Confusion: what to choose for pain Hot or Cold? (Hot pack vs. Cold pack)

Whenever it is about pain, everyone would have their own suggestions. Whether to use hot packs or to use cold pack or to apply turmeric powder on that and so on. There is so much confusion about this. These both are the easiest, cheapest, and safest self-treatment options for management of many common pain problems.

When to use ice pack?

Icing is used mainly when your injury is fresh. Acute injury would cause swelling, redness and increased temperature locally. Icing would grossly help you out in reducing the swelling and this reduction in swelling would decrease the pain.

When not to use ice pack?

It can cause temporary harm when it is used poorly. Do not use ice when you have stiffness or tightness. Don’t use it when already you are shivering. During such period, if you apply ice, the brain will get the wrong signals and will aggravate the pain.

Caution: never use ice in case of lower back pain or cervical pain (Neck pain). It might aggravate the symptoms.

When to use hot pack?

Heat is generally used for muscular chronic pain, stiffness, tightness. These symptoms would be of unclear cause, but there might be some trigger points which can be relieved by applying heat over it. Most of the time in patients with back pain would feel decrease in pain after heating, because there would be release in its trigger points and in tightness too.   

When not to use hot pack?

Heat should not be used when you have acute injury. Acute injury causes swelling and inflammation. Applying heat would worsen the swelling and so increases the pain. Avoid it when already you are sweating.

How about combining it?

Alternating between hot and cold is called “Contrast Bath”. It is very stimulating and could be helpful in recovering from injury with unknown efficacy.

Take Home message

Both have equal potency. As they are available easily and the safest amongst all other treatments, people use it very often. They are for temporary purpose. You can choose whatever makes you feel good! It is going to be dependent totally on your consideration.

Vitamin B12: Why is it required

Vitamin B12 is one of the water soluble vitamins, which is important for adequate function of red blood cells, nerve cells and brain cells.

Vitamin B12 deficiency is extremely commonly seen in clinical practice today. This raises several questions, as to whether the deficiency is increasing, or is it that we are checking more frequently for B12. There is also a question whether RO water is related to Vitamin B12 deficiency.

How does it help us?

·      It converts Carbohydrates into Glucose and provides energy to the body

·       It is essential for healthy nervous and digestive systems

·       It controls your cholesterol levels

·       It can help in some of the heart diseases and high blood pressure

·       B12 is very much important for healthy hair, nails and Skin

·       It can help you to fight against Breast cancer, lung cancer and prostate cancer

How will we get to know its deficiency? (Symptoms)

·       Constantly feeling tired

·       Depression

·       Poor digestion

·       Sleeplessness

·       Mood swings

·       Giddiness

·       Joint pain

·       Difficulty in breathing

·       Feeling dizzy

·       Inability to concentrate

·       Poor dental health

·       Poor appetite

·       Poor memory

·       Tingling and numbness in hands and/or feet

Who are most likely to have it?

Elderly people who tend to have impaired digestion. Because they are tend to produce less stomach acids which are required to convert Vit-B12 properly.

Vegan Diet followers, who avoid animal products in their daily foods

Smokers and alcoholics, as such products can block Vitamin B12 absorption.

(The RO process filters out some essential salts and minerals that we need in our day-to-day life so RO process may be responsible for the deficiency but vegetarian diet and vegan diet are considered as primarily responsible for the deficiency.)

Recommended daily amount

Infants 0-6 months     : 0.4 micrograms

Infants 7-12 months   : 0.5 micrograms

Toddlers 1-2 years      : 0.9 micrograms

Children 4-8 years      : 1.2 micrograms

Children 9-13 years    : 1.8 micrograms

Adult men/women

Above 14 years           : 2.4 micrograms

Pregnant women         : 2.6 micrograms

Breastfeeding women : 2.8 micrograms

Vitamin B12 rich food

·       Cheese

·       Yogurt

·       Grains

·       Eggs

·       Soya beans

·       Almond

·       Fish

·       Vanilla ice-cream

·       Green vegetables

·       Milk

Prevention of Vitamin B12 deficiency

Most people can prevent vitamin B12 deficiency by eating animal origin food products such as meat, poultry, seafood, dairy products, and eggs which are a good source of Vitamin B12. If you don’t eat animal products, or you have a medical condition that limits how well your body absorbs nutrients, experts recommend taking a B12-containing multivitamin and eating breakfast cereal fortified with vitamin B12. Several cereal fortified with B12 are now available in India.

