|HEALTH TRIBUNE||Wednesday, May 7, 2003, Chandigarh, India|
Say ‘no’ to sleeping pills
AYURVEDA & YOU
Wrong exercises can aggravate low back pain
LOW back pain is an extremely common symptom in the general population. It is estimated that 70 per cent of the people suffer from low back pain at some time in their lives. In 90 per cent of the patients, LBP resolves within six weeks, i.e. self limited. In another 5 per cent the pain resolves by 12 weeks. Less than 5 per cent of back paid account for true nerve root pain. Accurate assessment via a physical examination is more important than the growing trend of over-reliance on imaging techniques like MRI. About 50 per cent of the normal individuals undergoing MRI may have abnormal disc lesions without any symptoms.
The onset of back pain is generally initiated by forward bending to pick up some object. The reasons for such low back problems are either weak back muscle or weak abdomen muscle. The other common causes of low back pain are bad posture, wrong training methods or mechanical problems. Mechanical or functional back pain is the most common category of the back pain accounting for perhaps 80-90 per cent of all the cases. When back muscles are strained or torn pain can be very severe and can last several days or weeks. Flexion (forward bending) injuries result in soft tissue, i.e. disc and ligament, whereas extension (backward movement) more often results in injury to the bone.
In sports like cricket (fast bowlers), golf, tennis, gymnastics, etc, overuse or repetitive movements can cause stress fractures of the lumbar spine. Low back pain of a long duration can cause muscle weakness which in turn cause pain because weakened muscles have less ability to hold up the spine. Therefore, people undertaking regular exercises are less prone to back pain due to muscle strain.
Most of the problems related to back pain can be avoided if patients observe the following:
(a) While sitting, a slouched position is extremely common. Spine need to be straightened so that the head is balanced — not looking up or down and not pushed forward. Therefore, the correct posture is to sit with lower back touching the back rest of chair. The use of lumbar roll above the belt line, i.e. in the hollow of the back, encourages correct posture.
(b) While lying, a comfortable mattress is required. If the bed has a tendency to sag, mattress should be placed on the floor.
(c) While lifting any object, a person should lower himself to the level required while maintaining the back as vertical as possible. The distance from the object should be as close as possible to the body.
(d) To avoid load on the lower back, a person while getting up from the bed should just place himself in the side on position.
(e) The computer screen should be about 15-30 degrees below from the head position, and the key-board and mouse operated with relaxed shoulders and bent elbows. If the screen and the keyboard are offset from the centre, then dorsal problems will also occur.
(f) Office chairs should be fully adjustable — the tilt of the seat, and the back and height should all be adjustable to each individual use.
(g) Lumbar supports in cars are useless unless they adjust up and down to fit the lumbar lordosis of the person in question. If no seat adjustments are available, adopt a sitting up tall position (while driving with bent elbows).
(h) No one goes out and runs two-three hours without any training. Yet people will go into the garden and do two hours of weeding and digging, and wonder why they have back problems. Plan 5-10 minutes of bending jobs around your house and garden, followed by 5-10 minutes of standing and reaching jobs.
(i) Standing half bent over a sink, ironing board, etc, is dangerous for the back. Standing with legs wide apart drops the height without bending. The correct posture is to stand with the weight balanced over the middle of the feet, with slight lordosis, stomach muscles gently tightened and upper spine straightened.
The patients of chronic low back pain are either advised surgery or exercises. Surgery of the spine is neither preferred by doctors nor patients due to the disc proximity to the spinal cord. Patients treated with surgery have a 10 times higher risk of developing subsequent disc herniation compared with those who prefer not to undergo surgery. Therefore, exercises have their special role to play. Their prescription will vary with individuals and presenting conditions, etc.
There are differences of opinion regarding the REST recommendations for the treatment of low back pain. I, for one, feel that for acute or recurrent LBP with or without referred leg pain, bed rest for two-seven days is worse than performing day-to-day activities. It is not as effective as the alternative treatments to which it has been compared for relief from pain, etc. Prolonged bed rest may lead to disability, and increased difficulty during rehabilitation. Therefore, bed rest is not recommended as a treatment for simple back pain. Some patients may be confined to bed for a few days as a consequence of their pain, but this should not be considered a treatment. Patients should be advised to stay as active as possible and to continue normal daily activities and to increase physical activities progressively over a few days or weeks.
