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Technical Terms - Well Explained

Acupuncture

Acupuncture is one of the pillars of Traditional Chinese Medicine – Traditional Chinese Medicine. This Asiatic science of healing is more than 5,000 years old and based on the premise that the entire body is veined with channels, which are know as meridians. Along these meridians flows the Chi, or Qi – life energy. If this flow of energy is disturbed or blocked, people feel bad or become sick. Traditional Chinese Medicine uses a variety of methods in order to get this life energy flowing again. In addition to movement exercises, such as Qigong or Tajiquan, and massages like Shiatsu or Tuina, the main techniques are medication as well as acupuncture, including what is known as moxibustion (heating of the acupuncture points). Acupuncture is especially effective in the battle against back pain. Until not long ago, traditional medicine still had it that the results must be mere placebo effects. In the meantime, however, it has been found that the various acupuncture points are located in places where vessels and nerves get especially close to the skin's surface and that the skin presents a much lower degree of resistance there. It is assumed that the stimulation provided by the needle results in the release of certain hormones, which, via electric impulses, in turn inhibit certain transmitter substances that augment pain. Moreover, it is very likely that acupuncture needles activate the release of endorphins – analgesic and mood-improving neurotransmitters.

Anti-Interleukin-1 Therapy

A relatively new and very promising method derived from molecular biology. The anti-interleukin 1 therapy injects the body's own proteins into the vertebral joints or at the inflamed nerve root. This is the ideal solution for patients with arthrosis, in cases of sciatica or irritated nerves following a herniated disk. This therapy requires drawing a bit of blood from the patient, as it contains a fantastic agent - anti-interleukin-1. This substance is able to protect the cartilage and simultaneously inhibits transmitters of the immune system, which promote inflammation and destroy the joint. This agent in the patient's blood is encouraged to multiply at our laboratory before it is isolated, filled into syringes and frozen. It takes between five and eight injections to achieve a lasting improvement of between one and three years. Since these are the body's own substances, they can be used, without worry, even in patients with drug intolerances or diabetes.

Antirheumatic Drugs
Antirheumatic Drugs, non-steroidal

This group of drugs includes substances such as acetylsalicylic acid, Ibufrofen, Diclofenac, Metamizol and what is known as selective COX-2 inhibitors. Antirheumatic Drugs relieve the symptoms of inflammatory processes such as pain and swelling and help in cases of light or medium, acute back pain. The most common side effects are stomach troubles as well as damage to liver and kidneys.

Arthritis

An inflammatory disease on of the joints.

Arthrosis

A degenerative disease of the joints, caused by overload and misuse, excess weight and also injuries.

Disks
Disks, spinal

The disks between individual vertebrae serve as a kind of buffer. They do not fulfill this task on their own, though, as the double "S" formed by the spine acts as a shock absorber, too. The individual vertebral disks consist of a rather solid but nevertheless elastic outer fibrous ring and a soft, viscous gelatinous nucleus which itself is not supplied with blood. Depending on the age and condition of the disk, this soft center contains up to 90 percent water and its fibers can store up to 1,000 times their mass of moisture, soaking it up like a sponge.

Disk Prolapses
Disk Prolapses / Spinal Disk Protrusions

Spinal or lumbar disks are very forgiving yet can also cause problems. When, for example, the fibrous ring (annulus fibrosus) surrounding the intervertebral disk moves axially or laterally, this is called a disk protrusion. In cases where the gelatinous, spongy center presses down on the fibrous ring so hard that it tears, we are talking about a herniated disk (prolapse). When gelatinous substance mass already escapes the fibrous ring and enters the spinal canal, we are looking at a sequestered disk prolapse.

Chirotherapy

Chirotherapy means "to heal with one's hands" and is therefore also known as manual therapy (manus in Latin means 'Hand'). Chirotherapy is reserved for physicians; natural health professionals apply chiropractic joint manipulation. Chirotherapy had been known, albeit in a modified version, to Hippocrates, the founder of European medicine in the fifth century BCE. Modern chirotherapy was initiated by the Canadian healer Daniel David Palmer at the end of the 19th century. In general, chirotherapy is about getting blocked joints to function again. For this purpose, the therapist applies two types of methods: The mobilizing technique and the manipulative technique. The mobilizing technique restores the joint's mobility with soft turns that are frequently repeated. The manipulative technique uses fast, almost abrupt movements in order to put the joint back in its proper position. A precise preliminary anamnesis is most important here, including x-ray or – even better – Computer tomography or Magnetic Resonance Tomography images, which make a clear statement about the damage the spine sustained. Chirotherapy must not be applied in cases of acute herniated disks, spondylitis, injuries or fractures of the spine as well as tumors in the spinal area.

