Its all about what's within you

Walking Again

2025-09-08T06:04:00.000-07:00

Steps Toward Healing: My Journey in Physiotherapy

I often feel blessed to have found my place in this ever-growing and meaningful field of physiotherapy. My journey began back in 2018, at a time when I was confused and unsure about my path. My dream was always to become a heart specialist, but life had other plans for me. After taking a one-year break from studies, a gap that turned out to be a blessing in disguise, I found myself stepping into the world of physiotherapy. While I may not have become a cardiologist, that pause gave me clarity, direction, and the motivation to pursue a career that has changed my life forever.

At first, I didn’t know much about this profession. Like many people in my community, I only had a limited awareness of physiotherapy. I remember how often local folks would use the term “Kasrat Vada.” It may sound simple, but it holds great meaning, because movement and exercise are essential for everyone, whether a person is healthy, recovering from illness, or living with a condition. Over time, I discovered that physiotherapy is not just about exercises, it is about restoring hope, strength, and independence.

As I immersed myself in my studies, I developed strong practical skills and gained valuable experiences. From handling clinics alone to doing home visits, giving my best, and improving every single day has always been my goal. The more I worked with people, the more I realized how powerful physiotherapy can be in transforming lives. Our role extends across every field of medicine, and in many ways, physiotherapy is as vital and booming as any other branch of healthcare.

What I love most is the joy that comes from witnessing progress in my clients. Their smiles, their words of appreciation, and the blessings I receive, especially from older patients, continue to fuel my motivation. One of my proudest moments was when a client praised my work in front of my parents. That sense of pride and fulfilment is something I will always carry with me.

But the most beautiful part of this journey is watching transformation happen. To see a bedridden client take their first steps again, to watch them climb stairs, or become independent enough to care for themselves, it’s hard to put that feeling into words. It proves that with dedication, skill, and compassion, we can truly change someone’s life.

Physiotherapy has given me more than just a career, it has given me purpose. It has taught me the beauty of resilience, the power of healing, and the deep satisfaction of making a difference in someone’s journey. For all of this, I will always remain grateful.

Divya Parmar

Cyclist's Palsy

2021-09-08T06:42:00.004-07:00

Cyclist’s Palsy

INTRODUCTION

Cyclist’s palsy – It is the compression of the ULNAR NERVE (C8-T1) at the level of the hand, causes sensory and motor impairments of the hand in cyclist’s.

Typically the ulnar nerve becomes irritated and compressed in the wrist within or distal to Guyon's canal, due to the pressure exerted on the hands on the handlebars.

Both the superficial sensory and deep motor branch of the ulnar nerve are involved in cyclist’s pal

Compression syndrome of ulnar nerve divided into 3 groups :-

TYPE 1 – Involves both the superficial and deep palmar branch.

TYPE 2 – Involves only the deep terminal branch resulting in motor deficits with sensory function intact.

TYPE 3 – Involves only the superficial terminal branch resulting in no motor deficit.

ANATOMY

Nerve root – C8-T1

The ulnar nerve is a branch of the medial cord of the brachial plexus.

Travels distally along the medial side of the arm.

Nerve gives off two sensory branches which supplies sensation to the dorsomedial hand, the 5th digit, and half of the 4th digit.

At the wrist, the ulnar nerve enters the hand by passing through Guyon’s Canal. This tight tunnel is formed between the hamate, the pisiform, and the piso-hamate ligament which helps keep these carpal bones together.

Either within or just beyond Guyon's Canal, the ulnar nerve divides again in two motor branches. In the cyclist, it is at or just before Guyon’s Canal where compressive injury to the ulnar nerve most commonly occur.

MUSCLE SUPPLIED BY ULNAR NERVE

1. FLEXOR CARPI ULNARIS

2. MEDIAL 1/2 OF FLEXOR DIGITORUM PROFUNDUS

3. PALMARIS BREVIS

4. FLEXOR DIGITI MINIMI

5. OPPONENES DIGITI MINIMI

6. 3rd AND 4th lumbricals

7. 4-1 PALMAR AND DORSAL INTEROSSEI

8. ABDUCTOR DIGITI MINIMI

9. ADDUCTOR POLLICIS

10. DEEP HEAD OF FLEXOR POLLICIS BREVIS

GUYON’S CANAL

Guyon’s canal also called ulnar tunnel or ulnar canal, is an anatomical fibro-osseous canal located on the medial side of the hand. It extends between the proximal boarder of the pisiform bone and distally at the hook of the hamate. The ulnar nerve and ulnar artery pass through the Guyon canal as they pass from distal forearm to the hand.

