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Posts Tagged ‘back pain’

One of this country’s leading medical problems is back pain. It is cited as one of the five most common injuries occurring in the workplace. Some of these, of course come from accidents. However, many are simply preventable. In fact, the vast majority tend to come from stress and strain on your back. It only takes a second to lift something that pulls a muscle in your back. We take a look at some of the more common causes of low back pain.

The lower back consist of five intervertebral discs. These are often referred to as the lumbar. These discs are stacked on top of each other. They are separated by soft tissue, tendons, ligaments and muscles. The bones provide the structure and rigidity while the soft tissue provides for flexibility.

One of the major shifts in our society is working with computers. Many people are seated at a computer for hours and hours throughout the day. This can affect the lower back tremendously. Sitting in fixed positions for long periods of time has impact on your body.

The lower back needs to maintain its flexibility. This is important for our normal mobility. If the back becomes stiff, then it loses its flexibility. This situation can be more susceptible to injury and discomfort.

The more common causes of lower back pain are simply strains or overuse. Small strains or overexertion can sometimes cause an imbalance in the spine. There is a constant tension on the other muscles to absorb the new balance. This can cause fatigue and stiffness and potentially lead to greater injury.

Stress and tension can build up in the body from sitting in a given position for long periods. Another way this can happen is through improper posture. These cause tension to the spine because it is not being used in its most optimal position.

Most of us don’t realize the importance of our lower back. It gives us our mobility. Small impacts to the lower back can affect this mobility as well. The lower back and spine must provide two major functions. One is to absorb shocks and impacts. The second is to transmit the weight between the upper and lower body.

Many people sustain a small injury to their lower back generally; they just hope that it passes. However, many of these situations cause the spine to become out of ballots. The person will actually begin to change their posture and adjust to the effect of the injury. It is important to see these changes occurring and to take proper corrective action before injury occurs.

Two forms of back pain are acute and chronic. Acute is less severe and for shorter durations of time. Chronic can be very painful and last the rest of someone’s life. Many types of diseases or disorders result in chronic back pain.

The vast majority of low back problems are acute back pain. This comes from injury to the soft tissues. These can happen suddenly or they may happen slowly over time. If you list too much weight, this would be a sudden case. Improper posture can lead to one that occurs slowly and time.

If you suffer from lower back pain, you should seek out natural treatments if at all possible. Stretching exercise and massage chair therapy can be very therapeutic and relieving of pain and discomfort. Check with your medical professional as to your situation and they are recommendations.

Make sure you take care of your lower back. The keys to your mobility are its strength and flexibility. Making sure that you adequately stretch and strengthen the lower back will help you maintain your mobility much longer. As always, diet, exercise and massage provide for a proper balance to maintain the vitality of your lower back.

Don’t let the discomfort of Lower Back Pain get you down. Discover how you may restore the right balance and relieve soreness, pains and discomforts. Get the relief you need from Low Back Pain when you need it with a massage chair. Get frequent massage therapy to relieve tight muscles.

You may have many questions about gravity inversion tables and how they are utilized. Nevertheless, before going into details it you may benefit from knowing a thing or two concerning inversion tables. Misuse of this type of table may lead to results that are less than expected. The most common ailments that are eased through inversion therapy are neck, back and joint pain, poor blood circulation, and other ailments such as swelling.

In its plainest terms inversion therapy is hanging upside down. By hanging upside down you immediately shift the effects of tension on your back. Normally gravity is squeezing your back. During inversion therapy gravity is pulling your spine apart. This force elongates your spine creating more space between your vertebrae and thus decompressing your joints and muscles. As a side benefit, if you hang at the right angle you will feel an increase in your blood circulation.

Many liken the use of a gravity inversion table to sleeping. Some inversion therapy practitioners go as far as claiming that inversion therapy can be a substitute for sleeping. Not that you can go without sleeping but that the relaxed state that your body attains while sleeping can be attained through inversion therapy. Even when you are sleeping certain parts of your body are still under pressure while during a gravity inversion table session the whole body is free from pressure.