Computer tomography
Computer tomography

Computer tomography is an x-ray procedure with a ray circling around the patients. The instrument produces numerous cross-sectional images of the respective area of investigation, which the computer then compiles into a three-dimensional, and very detailed image. In addition to diagnostics, Computer tomography is primarily used in interventional pain management. Especially in the area of the thoracic or cervical spine, this method is helpful for additional imaging of soft parts such as the lungs or the vessels, which is something a C-Arm does not offer. The diagnosis concentrates on representing bone structures in cases of stenoses, injuries or signs of wear and tear.

Relaxation Techniques

Stress can lead to improper posture and thus to muscular tension or blocking of the vertebral joints. Methods of relaxation help to better cope with hectic everyday life and prevent such problems. There is a large variety of effective relaxation methods such as autogenous training, progressive muscle relaxation or breathing exercises. A combination of methods is also helpful in cases of back pain, incorporating both muscle training and relaxation, such as Yoga, Pilates or Gyrotonic.

Epidural Fibrosis

Epidural fibroses are post-operative adhesions of scar tissue, which often can cause strong pain. A short period free of pain for two to three weeks, followed by a renewed appearance of very persistent pain is typical for a fibrosis. With the help of contrast medium, magnetic resonance tomography shows the difference between scar or disk tissue that has slipped after surgery. Unfortunately, therapy for fibroses is very limited since operating again on the scar yields little success and even leads to a more pronounced scarring. Attempts at a surgical fixation are met with little chance of success.

Epidural Neuroplasty

The M-Cath enables the treatment of back problems exactly where they are located. This catheter was co-developed by us, based on decades of experience in treating spinal problems, and it presents an expedient advancement of catheter systems currently available on the market. It is suitable for the treatment of acute and chronic herniated disks and scars after preliminary surgery as well as spinal stenoses of light and medium severity.

This type of treatment requires local anesthetic as well as a mild sedation - also called dozing - administered by an anesthetist. Then, without any surgical cut, the M-Cath is inserted into the spinal canal through the natural opening of the coccyx, closely guided by imaging. The M-Cath is a special, highly flexible, thin plastic tube with an inner wire made from nitinol, which is an alloy of nickel and titanium. This combination ensures that the tube is both extremely flexible and also very stable in its form and can not bend when inserted into the spinal canal. At the end of the tube, there is a rounded plastic tip which is directly moved to the inflamed, swollen and constricted tissue of the relevant spinal disk. Through this tube, different substances such as anti-inflammatory, detumescent, analgesic drugs as well as blood circulation-enhancing and scar-dissolving medication are injected – right on target.

The catheter remains inside the body for two or three days, and twice a day, the drug cocktail is injected. The intervention itself takes about 30 minutes and can be carried out in an ambulatory way, too. In cases of very strong pain, or with older patients or patients at risk, hospitalization may become necessary. Thanks to the flexible tube, patients are able to move about freely, but they can return to work only after the catheter is removed.

Facet Joints

These are small intervertebral joints in the cervical and lumbar areas of the spine. These connecting joints are also known as facet joints since their smooth, almost elegant form is reminiscent of a polished precious stone. Their degeneration leads to an increase in friction and wear and thus to joint inflammation.

Foraminal Stenoses

Exostoses of bone tissue or protrusions of disk tissue can lead to constrictions at the nerve exits of the vertebral joints, which are called foraminal stenoses. This results in the irritation of the nerve roots as well as feelings of numbness and instability while walking.

A foraminal stenosis can be caused by facet arthrosis. This phenomenon of wear and tear results in an increased development of wild bone mass, which may constrict the nerve exit from behind. Yet disk tissue invading the nerve exit or exostoses of the vertebral bodies can pressure it also from the front. This can happen, for example, following old disk prolapses or in the wake of degenerative changes in the disks (osteochondrosis).