I also come across many cases of back pain who continue doing wrong exercises which put an undue load on the low back. Therefore, exercises should be done under expert supervision in the initial stages of treatment so as to ensure quick recovery and also to check the aggravation of pain. Exercises should be done according to the problem, and not the routine exercises for the abdomen or back which can aggravate pain. Experience shows that localised low back pain which accounts for 80-90 per cent of all cases of low back pain respond very well to mobilisation.
Say ‘no’ to sleeping pills
AFTER cosmetics, pharmaceuticals constitute the most rapidly proliferating consumables the world over. India is not lagging behind. Of all the drugs, our maximum consumption includes sleep inducers, sedatives, tranquillisers, anti-depressants and mood elevators. Some of these have become household names, are being self-prescribed and can easily be procured on the counter from the chemist, without a formal doctor's prescription.
In a number of health-care centres being operated by us in urban, rural and even slum areas, we come across patients who are habituated to use these drugs for long periods, without realising their ill effects. It is after persistent counselling and sustained effort that we succeed in weaning them off these slow-acting toxic psychotics.
Most of these habit-forming drugs broadly belong to the groups called benzodiazepines, non-benzodiazepines, phenothiazines and even stronger drugs like hypnotics and barbituarates.
Some of the familiar names in these categories of drugs are diazepam, lorazepam, alprazolam, nitrazopam, flurazepam, etc, which are being marketed in a plethora of brand names by Indian and multinational pharmaceutical companies.
They exert their pharmacological effects mainly by the inhibition of the central nervous system. Their short term use, as assessed by a medical professional, may induce the required amount of sedation, hyphosis, muscle relaxation, relief from anxiety, sleep induction, anticonvalsion effect, etc. However, their long-term use, beyond the prescribed duration by the patient himself, has a depressant and ultimately degenerative effect on the nerve cells.
The dosage and duration of these drugs have to be carefully assessed and regulated particularly in the case of debilated and elderly patients, who are more prone to misusing them. Again, these drugs have adverse interaction with several other drugs, which the patient is simultaneously being administered. The lay patient may not be aware of these interactions. Some of these drugs are also contra-indicated during pregnancy, for lactating mothers, in certain hepatic and renal diseases, as these are metabolised and excreted by the vital organs. Therefore, self-prescription is not safe even by the educated elite, especially the senior citizen.
Melatonin, another drug, popular in the USA, and now being used in India as well, particularly bythe NRIs coming home, is being promoted as a chronobiotic, which therapeutically adjusts the timings of the circadian sleep rythms, and alleviates symptoms of jet lag.
Lately, the imbalance of female harmones, decreased luteinising hormone and increased prolectin harmone concentrations in the serum have been reported, even after pharmacological dozes of melatonin. This drug is also contra-indicated for those on steroids and in cases of leukaemia. It is not safe to drive after a doze of melatonin during the previous night due to its hangover the next day.
Due to the stress and strain of modern lifestyle, a number of tricyclic, tetracylic and other categories of mood elevator and antidepressant drugs, with familiar names like imipramine, amitriptyline, nortriptyline, mianserin, etc, have flooded the market. Their good effect can be seen only after a few weeks of their administration. On the other hand their adverse side-effects like tachycardia, hypertension, palpitation, visual accommodation disturbance, urticaria, weight loss and at times even jaundice may be seen in some cases of long use. They have been reported to be harmful when administered to patients of heart disease, glaucoma, renal and hepatic disease, who all often suffer from depression.
Therefore, no psychotic drug should be taken without a doctor’s prescription. The prescribed duration should not be exceeded. As far as possible they should be avoided. In that case, is there an alternative?
Yes, resort to yoga and meditation. Psychotic drugs influence the psyche. So does yoga and meditation. Psychotic drugs, in the long run, damage the central nervous system, but yoga and meditation rejuvenate the central nervous system.
Patanjali's system of yoga and meditation is, in fact, a science which elaborately deals with the control of the psyche in a systematic manner. It is an effective cure for insomnia and depression even during the very preliminary stages of its practice under the guidance of a genuine teacher. But beware of the sham shops professing spiritual quackery.
The writer, a Doctor B.C. Roy National
Awardee, looks after 16 medicare centres in urban, rural and slum
areas in Chandigarh and the adjoining districts of Punjab and Haryana,
including four medicare centres exclusively for senior citizens.