The dread of hanging upside down might keep some people from using a gravity inversion table or from trying inversion therapy. The beauty of using inversion chairs is that you can adjust the angle at which you hang to an angle that you are most comfortable with. This way the fear of falling or of being totally upside down can be controlled and eased into over time.

Many celebrities have contributed to the growing popularity of inversion therapy. Because of the increased supply of oxygen to the brain, there is even the opinion that one can attain a stronger focus and enhanced mental activity with this therapy. In any way, a widespread acceptance of the public is an indication that inversion therapy really works.

Having more information about the benefits of a gravity inversion table and inversion therapy itself is still critical. One may be enticed to try it by just knowing the fundamentals, but having a thorough knowledge of what it does and how it really works is necessary. You can visit a doctor regarding this, but actually you really don’t have to go that far. Simply go online and look through the many pages on the Internet. Not only can you find a wealth of information regarding inversion therapy, but you can also browse the different products that go along with it.

If you have considered the pros and cons of inversion therapy for you and if you realized that there are more advantages that you can make use of, by all means you should go ahead and buy a gravity inversion table. Get the go signal of your doctor and invert right away.

Jon Schock thinks that frequent use of a gravity inversion table can help relax and ease back tension just like frequent sleep does. Visit his Back Inversion Table site to for more inversion therapy resources.

1.Weak muscles, caused by a lack of exercise, are the first major cause of most back pain. The body acts as a unit. The lower torso is carried by the lower back muscles as well as the abdominal muscles. Likewise, the chest muscles, shoulder muscles and upper back muscles are carrying the upper torso. It is important to strengthen and stretch the major back muscles, like the lats, traps and erector spinae as these support the spine. An exercise programme needs to strengthen not only back muscles but also muscles in the front of the torso, the abdominal muscles in particular. The abdominal muscles (often called the core muscles) help to support the spine and upper body. These are the internal and external obliques (that run down the side of your waist), the rectus abdominus, that run down the middle of your abdomen (giving you a six-pack if youre lean).

2.Lack of flexibility in the back muscles. A poor range of movement, also caused by inactivity, can result in back pain when you perform a movement outside of your normal range of motion. For example, if your lower back muscles are tight and you make a sudden twisting motion, you can strain those muscles. You need to stretch the muscles of the back to increase your range of motion.

3.Tight muscles in the legs, chest and shoulders. Because the body is a unit, you need to stretch connected muscles. The hamstring muscles and gluteal muscles, if tight, can cause rounding of the lower back, and which will cause back pain. Stiff shoulder muscles will likely cause neck and upper back pain. Tight chest muscles pull on the shoulder and will also likely cause neck and shoulder pain.

4.Incorrect posture. Most of us sit for long periods, whether at a desk, on the couch or driving a car. Poor posture while walking or standing can also affect the back. For example,rounded shoulders when standing or walking will lead to upper back pain. The best way of correcting posture is to strengthen the muscles through exercise.

5.Moving your body incorrectly. A common way of pulling and straining back muscles is whilst picking up objects. I’ve done that a few times, as I’m sure most of us have. When picking up objects, bend your legs and let the legs take the weight, not the back. Everyday actions like getting into and out of a car or sitting down in a chair are also important to be aware of. Twisting your body when you get into or out of a car can strain your back.

6.Obesity. Being overweight puts an undue strain on the back. Overweight people are also usually less flexible, with a smaller range of motion, so that sudden movements are more likely to cause strains and pain.

The inter-vertebral discs are made up of two main segments: the outer shell called the annulus fibrosis and the inner material called the nucleus pulposus. The outer lining is tough and has many layers like those of an onion with the different layers being oriented at differing angles to give strength in many directions. The layers of the annulus pass through the vertebrae above and below them, binding them all strongly together and meaning that a disc cannot actually slip out. The outer layers of the annulus are supplied with nociceptors and proprioceptive nerves, an indication they can send both pain and positional information back up to the nervous system.