As the ulnar nerve exits the Guyon’s canal it is divided into deep (motor) branch of the ulnar nerve and superficial (sensory) branch of the ulnar nerve.

Boarders

Roof: palmar carpal ligament, palmaris brevis and hypothenar connective tissue.

Floor: transverse carpal ligament, piso-hamete ligament, pismetacarpal ligament, flexor digitorum profundus tendons and opponens digiti minimi.

Medial wall: pisiform, abductor digiti minimi and flexor carpi ulnaris tendon.

Lateral wall: hook of hamete, transverse carpal ligament and the flexor tendons.

MECHANISM OF COMPRESSION

FACTORS such as -

·Pressure over the hypothenar eminence

·prolonged hyperextension of the wrist, stretching sensitive structures in the wrist.

·Worn -out gloves and unpadded handle bars

·transmission of vibration in rough roads can come from overinflated tires and width of the tire, causing vibration in the hands.

·High saddle or low handlebars causing excess weight borne by upper limbs

·develops during long-distance or prolonged cycling and occurs with both mountain bike and road cyclists.

·The position of the hands while holding the handlebar puts pressure on the nerves in the wrist.

· Especially when cycling downhill, a large part of the body weight is supported by the hands-on the corner of the handlebar. This leads to an even higher load on Guyon’s canal in the wrist or in the carpal tunnel.

·All this can cause neuropraxia, in which there is a temporary loss of motor and/or sensory function due to blockage of nerve conduction.

CLINICAL PRESENTATION

SIGN'S AND SYMPTOMS

·Numbness

·Tingling

·hand Weakness

·Clumsiness

·Cramping

·Pain

·Possible motor limitation

·Hypo-aesthesia over hypothenar eminence, little finger and medial aspect of ring finger

·paresis of hand grip, finger abduction and adduction

·difficulty in handling manual breaks

·grip weakness

·ADVANCED CASE DEFOMITY – Partial Claw hand

TINELS SIGN POSITIVE

FROMET'S SIGN POSITIVE

WARTENBER'S SIGN POSITIVE

INVESTIGATION

·Nerve conduction velocity - shows distal latencies in affected muscles (eg. abductor digiti minimi and first dorsal interosseous)

conduction velocity from above the elbow to wrist is normal

1. during recovery - Needle examination may show positive waves and polyphasic potentials in affected muscles .

2. After recovery - Needle examination shows no positive waves or fibrilation potential and polyphasic potentials in affected muscles.

polyphasic and biphasic amplitudes present

Thus electrodiagnostic techniques are useful in the diagnosis and follow up of this condition

motor latencies to affected muscles should be measure

sensory distal delay should also be observed

Needle examination is useful to determine evidence of reinnervation

electromyographic evidences shows axonal damage and reinnervation

nerve conduction studies shows tendency to improve with decreased distal latency

both terminal branches of ulnar nerve are affected

·Electromyogram may show positive waves in affected muscles ( eg. ADM and FDI)

interference pattern may be incomplete in affected muscles

no polyphasic potentials

·If there is suspected nerve damage, imaging through ULTRASOUND and MRI may be needed wil help determine the location of compression and confirm the diagnosis.

DIFFERENTIAL DIAGNOSIS

‎cyclist’s palsy

Fracture of hamate bone

Hypermobile pisiform bone

Carpal tunnel syndrome

Guyon’s canal syndrome

MANAGEMENT

Depending on the severity of the condition

· Oral or topical NSAID's medication to treat the inflammation

· In severe cases corticosteroid injections may be required to reduce swelling and ease the pressure on the nerve

· wrist splinting could help.

· If other treatments fail, a doctor might try a corticosteroid injection of the Guyon's Canal or decompression surgery (i.e. to release the nerve and take away the pressure).

Hand Strengthening Exercises

1. Finger bending exercise: start from a stretched hand, bend your fingers of the affected hand in a right angle and hold for 10 seconds while keeping your fingers straight; repeat 5 times.

2. Finger squeeze: place a small object (for example: pen, coin, sheet of paper) between 2 fingers of the affected hand and hold for 10 seconds; repeat 5 times for each pair of fingers and then move on to the next set of fingers.

3. Grip strengthening: use a rubber ball and squeeze it with the affected hand; hold for 10 seconds and repeat 10 times. Build up gradually to 3 sets of 10.^[13]

Stronger hand muscles will also help to prevent cyclist's palsy from recurring.