PATIENTS of rheumatoid arthritis (RA) should understand that this disease usually runs a typical course of natural relapses and remissions. Many of its symptoms, including pain and stiffness, periodically vanish even without any significant treatment. But relapses and flare-up episodes continue to occur with or without any known reason and timetable.
Due to the loss of cartilage and wasting of supportive muscles, a small percentage of chronic or more severe cases of RA start showing up signs of bony deformities and permanent stiffness of the joints. To effectively manage the complexities of this disease, there is need for enormous skill and expertise on the part of the physician. As a rule, the first step of the treatment should be aimed at neutralising the aggravated "ama". This includes adopting medicines and applying certain procedures which in ayurveda have been described as "langhana chikitsa". Some important points of the classic ayurvedic treatment are briefly given below.
Guggul has been rightly known as nature’s shield against arthritis. There are many preparations of it, but taking a combination of half-to-one gm of the famous Yograj Guggul along with two gm of Panchkol Churna twice a day for two-to-three weeks is quite helpful in controlling the flare-up phase of the disease. Panchkol Churna is a combination of five herbs — pippali, pipplamool, chavya, chitraka and sonth, all crushed in equal parts. Simultaneous use of Agnitundi Vati, Sanjivani Vati or Tribhuvan Keerti Rasa brings faster relief from many other acute symptoms.
After pain and inflammation reduce, the second stage of treatment meant for clearing the toxins from the body begins. This is achieved by administering Rasnasaptak Qwath for at least seven days with 20 ml of castor oil as an additive. A very light and easily digestible diet is recommended during this phase. Gold preparations or other higher medicines like Brihad Vata Chintamani Rasa and Rasa Raja Rasa are recommended only in the third phase of the treatment. Various Guggul preparations like Sinhnad Guggul , Rasnadi Guggul and Amvatari Rasa are also very effective at this stage.
To stop the re-accumulation of "ama", regularly taking Vaishwanar Churna in a daily dose of three gm is quite helpful. It can be made at home by crushing together ajwain and rock salt 50 gm each, ajmoda 75 gm, sonth 100 gm and peel of hararh 300 gm. In an acute phase, ayurvedic texts recommend applying of dry fomentation of hot sand bags also. Various oil massages like that of Mahanarayani Tailam and the panchkarma therapies should only be applied in settled cases or when "ama" has subsided. Mahayograj Guggul is an acclaimed medicine for the chronic cases of this disease.
Ayurveda recommends specific dietary regime and lifestyle modifications for the patients of RA. By shunning heavy fried, stale and sticky food they should opt for light and easily digestible diet with ginger, hing, sonth, garlic, black pepper and jeera as additives. Taking of warm water by boiling a pinch of crushed ginger in it helps to keep the formation of "ama" under control. Excessive use of eatables like milk preparations and non-vegetarian food, bakery items, incompatible food, cold or icy desserts and frequent intake of rice (in the north-western part of India) should be avoided. Patients of RA should adopt a balanced daily routine and should also avoid all factors which they know are the reasons for the disease.
Caution: Ancient sages propounded ayurveda for the benefit of mankind. This is a totally transparent medical system which does not facilitate secret cures or magical remedies. There are incidents when under the garb of ayurvedic treatment, innocent patients of RA are administered certain "medicines" which are sprinkled with steroids or other pain killers. To avoid such situations — when not only ayurveda gets a bad name but the patient also puts his health to great risk — always insist on getting a prescription.
Washington: A new study has found that children who frequently change schools are more likely to have behavioural health problems than those who don't.
According to a new Cincinnati Children's Hospital Medical Center study, school mobility is an independent predictor of behavioural problems — regardless of one's race, income, maternal education level or any other factor measured in the study. ANI
Pain relief drugs
Washington: A new study conducted at the Ohio State University has found that a common pain relief medication could help skin cancer treatment, according to reports presented at the annual meeting of the Society for Investigative Dermatology meeting in Miami Beach. ANI
Family's income factor
Washington: A new research has revealed that a family's income level can greatly influence a child's physical development.
The research by pediatricians at the University of Michigan Health System found that children from low-income families, at or below the poverty level, have lower birth weights and are measurably shorter by age one than children from higher-income families. ANI
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"We found that if we block the
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