The nucleus of the disc is encompassed by the inner layers of the annulus and this gives compressive strength to the structure. About two-thirds of the disc is made up of the nucleus and it supports about 75% of the compressive loading. 2.5 times their weight in water can be attracted and held by the large molecules which make up the nucleus, which is 90% water until we get into our 20s, when it starts a slow decline over the next four decades to sixty-five percent. A blood supply is only present in the outer one third of the annulus so the remainder of the annulus and the nucleus must rely on the diffusion of water and nutrients from the vertebrae to remain healthy.

The annulus can be stressed repeatedly by loading and twisting forces which cause microscopic trauma to the fibres and result in annular tears developing. Circumferential tears track around the disc between the layers and radial tears cross the layers from inside to out, with a combination of these tears sometimes developing into larger splits from the inside nuclear material to the exterior. This can permit extrusion of the disc material out of the disc and inflammation or compression of the exiting nerve roots, leading to severe leg pain known as sciatica.

Of the weight being transmitted through the spine, 80 to 90 percent of it goes through the back third of the disc in the first twenty years of life. As we age the spine alters and degenerative changes narrow the lumbar discs, pushing the forces onto the posterior facet joints. The facet joints respond to the increased stresses by becoming arthritic and increasing in size with arthritic changes and development of osteophytes at the joint margins. The exit foramens of the spinal nerves and the main spinal canal itself can be compromised by the degenerative changes in the discs, joints and ligaments, leading to nerve compression and leg symptoms, referred to as spinal stenosis in older patients.

The intervertebral disc and other spinal structures around the spinal segments have been shown to be potential causes of pain. Direct stimulation of the outer layers of the disc has been shown to produce pain in a proportion of patients undergoing operation. The large water attracting molecules break into smaller molecules as the disc ages and repair of this process is slow. The tears and fissures in the annular fibres increase the gradual breakdown and dehydration of the disc structure, with the poor blood supply to the outer disc layers insufficient to prevent the continuing internal disc degeneration.

Chronic spinal lesions may be related to poor blood supply across the endplates but the correlation between spinal pain problems and the degenerative stages is not good. This complicates the ability to relate the changes found on imaging such as MRI scanning and x-ray to the patient’s symptoms and so come up with a plausible cause for the pain.

Pain problems in the intervertebral discs may also involve biochemical and other factors and a lower pH has been found in painful as compared to non painful discs. In animal studies reduction in the pH of the discs heightens pain reactions and increases the pain behaviour of the creatures. Increased neuropeptide levels have been produced in the experimentally deformed discs of animals and could be involved in modulation and transmission of pain in the central nervous system. Mechanical stresses, micro-trauma and biochemical changes may increase production of inflammatory chemicals and enzymes which can breakdown tissues. These factors may all increase the disc and other spinal structure changes.

A Pilates Spine Corrector Barrel is a wonderfully designed piece of Pilates equipment that enables the user to stretch their muscles and improve flexibility. The Spine Barrel Corrector is a great addition to your Pilates Home Equipment studio. It is perfect for practicing Pilates from home.

The Pilates Spine Corrector Barrel has received numerous rave reviews by its users and is one of the finest pieces in Pilates home equipment. It is purposely designed to strengthen the spine, the core of the body, the abdomen, the back, and the shoulder muscles.

The barrel helps to support and correct spine curvature, and additionally it helps to relieve chest muscle tightness. Both of these contribute to a better nights sleep. An exercise of this type that concentrates on the core muscle group, is important as we age, as our spines will naturally lose its natural curve that it once had.

Users of a Pilates Spine Corrector Barrel claim that exercises on the spine stretching machine, will benefit those with or without back aches problems. Other Pilates Spine Corrector Barrel users claim that the results are the same as if they had participated in physical therapy or had chiropractic care performed on their back and muscles. Chiropractic care uses a similar philosophy, such as the stretching of the muscles, however now you can achieve this same result through practicing Pilates from the comfort of home with the spine corrector.