Sacroiliac Joint

The sacroiliac joint (Sacroiliac Joint) connects the pelvis and the spine and belongs to the planar joints. A comparatively high static pressure can cause blockage, just as in the spine, and impair its function (Sacroiliac Joint Syndrome).

Ischialgia

Strictly speaking, ischialgia, or sciatica, is not an illness but rather a sign that the sciatic nerve has been irritated. Sciatica belongs to the group of lumbalgia, which concern problems of the lumbar spine. Sometimes, the pain appears fast and furiously, so that the afflicted person can hardly move.

Ischialgia happens when one of the roots of the sciatic nerve, which exit the spinal canal and supply the legs, has been irritated or pinched. The damaged nerve emits pain signals. These express themselves as dull, persistent aches, which seem to be located in the derrière, radiating into the leg and even the foot.

Cold Therapy

Generally, cold helps with back problems that are accompanied by inflammation. Yet it is not possible to tell exactly who responds to it well, and patients must try for themselves if they feel better applying cold or heat. This is usually quite clear to the patient in question. We know about the principle of cold spray, which is used to provide short-term relief for injured muscles but also for superficial, small surgical interventions.

This spray contracts the blood vessels, blocks the pain receptors, including the nerves that transfer pain, and thus relieves it. The simplest form of cold therapy is what is known as a Cool Pack - plastic cushions filled with non-freezing gel, which are kept in the freezer. These cool packs are best wrapped into a thin cotton cloth before application; otherwise, the impact of the cold could be too intense. Also healing earth or curd are suitable for cold packs and compresses. Cryotherapy is a high-tech variant of cold therapy. Topically applied, the vapor of liquid cold nitrogen is blown onto the places that hurt. This reduces the pain and makes the joints more flexible for a short time – the ideal basis for subsequent physiotherapy. At minus 110 degrees in the Cold Chamber, the cold is felt all over the body. Three minutes in a bathing suit - but wearing protection for hands and feet – are enough to make the pain almost immediately disappear. After a series of 20 visits to the cold chamber, 90 percent of patients declared that they were suffering from considerably less pain and did not need as much medication as before. In addition, the cold chamber should also stimulate the immune system and is thus also helpful in cases of inflammatory spinal diseases.

Cortisone

Cortisone is a hormone, which is, among others, produced by the suprarenal glands. It has a strong anti-inflammatory effect, yet the right dosage is important. As far as cortisone is concerned, high dosages are not the point, but rather a precisely targeted treatment. The side effects of cortisone become especially apparent during long-term or permanent therapy. , For instance, the body reduces its own production of cortisone. Therefore, administration of cortisone may not be terminated abruptly but must be phased out. In addition, cortisone has a damaging effect on the bones and can facilitate osteoporosis, albeit only after long-term use and the long-term intake of calcium, vitamin D or fluorine. If used over an extended period of time, cortisone may also trigger diabetes.

Magnetic Resonance Tomography

Contrary to Computer tomography, Magnetic Resonance Tomography does not work with radiation but uses a magnetic field. The examination entails relatively loud noise so that the patient usually wears earphones and listens to music. The diagnosis focuses on the imaging of the soft parts, such as spinal disks, cartilage, nerves or scar tissue.

In addition to diagnostics, Magnetic Resonance Tomography is used in cases with the same indications as Computer tomography, albeit with innovative needles, which, due to the strong magnetic field, are made of non-metallic carbon fibers, to prevent the images from showing a distorted representation. This examination is comparatively complicated and expensive.

Microtherapy

Microtherapy is a modern method of treatment, which focuses on minimally invasive intervention under visual guidance using imaging techniques such as the C-Arm, Computer tomography or Magnetic Resonance Tomography.

Muscle Relaxants

The term muscle relaxant describes a variety of active substances; the type most often used is Tetrazepam, which is related to Valium. It belongs to the group of Benzodiazepines, which are sedatives with anxiolytic effects, yet it is approved only as a muscle relaxant. Like other muscle relaxants, it works on the central nervous system and prevents the nervous impulses that contract the muscles from being transferred. This avoids a permanent tension of the muscles and thus protects against tension and pain. By no means are muscles relaxants to be used on a permanent basis. They are actually only intended to relieve the pain until its cause has been found. After that, other drugs or treatments come into play.