  

Simplified Solutions for your Hurting shoulder (Frozen Shoulder)

Are you getting your shoulder pain worst day by day? Is your shoulder getting stiff? These are the symptoms suggestive of the frozen shoulder. Just like an ice in refrigerator, your shoulder is getting frozen causing pain, stiffness and ultimately difficulty in daily living activities. This is a condition in which the surrounding structure of shoulder joint (i.e., Capsule of joint) gets swollen and tightened, causing pain and stiffness in shoulder.

More incidences are seen in women than men. You are more likely to get this condition if your age is between 40 to 60 years. Your risk might also go up if you’re in the process of recovering from a medical condition like a stroke, or surgery like a mastectomy that keeps you away from moving your arm. A diabetic patient is more prone to get this condition. Though only 10% to 20% diabetic patients might have frozen shoulder.

Decide in which stage you are!

Stage1: Freezing stage

Pain in shoulder, sometimes gets severe

Sleepless nights due to pain

May last for 6 to 8 months

Difficulty in moving shoulder

Stage2: Frozen stage

You might have less pain but more stiffness

May last for 8 to 12 months

More difficult routine activities e.g., combing hair, wearing shirt etc.

(Difficult or impossible overhead activities)

Stage3: Thawing stage

Symptoms might get relieved

May take around 10 months to 2 years

The extreme condition requires doctor's advise.

A Manipulation is the better option if you have worsen your condition

contact our experts to know about Manipulation technique

Solutions as per stage of the condition

Ø Solutions for stage1:

Most important part is to relieve pain in this stage. Following will help you to get relief from pain;

A hot water fomentation

Mild stretching exercises

Simple shoulder joint movements   

Ø Solutions for stage2:

Stiffness is the most affective part in this stage

More you activate your shoulder, better the recovery

Try to do more exercise of shoulder in this stage

Shoulder up-down, sideways movement, rotations are helpful to make it little free

Pulley exercises are the best to get your shoulder stiffness decreased

The other way to relax your shoulder muscle is pendulum swing

Continue the hot water fomentation along with all these exercises

Solutions for stage3:

Eventually you might be feeling better but to prevent its recurrence, physical exercises are required

Stick exercises are the best suggested for this stage

The extreme condition requires doctor's advise.

A Manipulation is the better option if you have worsen your condition

contact our experts to know about Manipulation technique

How will you Delay Knee Surgery?

Knee replacement has become the choice of treatment for old aged people with knee problems during last few decades. Sometimes it is likely to happen that patient would choose knee replacement surgery though it’s not required. In that case, thorough counseling and education of patient regarding the surgery becomes necessary. It is not surprising that so many knee replacement institutes are lacking patient education program.

Here this blog will help you for decision making process of knee replacement surgery. Our operative surgeons, Dr. Rajiv Paradkar and Dr. Vrajesh Shah, have great experience of 15-20 years in joint replacement surgeries. Some firm statements regarding knee replacement operation decisions from the desk of VIROC doctors are as follows;

1.     Know the main cause of knee pain. Generally osteoarthritis of knee is the reason of knee pain in old age, but patient should be aware of disease’s stage. More often last stage of knee osteoarthritis requires knee replacement. If the underlying cause of knee pain is different then you need other interventions.

2.     Once cause is found then go for conservative treatment first. We start with some glucosamine medicines (for cartilage and joint lubrication) with low dosage of non-steroidal anti-inflammatory drugs to treat pain.