The Pilates Spine Corrector Barrel is lightweight, weighing approximately 18 to 24 pounds and will take up limited space in your home. The wooden exterior is stated to be very sturdy due to its wood structuring. Easy to use and comfortable with a padded top, the Pilates Spine Corrector Barrel is equipped with handles on both sides to facilitate your exercise workout with ease. Because this barrel is a relatively lightweight piece of exercise equipment there will no difficulty in moving it around to perform certain exercises.

Not only does the Pilates Spine Corrector Barrel help the support and correction of a curved spine, such as in scoliosis, it is also used to aid other medical conditions, such as arthritis, osteoporosis, as well as an exercise workout to help with weight loss.

For a good, solid piece of Pilates home exercise equipment and the Pilates reputation, this is a reasonably priced health aid that will benefit everyone. The Pilates Spine Corrector Barrel was designed by the original master of the Pilates exercise movement, Joseph Pilates. The demonstration of exercise routines is accompanied in the video that this item is normally sold with.

If you are afflicted with any of the disabling mobility circumstances noted above or having increased stiffness due to age then the Pilates Spine Corrector Barrel may be the answer for relief of your back discomfort. As with any type of exercise program you should receive your physicians clearance before you begin.

If you happen to look at a large majority of people sitting on chairs, you are going to see that they are either slouching, lounging or just leaning back, relaxing in a manner which does no good to their spinal cord.

There are many meditations and special things that you can do to help relieve pain. However, most of these different things you can do, will do absolutely nothing to help your posture , spinal cord, back, neck, or your stomach. Where the pain usually starts is from someone having a bad posture and putting strain on the spine, and the only way to correct it, is to correct your posture.

Many of us have a 9-to-5 job, and find ourselves slouching in front of a computer, definitely not bothered about the chair we are sitting in, or our posture. Our job is to leer away at the monitor, not being bothered much about the effect that slouch has upon our shoulders, neck, back and stomach. And then we go complaining to our doctor about neck problems.

The muscles in the body will degenerate over time if you are not exercising. These same muscles are the ones that most people do not realize are the ones that best support your back, which can lead to bad posture. The best way to combat this, if it is happening to you is to find an ergonomic chair to support the posture in your back.

Most chairs that you sit in, will seem comfortable while sitting there, but that is because the body is so used to that slouching position. If are reading this in your favorite chair at home look at how you are sitting now and determine if you’re posture is good or bad.

Laying back in a chair and kicking you’re feet up, can also be bad for posture, as you will be putting a lot of strain your tailbone by doing this. Keeping your feet on the ground, and on a solid surface will allow them to support your body in a way to correct your posture.

People tend to change their posture for specific occasions but as soon as that occasion has past they go back to slouching and hurting their body. This can be found in many cases in an interview, because most people trying to get a job know that interviewers pay attention to that.

Most of us have our keyboards right next to our monitor. Not only does it mean that we have to raise our shoulders to ear level, while we are typing, but it also means that the shoulders are not in their right position. If we place the keyboard at a lower level, say, at an angle of 20 degrees, our shoulders are automatically going to drop down the moment we start to type. Make sure that the elbows are not pointing backwards, while you are typing. You should also have a little reach, but your keyboard should not be positioned too far away.

One thing that will help tremendously is getting your body strength to a point in which it will allow you to correct posture. Doing simple exercise around the house or at work to strengthen your neck will help a lot.

Many of us are going to find it extremely difficult to get into the habit of sitting up straight on a chair, especially as our back muscles and stomach muscles fall into slouch position the moment we sit down. Continuous practice is going to help us here.

Post-operative therapy after hip replacement is mostly performed by the patient getting on with normal life but in most cases it’s useful to quickly analyse their progress and suggest avenues for improvement. It is important to assess any deficiencies in the patient’s performance and correct them early as arthritis of the hip causes several problems to develop. Muscle power drops around a painful joint, reducing the stability and support for the joint as the pain inhibits natural movement and activity. Lack of normal full movement allows joint restrictions to develop, leading to an abnormal walking pattern.