The most common side effect of muscle relaxants are tiredness and drowsiness. In addition, there is another grave problem: Tetrazepam is highly addictive, just like other Benzodiazepines. An abrupt discontinuation therefore leads to severe symptoms of withdrawal. For this reason, it should be phased-out slowly and only under medical supervision.

Myogeloses

The term myogelosis is derived from the Greek and means "frozen muscle" and thus vividly describes the condition. The muscles feel hard, as if frozen, and not soft and flexible.

The nodules that can be felt inside the tissue in cases of myogelosis are lactic acid (lactate). This by-product is created when, while making extreme efforts, the body is forced to obtain its energy in an anaerobic way, meaning without oxygen. It thus literally turns sour, becomes exhausted and starts to increase its production of lactic acid. Normally, a myogelosis recedes on its own.

Osteopathy

Life is movement. This is the motto of osteopathy. It is closely related to chirotherapy yet is considered to be a lot gentler. For this reason, undesirable side effects are comparatively rare. The method was established by the American physician Andrew Taylor Still at the end of the 19th century. In Germany, it gained importance as an alternative medical procedure only 40 years ago. According to Still, restricted movement of joints and fascia (a layer of connective tissue that encloses organs, muscles and muscles fibers) may not only lead to diseases of the musculoskeletal system but also of the cardiovascular system or other organs. These restrictions of mobility are to be dissolved by targeted pressing, gentle turning and light poking. There are several types of osteopathy. Structural osteopathy focuses on muscles, bones and joints, while visceral osteopathy concentrates on the inner organs. What is known as craniosacral therapy is a subspecies of osteopathy. The focus here is on the stimulation of the central nervous system, and especially the spinal cord.

Osteoporosis

Osteoporosis literally means "porous bone." This condition involves an increasing loss of bone mass through the reduction of calcium in the bones. Osteoporosis has become a widespread disease in our time. In Germany, for example, there are about six million osteoporosis patients: one in three women is affected.

Every seven minutes, for example, a woman in Germany suffers a fracture of a vertebra, and two thirds of them are women after menopause. Most have no idea that the underlying cause is osteoporosis. There is something many don't know: 10 percent of men over 60 also suffer from osteoporosis, caused by an unhealthy life-style and unbalanced nutrition as well as an increased intake of alcohol or drugs.

Osteoporosis is an insidious disease: It is a silent, subtly progressing condition. The bones are weakened by the loss of bone mass until even slight exertion, such as a light fall, can lead to bone fractures. Fractures of the vertebra happen almost unnoticed, which then can lead to what is known as a widow's hump. Also the femur or the radius of the forearm are locations prone to fractures caused by osteoporosis. Often, the disease is only recognized when this happens. By then, though, much of the bone's mass is already gone and can not be rebuilt. All that can be done is to try and prevent further decrease. In advanced cases, osteoporosis is also accompanied by strong back pain, and the posture tends to lean forward. In addition to this pain, many women also suffer from this change to their physical appearance as well as an increasingly limited ability to move.

By now, we are successfully treating patients with osteoporosis with biomechanical Juvent Therapy. Patients are standing on a gently vibrating platform, which automatically adapts to the user. Soft impulses target even the smallest muscles and bone cells, gently stimulating them and encouraging them to build up. The patient does not experience this therapy as strong shaking but rather as slight vibrations passing through the body.

Physiotherapy

What today is called physiotherapy is nothing more than good old medical gymnastics. We not only use it during the first stage of treatment for light pain but also combine with our interventional pain methods of therapy for patients with stronger pain, during the stage when the pain subsides. When the pain is still acute, physiotherapy does not make much sense as, on the one hand, the physiotherapist is frustrated since patients are barely able to perform exercises because of their pain, and on the other hand because patients might often feel worse after therapy than before. Physiotherapy includes both active exercises to strengthen the muscles and improve the coordination of movements, and passive methods of therapy that apply physical stimuli such as heat, cold, pressure, electricity and radiation. There exists a wide range of different procedures which are used by physiotherapists.

Prolapse/Protrusion

When, for example, the fibrous ring (annulus fibrosus) surrounding the intervertebral disk moves axially or laterally, this is called a disk protrusion. In cases where the gelatinous, spongy center presses down on the fibrous ring so hard that it tears, we are talking about a herniated disk (prolapse).

