of the more common reasons adults visit their doctors. Frequent dizzy spells or constant dizziness can significantly affect your life. But dizziness rarely signals a life-threatening condition.

Treatment of dizziness depends on the cause and your symptoms. It’s usually effective, but the problem may recur.

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Symptoms

People experiencing dizziness may describe it as any of a number of sensations, such as:

• A false sense of motion or spinning (vertigo)
• Light-headedness or feeling faint
• Unsteadiness or a loss of balance
• A feeling of floating, wooziness or heavy-headedness

These feelings may be triggered or worsened by walking, standing up or moving your head. Your dizziness may be accompanied by nausea or be so sudden or severe that you need to sit or lie down. The episode may last seconds or days and may recur.

Causes of Dizziness

Dizziness has many possible causes, including inner ear disturbance, motion sickness and medication effects, poor circulation, infection or injury.
Inner ear problems that cause dizziness (vertigo): Your sense of balance depends on the combined input from the various parts of your sensory system. These include the following:

• Eyes, which help you determine where your body is in space and how it’s moving
• Sensory nerves, which send messages to your brain about body movements and positions
• Inner ear, which houses sensors that help detect gravity and back-and-forth motion
• A viral infection of the vestibular nerve
• Meniere’s disease: excessive build-up of fluid in your inner ear.
• People who experience migraines may have episodes of dizziness

Circulation problems that cause dizziness

You may feel dizzy, faint or off balance if your heart isn’t pumping enough blood to your brain. Causes include:

• Drop in blood pressure
• Poor blood circulation

Neurological conditions that cause dizziness

• Parkinson’s disease
• Multiple Sclerosis
• Dizziness can be a side effect of certain medications such as anti-seizure drugs, antidepressants, sedatives and tranquilizers and blood pressure lowering medications
• Anxiety disorders like panic attacks and a fear of leaving home or being in large, open spaces

Other causes of Dizziness

• Low iron levels (anaemia)
• Low blood sugar (hypoglycaemia)
• Carbon monoxide poisoning
• Overheating and dehydration

Risk factors

Factors that may increase your risk of getting dizzy include:

• Older adults are more likely to have dizziness
• A past episode of dizziness

Complications

Dizziness can increase your risk of falling and injuring yourself. Experiencing dizziness while driving a car or operating heavy machinery can increase the likelihood of an accident.

Back Care for Sick Patients

By Dr.Ravindra Patil

What is back care?

Before we understand back care, we must understand what are pressure sores or bedsores. Back care procedure is done to prevent pressure sores.

Pressure sores are also called pressure ulcers or decubitus ulcers or bedsores. They are injuries to the skin and underlying tissue resulting from prolonged pressure on the skin. Bedsores most often develop on skin that covers bony areas of the body, such as the heels, ankles, hips, tailbone and back of the head.

People who are at risk of bedsores have medical conditions that limit their ability to change positions. They are bed ridden or chair ridden. They are forced to spend their time in a bed or chair.

Bedsores can develop over hours or days. Most sores heal with treatment, but some never heal completely. We can take steps to help prevent bedsores and help them heal.

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Symptoms

Warning signs of bedsores or pressure ulcers are:

• Unusual changes in skin colour or texture
• Swelling
• Pus-like discharge
• An area of skin that feels cooler or warmer to the touch than other areas
• Tender areas

Bedsores fall into one of several stages based on their depth, severity and other characteristics. The degree of skin and tissue damage ranges from changes in skin colour to a deep injury involving muscle and bone.

Common sites of pressure ulcers

For people who need to stay in bed, bedsores may happen on:

• The back or sides of the head
• The shoulder blades
• The hip, lower back or tailbone
• The heels, ankles and skin behind the knees

Wheelchair bound people also may suffer pressure sores at pressure points.

When to see a doctor

If you notice warning signs of a bedsore, change your position to relieve the pressure on the area. If you don’t see improvement in 24 to 48 hours, contact your doctor. Seek immediate medical care if you show signs of infection, such as a fever, drainage from a sore, a sore that smells bad, changes in skin colour, warmth or swelling around a sore.

Causes of bedsores

Bedsores are caused by pressure against the skin that limits blood flow to the skin. Limited movement can make skin vulnerable to damage and lead to development of bedsores.