Pre-operative education and rehabilitation is important so the person knows what they are trying to achieve with their exercises and gait practice. Range of motion and strengthening exercises can be given along with gait correction. If the gait cannot be easily corrected by instruction, consideration should be given to using a walking aid. Either a stick or a crutch can be used depending on the degree of support needed, held in the opposite hand to the arthritic joint. If the patient walks with a good pattern this is sufficient, but if they still walk poorly they may need two sticks or crutches to achieve a reasonable gait pattern.

On the first post-operative day the physiotherapist assesses and treats the patient both in the bed and up mobilising. Quadriceps and buttock muscle contractions performed hourly allow the leg to regain muscle control to enable movement. Repeated gentle hip flexions by sliding the heel up and down in the bed can help the patient regain control of the leg and restore this functional activity which they need to master bed mobility. Circulatory improvement is also encouraged by pumping movements of the ankles routinely but the size of this effect may not be very great.

Hourly contractions and gentle movements of the hip will get the joint moving and restore some confidence in the patient that they can independently move their leg around, which initially feels very heavy. The physiotherapist and an assistant will mobilise the patient as their condition allows, using crutches or a frame. Early sitting out in a chair is encouraged with a seat high enough to prevent too much hip flexion. As the side of the thigh has been operated this can limit the amount of knee bend so patients are encouraged to regularly slide their feet back towards themselves in sitting.

Initially mobilisation should produce a safe and acceptable walking pattern and after the initial period the physiotherapist will progress to teaching as close to a normal gait as possible. Once the patient has achieved a step-through gait and are walking well their gait pattern should be very close to normal with the addition of a pair of crutches the only clue they have had an operation. Muscle activation is normalised by the natural rhythm of an automatic activity such as walking and a correct sequence of muscle activity lowers the energy requirements for walking and increases muscle strength.

The physiotherapist may prescribe an exercise regime for the patient if he or she identifies a particular weakness in the hip musculature. The upright position with the patient holding onto a solid object is the safest starting position and promotes stability and confidence. Three movements can be used to start with: bringing the thigh up towards horizontal in front of the body; making a sideways movement of the leg outwards whilst keeping it straight; pushing the leg behind the body whilst keeping the body upright and the leg straight. The main hip and pelvic muscles which control hip stability are worked by these movements.

In some cases these exercises will need to be supplemented by harder ones or by prescribing hydrotherapy. Pool therapy is very useful for patients after their joint replacement as they feel supported and in control of the leg but the water gives significant resistance to muscular activity. Resistance can be increased by using floats attached to the foot and the water resists the practice of the gait pattern, resisting the whole process. Care must be taken not to exercise hip replacements unduly or this can loosen the cement-bone interface and reduce the life expectancy of the replacement.

You may be familiar with the picture, either personally or from a story somebody told you. A young man goes out for the evening, all dressed up and smelling of aftershave. He meets his mates in the pub and has a few beers, starting off the process of intoxication which continues most of the night. After the pub there is the nightclub and more drinking until it’s time to roll out and round to the kebab house to have a snack. After a bit more hanging about he goes home or to one of his mates’ houses to watch television, chat and perhaps drink a little more.

He’s going to have a hangover in the morning but there is no surprise there and he certainly won’t be. The thing he doesn’t expect is falling asleep for some time in the odd position he last happened to adopt whilst watching the TV. He’s sitting sideways on a chair and has draped his arm over the back of the chair and that’s how he has fallen asleep. Some hours later he wakes up and finds himself in the same position. The arm is numb but he shakes it about and rubs it to get it back to life like we often have to when we lie on our arm at night.

If we adopt an odd or stressful position when we sleep the increasing discomfort in the part wakes us up or we naturally just move to a better posture. When we are drunk however we may not do this and this was the problem which allowed the bodily structures in his armpit to suffer significantly increased stresses for perhaps some hours before he finally woke. The arm will hardly move at all and he becomes concerned when it does not respond to shaking and rubbing by recovering its movement.