X-Ray

X-rays present an imaging diagnostic procedure for bone injuries, osteoporosis or deformations such as scoliosis. X-rays are unsuitable, however, to diagnose spinal disk problems. They are electromagnetic waves, which are especially well absorbed by hard tissue such as bones. Therefore, bone structures appear in light color on the x-ray image. Even if the dosage of radiation is lower nowadays than a few decades ago, physicians should carefully consider each time whether to perform an x-ray examination.

Sequester

When the gelatinous mass of the disk's nucleus breaks through the fibrous ring (annulus fibrosus) surrounding the intervertebral disk and invades the spinal canal, this is called a sequester or a sequestered disk prolapse.

Scoliosis
Scoliosis / Morbus Scheuermann

Scoliosis is a curved distortion of the spine in the thoracic and/or lumbar areas. In Morbus Scheuermann, the vertebrae in this area are affected by a growth disturbance of unknown origin. Both diseases are often diagnosed in children and youngsters during puberty.

Scoliosis is a disease of the back, with the spine curved to the right or left, while additional individual vertebrae are distorted, too. About 90 percent of scolioses are idiopathic. This means that the cause of the illness is unknown. It is predominantly diagnosed in children between the ages of ten and twelve. Girls are four times more frequently affected than boys.

The distortion can appear in the lumbar area but also in the thoracic section of the spine, and at times, even both areas are affected, in which case we are talking about a double-S-scoliosis. Children with scoliosis in an advanced stage often display a very characteristic distorted posture: On one side, their hip protrudes very clearly, one shoulder is somewhat higher than the other, and one half of the back curves back in a more pronounced way. At some time, this distorted posture is bound to be discovered, be it while buying clothes or during sports class at school. But it does not have to come to that: The earlier scoliosis is detected, the better the chances to correct the situation.

Morbus Scheuermann is a growth disturbance that affects the vertebrae in the spine's thoracic area but also in its lumbar section. Most commonly, it appears between the ages of ten and fifteen. Boys are affected twice as much as girls. For a hitherto unknown cause, part of the bone substance dies away during this disease. Thus, the vertebral bodies acquire a tapered shape and the disks sink into the vertebrae, a phenomenon also called Schmorl's nodules. This results in pain - and a very pronounced humpback. Often, parents misinterpret this posture as gawky or lazy. After puberty, the Scheuermann disease comes to a halt, the pain disappears but the rounded back remain

Spinal Stenosis

Exostoses of bone tissue or protrusions of disk tissue can lead to constrictions at the nerve exits of the vertebral joints (foraminal stenoses) or in the spinal canal (spinal stenoses). This results in the irritation of the nerve roots as well as feelings of numbness and instability while walking.

A foraminal stenosis can be caused by facet arthrosis. This phenomenon of wear and tear results in an increased development of wild bone mass, which may constrict the nerve exit from behind. Yet disk tissue invading the nerve exit or exostoses of the vertebral bodies can pressure it also from the front.

This can happen, for example, following old disk prolapses or in the wake of degenerative changes in the disks (osteochondrosis). All this results in the irritation of the relevant nerve root and radiates out into the back and legs, including feelings of "furriness", prickles and needles, an antsy kind of itching and the loss of reflexes. In spinal stenoses, there is a difference between primary and secondary forms. Primary means that a person has already been born with a constricted spinal canal.

Yet many people above the age of 60 suffer from a secondary stenosis caused by wear and tear, meaning an acquired constriction of the spinal canal. This constriction may have different causes: damaged spinal disks which protrude, and exostoses of bone tissue at the intervertebral joints (spondylophytes), but also a thickening of the ligamentum flavum, the ligament, which holds both vertebral bodies together, thus adding stability to the spine.

Spondylarthrosis

In much the same way that the knee joint frequently develops arthrosis due to wear and tear, the same can happen in the spine's lumbar area. With a spondylarthrosis, the small joints between the vertebrae in the lumbar and cervical spine are affected by these signs of wear and tear. These connecting joints are also known as facet joints since their smooth, almost elegant form is reminiscent of a polished precious stone. Primarily, wear and tear leads to increased friction and abrasion, just like in a ball-bearing, resulting in inflammatory articular disease, similar to what is known in the knees and hips.