Primary contributing factors for bedsores are:

• Constant pressure on any part of your body can lessen the blood flow to tissues. Without a good blood flow, essential nutrients don’t reach the skin and it is damaged.
• For people with limited mobility, bedsores occur in areas that aren’t well padded with muscle or fat and that lie over a bone, such as the spine, tailbone, shoulder blades, hips, heels and elbows.
• Friction occurs when the skin rubs against clothing or bedding. It can make fragile skin more vulnerable to injury, especially if the skin is also moist.
• Shear occurs when two surfaces move in the opposite direction. For example, when a bed is elevated at the head, you can slide down in bed. As the tailbone moves down, the skin over the bone might stay in place — essentially pulling in the opposite direction.

Risk factors

Your risk of developing bedsores is higher if you have difficulty moving and can’t change position easily while seated or in bed. Risk factors include:

• This might be due to poor health, spinal cord injury and other causes.
• Skin becomes more vulnerable with extended exposure to urine and stool.
• Lack of sensory perception. Spinal cord injuries, neurological disorders and other conditions can result in a loss of sensation. An inability to feel pain or discomfort can result in not being aware of warning signs and the need to change position.
• Poor nutrition and hydration. People need enough fluids, calories, protein, vitamins and minerals in their daily diets to maintain healthy skin and prevent the breakdown of tissues.
• Medical conditions affecting blood flow. Health problems that can affect blood flow, such as diabetes and vascular disease, can increase the risk of tissue damage such as bedsores.

Prevention

You can help prevent bedsores by frequently repositioning yourself to avoid stress on the skin. Other strategies include taking good care of your skin, maintaining good nutrition and fluid intake, quitting smoking, managing stress, and exercising daily.

Back care steps which conscious patients must take

Consider the following recommendations related to repositioning in a bed or chair:

• Shift your weight frequently. Ask for help with repositioning about once an hour.
• Lift yourself, if possible. If you have enough upper body strength, do wheelchair push-ups by raising your body off the seat by pushing on the arms of the chair.
• Some wheelchairs allow you to tilt them, which can relieve pressure.
• Select small cushions or a mattress that relieves pressure.
• Use cushions or a special mattress called an ‘air bed’ to relieve pressure.
• Adjust the elevation of your bed. If your bed can be elevated at the head, raise it no more than 30 degrees. This helps prevent shearing.

Back care steps in nursing

In hospitals, an ‘air bed’ is given to patients who are immobile. Nursing care plays a vital role in preventing bedsores. Steps of back care in nursing are summarised below:

• Keep skin clean and dry. Wash the skin with a gentle cleanser and pat dry. Do this cleansing routine regularly to reduce the skin contact with moisture, urine and stool.
• Protect the skin. Use moisture barrier creams to protect the skin from urine and stool.
• Change bedding and clothing frequently if needed. Watch for buttons on the clothing and wrinkles in the bedding that irritate the skin.
• Inspect the skin daily. Look closely at your skin daily for warning signs of a pressure sore.
• When we sleep on our back, we keep on turning, but sick patients cannot turn. Try and turn them under the doctor’s advice.

These five steps of back care are crucial.

Back care procedure

Aim of back care is to:

• Stimulate the circulation and give general relief.
• Prevent bedsore
• Give comfort to the patient.

7 steps of back care massage

• Help the patient to turn on his abdomen or on his side with his back toward the nurse and his body near the edge of the bed.
• Raise the patient’s gown.
• Apply medicated lotions to the back to reduce friction.
• In rubbing the back use firm long strokes and kneading motions.
• The amount of pressure to exert depends upon the patient’s condition.
• Begin from the neck and shoulders then proceed over the entire back.
• Massage with both hands working with a strong stroke. In upward than in downward motions. Give particular attention to pressure areas in rubbing in the lotions.

Turn patient on his back and pull down the gown. These back massage steps in nursing should be regularly followed.

Hand Movements Used

Effleurage (stroking—is a long sweeping movement with palm of hand conforming to the contour of the surface treated, over small surface (on the neck) the thumb and fingers are used. Strokes should be slow, rhythmical and gentle with pressure constant and in the direction of venous stream.

Kneading—performed with the ulnar side palm resting on the surface and the fingers and thumb grasping the skin and subcutaneous tissues which move with the hand of the operator.

Friction—is performed with the whole palmar surface of the hand or fingers and thumbs over limited areas. This movement is a circular and kneading with pressure against the underlying part of tissue which cannot be grasped.

Back care ppt

Google is of such great help, just type ‘back care ppt’ and you will get many presentations explaining steps of back care.