Reacting to stimuli is what nervous tissues are designed to do but they can react in negative fashion if the applied stimulus is too large or lasts too long. Pressure applied for a long period or a direct blow to an area can both cause nerve trauma, with honeymooners’ palsy being the term for nerve damage caused by one partner using the other’s arm as a pillow during sleep. Longer term nerve pressure can disrupt the blood supply to the nerve and compromise the function of the nerve, a condition called neurapraxia.

Nerve damage is classified into three categories: axonotmesis, neurotmesis and neurapraxia. Neurapraxia is the mildest variety of nerve trauma and there is internal biochemical damage to the nerve but no break in the internal axon or the nerve itself. The nerve being intact, it does not need to regenerate but recover. Nerve impulse conduction is disrupted by the area of nerve trauma and gives paralysis of the muscle with some difference in feeling. Compression may cause avascular damage to the nerve, resulting in inflammatory changes.

While the arm will recover from the nerve insult which it has suffered, sometimes quite quickly, an average recovery time to good function is between six and eight. The major functional disruption is the loss of the ability to move the arm and the ability to feel the arm and control the circulation and sweating to it are either less affected or not affected. Examination by a doctor is useful to exclude more severe injury to the nerve and to caution the patient in how to look after their arm until it recovers, particularly if there is feeling loss.

The non-functional arm will need to be supported as its muscles are paralysed, with a sling keeping the shoulder protected and holding the arm in a safe position. Loss of sensibility in the arm can mean that the person can damage it against something like a hot object without knowing, so they need to be advised to look after it. Activities such as sport can produce these kinds of injuries as can related palsies such as falling asleep whilst sitting on a toilet.

The increase in porosity of our bones and the consequent loss of strength is known as osteoporosis and reduces our bones’ capacity to counteract normal functional activities. The bone’s outer layer is called the cortex and is dense and strong to resist mechanical stresses. The inner bone structure is more like a structural meshwork known as cancellous bone, with bone marrow, blood vessels and collagen tissue filling the interstices. The bony interstices become larger as osteoporosis progresses and there is a reduction in bone strength with the loss of the cross connecting struts. The whole skeleton is affected by the disease but it exhibits itself mostly in the hip, spine and wrist.

Being active and dynamic is not the typical view of the bony skeleton but it is a growing and changing tissue which is constantly renewed over time, taking between seven and ten years to complete the whole replacement. The renewal process is called bone turnover and it can be much faster to replace the entire skeleton in a child, a process which can be as short as two years. The growth plates of our long bones close around sixteen to eighteen years of age and at this time we stop gaining height and size. It is however not before the middle of our twenties that the process of increasing our bone density reaches its highest level.

Bone turnover then maintains a balance between the building up and breaking down processes which remain stable for the period of our early adult lives. Reaching middle age starts a phase of bone life in which the breakdown process becomes more dominant and we begin to lose a proportion of our bone mass. The loss of bone density is more accelerated and more profound in particular patient groups, most obviously in older women after menopause. Osteoporosis does occur in men and risk factors for this include long-term steroid treatment, poor nutrient absorption from colitis, long term immobility, alcohol abuse, being too thin, low male hormone levels and smoking.

One in three women is affected by osteoporosis in their lifetime so it is often thought to be a disease affecting women. However men are affected as well, with one in twelve having this at some time, even though only 20% of spinal fractures and 30% of hip fractures occur in men. Men may suffer from osteoporosis less for several reasons: they attain a higher bone mass to start with so have a higher level to start from and men suffer a much less dramatic bone loss in the middle years of life. Men in particular lose smaller amounts of the structural cortical bone than women.

Osteoporosis is a silent disease and the first indication many people get that they have the disease is the acute pain of fracture such as in the spine or wrist, often because of a trivial fall or blow. Spinal fractures cause wedging of the thoracic spine in particular, with acute pain which can be very disabling, and in some cases becomes chronic. The process of crushing and wedging can also occur quietly without dramatic pain, showing itself by the development of a spinal curvature called a kyphosis or a significant loss of height. A severe kyphosis can restrict the space in the ribcage, causing breathing and digestive problems.