1. Wrist range of motion: bend the wrist forward and back to neutral position, then bend the wrist backward and back to neutral position; hold each position for 5 seconds; repeat 10 times.^[13]

If a transient "palsy" has occurred with temporary motor paralysis with minimal sensory and autonomic function loss it is a reversible process, if the mechanical compression seizes the nerve will regenerate on its own and function of the muscles will be restored.

In more severe handlebar palsy cases it can take weeks to several months to heal, depending on the severity of the condition. While the nerve and muscles are regenerating, the patient needs to interrupt his sport activities for a while.

Modalities include:-

ACUTE PHASE

CHRONIC PHASE

· Ice(cryotherapy)/heat

· Electrical Stimulation

· Low level laser

· Ultrasound

· Active release techniques

RECOVERY

Is spontaneous

Limit cycling to occasional non-competitve short session

Use of handlebar padding

Corrected inadequate hand position

CYCLIST PALSY PREVENTION

In order to avoid cyclist's palsy or to reduce the prevalence of this type of non-traumatic hand and wrist injury during cycling, it is important to have a look at the prevention strategies.

Cyclist palsy prevention starts with your bike position.

Make sure your position doesn’t allow the arms to be fully extended when holding the brake levers.

Aim for around 170 degrees when the arms are extended .

Your weight must be distributed evenly across your hands on the handlebars and the arms shouldn’t be carrying more than 20-30% of your weight on a bicycle.

You can also add bar tape that includes gel and wearing gel cycling gloves can also help with prevention and comfort.

Remember it is also important to move your hands around often and try not to keep them located in a single position for more than 1 hour at a time.

An effective measure is to cushion the pressure points, by using padded handlebars, handlebar grips or padded cycling gloves. This provides an extra layer of fat tissue inside the palm of the hands so that there is better shock absorption and protection from pressure.

Also, the position of the hands-on the handlebar is important. The cyclist should try to avoid a hyperextended position of the wrist. Furthermore, during a long ride, it is advisable to change hand position regularly.

Individual adaption of the type of handlebar and the consequential riding position is equally crucial in the prevention of this ailment. Using an upright horn handlebar instead of a drop model might be considered for certain individuals. This will bring the torso position more upright and will diminish the pressure on the hands.

Another option is to equip the bike with both a conventional handlebar and an aerobar, which will allow the cyclist to lean forward and to rest the forearms on pads during certain parts of the track so that pressure can be taken away from the hands temporarily during a cycling trip.

Enthusiastic long-distance cyclists should also adopt a comfortable and resilient riding posture. If the trunk gets tired or in case of general fatigue, the hands will invariably bear more weight to stabilize the rider on the bike.

Developing a better posture on the bike requires strong trunk muscle endurance. Make sure to sit in a comfortable position on the bike.

The torso should lean forward at about 45° to 50°. The shoulders should be relaxed. The arms should be at 90° to the torso. The elbows should be slightly bent, not straight or locked. Bent elbows will act as shock absorbers for any bumps in the road and will alleviate shocks from the hands. The hands should not be gripping excessively, but resting smoothly on the handlebar.

Finally, the cyclist should make sure to ride on the right size of bicycle and to adapt the position of the saddle and handlebar to make sure that these allow to sit on the bike in a normal position

synchronize your thoughts.

2020-07-26T05:45:00.005-07:00

Our brain is a mischievous and mysterious part of our body...

What do you think, do our brain plays with us or we play with our brain????

Either can be possible but according to me we play first with our brain and then our brain plays with us. Because we built it in such a way that after understanding everything it starts to play with us and we reflect it in our emotions.

We see different things in our life which our brain had never come across before but after understanding that thing, when we come across it again the brain starts using our emotions towards it.

A human can develop lots of emotions, may it anxiety, happiness, sadness, anger, and whatnot lots of emotions, and a state of apprehension is reached when situation became complex.

Confusing right !!!

Our brain is only limited to what it understands.

In other words, if I say it " our brain is built by us, we are the controller of our brain and when every input is added successfully it starts its work and then after it controls us in tremendous ways.

How beautiful is the nature of our brain or if I say it is the stupid one as well as cleverest, the same way coin has two sides brain also has, it is only up to us which side is being built in our brain more prominent and thing is that only we are responsible for it.

The brain's work is to understand our inputs, interpret it, connect it with our memories, uses the input in different situations of our life, reflect in different emotions. It is our choice to add which input in, and our brain does do not have any choice to access a particular input, but it will try to access each and every input.