Scintigraphy

Scintigraphy is a procedure from nuclear medicine, which uses the injection of radioactively marked substances that, for example, accumulate in the skeleton. The gamma rays emanating from these radioactive substances are caught by a scanner or camera and converted into an image, called scintigram. At the focus of inflammation, for example, metabolism is faster, and in these locations, radioactive substances are distributed differently than in the remaining tissue. They appear on the scintigram either in a darker form, or in red on a color scintigram, which points at high activity, i.e. an inflammatory response.

Traditional Chinese Medicine

Traditional Chinese Medicine stands for Traditional Chinese Medicine. This Asiatic science of healing is more than 5,000 years old and based on the premise that the entire body is veined with channels, which are know as meridians. Along these meridians flows the Chi, or Qi – life energy. If this flow of energy is disturbed or blocked, people feel bad or become sick. Traditional Chinese Medicine uses a variety of methods in order to get this life energy flowing again. In addition to movement exercises, such as Qigong or Tajiquan, and massages like Shiatsu or Tuina, the main techniques are medication as well as acupuncture, including what is known as moxibustion (heating of the acupuncture points). Acupuncture is especially effective in the battle against back pain. Until not long ago, traditional medicine still held that the results must be mere placebo effects. In the meantime, however, it has been found that the various acupuncture points are located in places where vessels and nerves get especially close to the skin's surface and that the skin presents a much lower degree of resistance there. It is assumed that the stimulation provided by the needle results in the release of certain hormones, which, via electric impulses, in turn inhibit certain transmitter substances that augment pain. Moreover, it is very likely that acupuncture needles activate the release of endorphins – analgesic and mood-improving neurotransmitters.

Trigger Points

When stretching and strengthening exercises do not deliver the desired results, the therapist applies a variety of different techniques in order to dissolve trigger points. Treatment with acupuncture, or with what is known as dry needling, has been proven successful. Trigger points can also be destroyed with low-dosage shock waves or in a purely manual way by pressure applied with the hands or a stick. The osteopathic strain-counterstrain method is useful as well. The body part in pain is pushed passively by the therapist into a position, which is the most painless and held for 90 seconds each time. This way, the stretching receptors of the muscles are supposed to "relearn" how to achieve a healthy balance, which then counteracts the emergence of trigger points.

Heat Applications

With back pain that has an inflammatory source, heat can be rather counterproductive. For all other back problems, especially for muscle tension, sciatica or muscle pain caused by arthrosis, pleasant heat can provide distinct relief. Heat stimulates the body's metabolism and supports blood circulation; nutrients are transported to the cells faster, and pollutants are flushed out more quickly. In addition, the muscles relax, and the tissue's elasticity is improved.

What is known as hyperthermia treatment also warms up the deep tissue to about 40 degrees and causes the body to produce additional white blood cells, which strengthens the immune system. The simplest forms of heat therapy are a hot bath, a hot-water bottle, the good old red light lamp or a thermo bandage. You can apply all of these yourself, at home and without much trouble. These methods relieve the pain shortly and provide temporary respite in cases of acute pain. They are easily combined with the oral administration of NSARs. The dosage of these painkillers can thus be kept at a minimum. Professionals such as physiotherapists, massagers and medical bath attendants offer an entire range of additional heat applications. The classic ones among them are packs and baths with mud, fango or moor, often in combination with massages. These substances contain important minerals and trace elements, and in addition, also anti-inflammatory agents. Baths or little bags with hay flowers used as a compress are also helpful with back problems. With their humidity and heat, they relax the muscles and at the same time, exert a strong calming influence. Ultrasound, high frequency and infrared light can also be applied to warm up tissue and muscles.

Root Irritation Syndrome

Strictly speaking, sciatica, or better, ischialgia, is not an illness but rather a sign that the sciatic nerve has been irritated. Sciatica belongs to the group of lumbalgia, which concern problems of the lumbar spine. Sometimes, the pain appears fast and furiously, so that the afflicted person can hardly move.

Ischialgia happens when one of the roots of the sciatic nerve, which exit the spinal canal and supply the legs, has been irritated or pinched. The damaged nerve emits pain signals. These express themselves as dull, persistent aches, which seem to be located in the derrière, radiating into the leg and even the foot.


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