45% of men with osteoporosis have no identifiable cause for their disease, with genetic factors likely to be important in the large majority of cases. Having a history of osteoporosis in the close family predisposes to having a lower bone density and an increased risk of spinal fracture. Levels of testosterone are important in the maintenance of bone density and a low concentration is a major risk for osteoporosis, with a 70 year old man only producing about half the testosterone of someone of 30 years old. Testosterone can be replaced as a treatment if a hormone specialist thinks it is necessary.

Corticosteroid treatment is used to counter the inflammatory effects of ulcerative colitis and asthma as well as other less well known disorders. The levels of bone loss can increase with only six months treatment with a steroid such as prednisolone so they are only prescribed when essential to combat an illness. Individuals should not change their steroid doses with consulting with their medical advisers as this could produce severe side effects.

Plate types vary with different bones and different fracture locations. One of the common types is a dynamic compression plate or DCP. The screw holes in this kind of plate are angled away from the centre of the device so when they are tightened up the bone fragments are pulled towards the centre, providing compression. The smaller plates are only 1mm thick which permits bending to fit the bony area and is mostly used for fractures of the distal ulna and lateral malleolus. Plates have been designed to fit fractures which occur near joints, reducing the size of the devices and increasing the options for fixation.

Ninety-five degree angled plates are typically used in fixation of fractures of the upper femoral areas so that the normal alignment of the bone can be restored. Surgeons need to be three dimensional thinkers to insert this kind of fixation and accurately recreate the anatomical relationships in the area. Pelvic and acetabular fractures are more often fixed with reconstruction plates as they are thinner than dynamic compression plates and more easily mouldable. Fractures often occur close to or just below the prostheses of joint replacements and they may be fixed by bigger plates and cerclage wiring.

High levels of fracture stability can be provided by compression of the fragments and a good restoration of anatomical alignment by the fixation. If firmly stabilised and without any fragment gap then the fracture will heal by primary healing. Absorption of the dead bone at the site of fracture occurs by the action of osteoclasts, with blood vessels growing into the region and then bone producing cells proliferating. Disruption of the blood supply by the plate can produce some osteoporosis under the plate, leading to reduced bone strength from this and the screw holes once the plate is removed, necessitating careful decisions about the amounts of force to be applied to the area.

The initial part of performing internal fixation is the exposure of the fracture site and the removal of the accumulated haematoma, followed by aligning the fragments as close to their original position as possible. Fracturing a bone disrupts the blood supply and the periosteal membrane provides the remaining blood supply to the area, a blood supply the surgeons take care not to disrupt by stripping the membrane from the bone during operation. This could delay the healing process due to reduction of blood supply. Fractures which are unstable or have multiple fragments have to be spanned by a bridge plate to restore bone length, rotation and alignment although this fixation cannot take significant load.

The LISS (Less Invasive Surgical Stabilisation) plating system is a recently developed technique which reduces the contact between the metal and the bone or periosteum, reducing the potential for disruption of the blood supply in the fracture area. Modern designs contour more effectively to the bony anatomy and allow for locking of the screws, which are both advantageous by maintaining the fracture in the correct position whilst allowing increased forces to be applied to it in the healing period. These new designs are most useful in fixing the ends of the bones in fractures of the tibia, femur, radius and humerus.

If there is enough room for easy fixation and the fracture is of a more stable type then conventional plating techniques may be used for fixing breaks of the shafts of bones such as the radius, ulna and humerus. Locking screws are more appropriate if the bone is osteoporotic or the fixation options are limited. Future development will likely lead towards locking techniques being the first option for all fractures, but they are much more expensive and wider use awaits reduction in costs. If the costs of revising the fixation due to malunion by conventional plating are factored in then the more expensive initial system looks more cost neutral.

Nails

It was in the 1930s that Kuntscher refined the intramedullary nailing technique which then became the treatment of choice for shaft fractures of the femur. Humeral and tibial fractures as well as femoral breaks nearer the bone ends were the next progression. Early joint movement and weight bearing walking is allowed by this.