But it's only our brain which tries to execute our every thought in action.

We see things observe them, the people around us also sees the same things observe it but somewhere there is a difference in both the perspective. why???

Because of the process of COGNITION in our brain that works.

what is COGNITION??????

It is just our mental action of acquiring knowledge and understanding through thought, experience, and senses.

In the above picture, you can see two people have different views of there own and they both are correct at there places, in the same way, our brain has so many different thoughts which we think all are correct because from the start to different stages of life we come across many things and we observe things in a different way and try to connect it with our previous experiences, memories and we built our brain to be developed in such environment.

But to choose that one thought from the bundles of thoughts is quite tedious, but somewhere there is a solution to discriminate things.

For that, we need not experience many things as I do agree experience is must but all the time you are experienced in things is not possible it's only that we should not limit our thoughts in one direction we should develop thoughts in all direction a positive a negative in every direction and then reach a conclusion what to choose. it's not bad to have negative thoughts, it's bad to choose them and we are responsible for our decisions.

In the above picture both people are correct but to choose either of them at the appropriate situation is quite simple because we know that in a sequence of numerical "6" always comes before "7" and after "5" and just like it "9" always comes before "10" and after "8".

So now choosing between them is quite simple, but we talk about a number like 69 six will come before 9 and 9 after 6 but if we interchange their places there meaning as well as values will change.

So it's just that choosing appropriate thought at the appropriate time is important not always the way you want things to happen will work out but if you want it to let your decision be appropriate if above both man in picture work in synchronization than they both can use their view at the perfect time which may be useful for both of them. in the same way, we need to make our different thoughts to be in synchronization, so we can use each different thought which reflects the emotions at the appropriate time.

And at last your problem of choosing what will come to the conclusion.

For that, you just need to synchronize your thoughts just like the patterns in the kaleidoscope.

Let our brains make a beautiful pattern of our thoughts.

In our childhood, we all had played with a kaleidoscope if you never had tried it just try it.

what is the mechanism of the kaleidoscope and how it is related to our brain ???

Let the mirrors of kaleidoscope be our brain. and the beads of different colors as our thoughts.

So when we add those beads in kaleidoscope it reflects in each mirror and in synchronization with each reflection it makes a beautiful pattern. with each different movement of the scope, a new pattern is formed which is a beautiful view.

In the same way, let our different thoughts reflect in synchronization with each other so we can see beautiful humanity within ourselves with each different stage of our life a new beautiful image of your own will develop and let it develop.

It's your frame of mind.

2020-07-14T04:23:00.016-07:00

In different stages of life from childhood till the end we go through so many things which forces us to think differently, with each and every new thing we come across in our life we observe it, try to understand it, learn it, we give our perspective, we give our thought to it, pursue towards it, and then we take actions towards our thoughts isn't that's what happens to all of us????

But have we ever tried to think about,

🤔 what our thoughts may reflect like ???

🤔 Which path it may lead to us???

🤔 Where is its end, of all these thoughts??

🤔 Are they appropriate or are just abruptly popping up????

Thoughts...

Thoughts are like growing trees when our brain comes across some new thing or any new environment it starts growing a new tree along with its new branches, with each new thought there are more thoughts bombarding our brain.

Imagine our brain with lots of trees in it each branch of the tree has its own meaning, the same way thoughts are like trees...

A single stimulus is enough to grow a huge tree, that's the power of our mind.

What we need to do???

In order to achieve a frame of mind, we need to make our thoughts clear, simple, and steady, but how!!!

That's what we are searching for...

Before knowing, what is a frame of mind??? Let me explain it with a simple basic law, which we all already know and can relate to this. how!!!!!!! 🤷‍♀🙄

I'll explain it...

We all had learned the basic law of reflection of light, it states that "The angle at which the rays is incident on the surface, equals the angle at which is reflected," i.e if light falls on a smooth surface it will reflect back at the same angle as it hits the surface and gives a proper specular reflection ( proper image), instead of when light hits on an object and reflects in lots of different direction and gives a diffuse reflection, this phenomenon take place on a rough surface which produce a vague reflection.

Thus, in the same way, consider our thoughts as rays of light and our mind as a surface(smooth or rough)

When our thoughts come in our mind, the brain understands it, interprets our thoughts, and then it reflects back in the form of our attitude.

If a person has a clear mind just like a smooth surface the person's thoughts may reflect a good image, a good attitude, a better personality may develop within him/her and may lead to a proper path.