3.     Good amount of physiotherapy is the best part of conservative treatment. Proper exercises could diminish your knee pain by decreasing the swelling over knee. Along with the exercises, electrotherapy and hot water fomentation would give you the best outcome.

4.     Most important advice is the weight reduction. If patient is obese then losing weight would give him\her drastic relief.

5.     If above all treatment fails then we would suggest you to go for some alternative interventions i.e., Stem cell therapy, PRP injections and Ozone (O₃) therapy. These are some types of treatment which are available at VIROC hospital.

6.     Many patients would be suggested for local steroidal injections and arthroscopic surgery. But we hardly recommend such alternatives which require more finances

.

7.     At last, after all possible treatments only consider your pain factor. If your pain is worsening day by day and it affects your daily routine, also the X-rays suggestive of last stage osteoarthritis then go for the replacement surgery, regardless of the age factor (recommended age range is 60 and above).

India will emerge as the capital of Osteoarthritis by 2025 with more than 60 million to be likely affected. Thorough awareness and preventive steps towards fight against Osteoarthritic knee pain has now become mandatory.

Overweight! An Addition to risk of knee osteoarthritis

Knee is the major weight bearing joint of the body. The knees are the shock absorbents of the body. Their role is to absorb the force when we step, jump, run, play, or do any movement with our legs. Hence, it is no rocket science to understand that if you are overweight, your knees would be experiencing more shock and the heavy weight causes further damage to the knees and the cartilage (A cushioned or shock absorbing layer in the knee joint) too. You will feel surprised to know that the Knee joint feels five times the body weight at each step. So, the more you weigh, the more pressure on the knee and the quicker the cartilage wears out.

Osteoarthritis can be extremely painful as the cartilage between the bones is depleted or in severe cases gone, which makes the bones rub together. According to the theory of BMI, Body Mass Index, people whose BMI is in the range of 25 to 30 are considered either overweight or obese and they are under the constant threat of becoming a victim of osteoarthritis.

 Apart from this direct relation, there are two other factors that connect heavy weight and knee pain;

·       The first one is Poor blood circulation. Overweight people suffer from various problems due to improper blood circulation and one of them is knee pain. Lack of blood rotation causes lack of oxygen and knee muscles tend to get weak over the period of time.

·       The other factor is Leptin. It is the master hormone that is released by fat cells of the body and many experts believe that it works in favor of osteoarthritis.

Fortunately, exercise can help you lose weight and fat, gain muscle, and keep your knees healthy! Here are some exercises which might help you to get relieved from knee pain;

1.    Chair sit-ups:

a.     Sit on a chair without arm rest

b.    Get up from the chair with feet flat over the floor

c.     And sit again

d.    Repeat this for 10-15 times twice a day

 

2.    Leg raises:

a.     Lie flat

b.    Lift your leg by keeping knee straight

c.     Put it down

d.    Repeat it for about 10-15 times twice a day

3.    Knee press:

a.     Lie flat with both legs straight

b.    Place a pillow or towel roll beneath the knee

c.     Press it for 5-10 seconds

d.    And then relax

e.     Repeat for 10-15 times twice a day

4.    Knee curls:

a.     Lie flat on your stomach

b.    Bend your knee

c.     Then straighten it

d.    Repeat this for 10-15 times twice a day

5.    Calf stretch:

a.     Hold this position for 5-10 seconds

b.    Repeat it for 10-15 times twice a day

6.    Hamstring stretch:

a.     Hold the position for 5-10 seconds

b.    Repeat it for 10-15 times twice a day

Not to do:

·       Running

·       Squatting

·       Cross leg sitting

Losing weight can be the most effective way in order to provide a long life to the joints. Other than this reducing weight can also provide amount of mobility to the joints and it can also reduce the intensity of pain. Lower inflammation level is again a great benefit of shedding weight. We often come across people saying that they want to exercise and lose weight but they can’t because their knee hurts a lot. So now it seems to be a never-ending cycle. Hence the easy way out here is taking baby steps.