But if a person has an unclear mind just like a rough surface the person's thoughts may reflect in various different direction and it gives an imprecise attitude towards things, a vague image.

And that's what I want to tell you, a frame of mind is just your attitude, that's what it means.

What's Human nature ???

It's very natural that a person may have different thoughts, different opinions, different views which are reflected from there minds, it may be positive, a negative one, if I say a bundle of things bombarding our brain and that's true because it is human nature to think abruptly, and that's what our brain does create lots of thoughts but it is necessary to keep our mind clear for all these thoughts to reflect back like a specular reflection instead of letting scatter it in all direction and when each and every thought of our brain (+ve/-ve) falls on a clear mind it leads to a positive attitude towards the surrounding, towards the environment, and the most towards yourself.

What we need to learn???

Emotions https://pin.it/61hNgO5

A person shows many types of attitudes, isn't it? A positive, negative, good, bad, rude, emotional, confident, etc.

But are we putting all this when we really have to reflect it, that's what it's necessary to, is putting an appropriate attitude of yourself on an appropriate situation, environment, towards other is what we need to learn, thus for that, a clear mind is needed which we can get through many mind practices, one of which I had explained in my first blog click on the following link to know more about introspection http://vantagespot.blogspot.com/2020/07/interospection.html

Mankind should learn to have a frame of mind, ask yourself are you having a frame of mind?

The answer is Yes we do have, but do we know what kind of frame of mind (attitude) we are having??

Ask yourself again and again, what are you, what are you reflecting like, why are you like this??? Is what all we are finding

Many people say sit before the mirror and interrogate with yourself, talk to yourself but I think it might be a good practice to do but why to do such things, I personally feel why to sit in front of a mirror instead its better to make your mind a mirror which will reflect you internally, instead of sitting in front of the mirror and just know your presence it feels it's insane.

"You yourself is only a mirror of your own kind which will reflect you internally and virtually your personality ".

In the end, just know yourself, reflect your thoughts on a clear mind, know your personality, develop it, know who really you are, and reflect with the best attitude towards surrounding and environment.

It's just that you should know to control it and thus we say...

Interospection

2020-07-05T09:11:00.006-07:00

WHAT IS INTROSPECTION????

Basically, it's observing one's own mental and emotional processor, in the other words if I say it's learning your own self, or knowing yourself through the conscious mind.

It's a special kind of art within you. Where you can understand yourself thoroughly.

WHY A PERSON INTROSPECT???

Many of us might be visiting a psychiatrist to overcome our queries, and they help us with our multiple thoughts running in our mind, and also deals with the emotions that are huddled in our way.

But introspection is just a beautiful method where you don't share your problems or caravan of multiple thoughts with another person to overcome them, but you deal it with yourself.

As we need to discuss why introspection???

because some of us are very introvert that they don't like to share their life's matter with others or might don't trust others, or they feel like when they will tell their things to others they will not understand what a person wants to express, or there might be a joke of them... So there are many things which lead to introspection.

As they think the way they themselves understand is the best way then other people do, it's a good method to deal with your own soul, I must say that it's not a disorder, it's just knowing yourself thoroughly.

How to be introspective???

Is just so simple talking with your own selves, to deal with your thoughts, and it might lead to a simple way of getting answers from your own perspective, others perspective does matter but when you think about something you get all the perspective. by thinking again and again you can achieve their perspective too that some point of your thinking.

Many of us might have tried it already but they are not aware of it.

It's just spending some of your time for yourself, at first a person has thousands of thoughts bombarding but when he masters in this he achieves peace of mind, which leads to a goal-achieving practice.

Many of the scientist and great leaders practice this and they listen to themselves.

As we know our mind is filled with many different thoughts constantly coming but it's up to you which part of you take it a positive one or negative. For that, you need to think about all the outcomes of each and every thought of yours.

What leads to introspection???

As I already said it leads to a peaceful mind, which intern leads to achieving your goal and leads to your growth. Your mind gets trained to listen to yourself and with a new environment within the mind or within you, a new person will develop, who thinks before any action. Because for finding any answer you yourself are the best person to give advice because you had seen, observed every part of the situation but if you tell this to others who never had gone through that situation might be difficult for him to help you and their advice may hurt you. But listening to yourself is important from every perspective of any problem. Many different thoughts come but you should be knowing why such kind of thought had popped up in your mind because you had thought of it and it ends at why... That's the end you are in control of your own self.

"ENCOURAGING YOUR MIND FOR YOURSELF IS THE BEST WAY TO LEARN YOUR MIND... "