Physiotherapy Cures and Prevention

TENNIS ELBOW

2011-05-05T19:32:00.000-07:00

Tennis Elbow, also known as lateral epicondylitis is an extensor tendinopathy which involves ECRB tendon. Its an overuse injury resulting from repeated use of wrist extensors and is commonly experienced by plumbers, gardeners, cleaners, carpenters, mechanics, bowlers, baseball players and tennis players.

The symptoms usually involves pain radiating from the lateral aspect of the elbow to the forearm and back of the hand when grasping or twisting or lifting heavy objects.

Mill's and Cozen's tests are the special tests used to diagnose the tennis elbow in which when the long extensors of wrist are stressed, it causes pain on the lateral epicondyle of the elbow which is the origin of the common extensors.

Physical Therapy Treatment goals
a) Pain reduction- Cold therapy in the form of ice packs (for approx. 15Mins, 2 times a day) Therapeutic Ultrasound, Iontophoresis using NSAIDS or corticosteroids.

b) Activity modification- Avoid pain aggravating activities, Change in technique or ergonomic changes at work station to reduce load on wrist extensors.

c) Counterforce bracing- To reduce stress on the common extensor origin. Its worn 10cm distal to the elbow joint on the proximal forearm.

d) Exercise therapy- To stretch and strengthen the muscles of the forearm and to maintain the flexiblity of the muscles of the forearm.
1. Gentle streching exercises of wrist flexion, extension and rotation with elbow in extension. Avoid vigrous stretching and stretching to the point of pain. Maintain the stretch for 15- 20 seconds.
2. Strengthening of wrist flexors, extensors, ulnar and radial deviators alongwith supinators and pronators with elbow flexed and forearm supported using weight cuffs or dumbbells. These exercises can be started in gravity eliminated plane and later on can be progressed to against gravity activities.
3. Isometric finger extension(using a rubber band around fingers) and flexion exercises(by squeezing a tennis ball).
4. In later stages, focus should be on eccentric contractions of the wrist extensors.

Other treatment options (for chronic cases)
Steroid injections
Surgery- If 6 months of conservative treatment fails or at the discretion of the orthopaedician.

Shoulder impingement syndrome and Physical Therapy

2010-10-15T07:32:00.000-07:00

Shoulder impingement results from the compression of the rotator cuff muscles under the coracoacromial arch.
Inflammation and pain occurs and is aggravated by the shoulder and arm movements.Pain is felt on antero lateral aspect of shoulder radiating down to mid arm at times.
It can be confirmed with Hawkins-Kennedy impingement test and Neer's impingement test.

ETIOLOGY of shoulder impingement syndrome is multifactorial-

1. Acute trauma: fall on to the shoulder or direct blow on the shoulder.

2. Chronic injury from:
a) Repeated overhead activity like throwing, lifting and catching.
b) Improper postural habits leading to muscle imbalances between deltoid and infraspinatus, teres minor, subscapularis or between supraspinatus and gravity. As a result one group of muscles become tight and other gets stretched and become weak.Loss of rotator cuff strength causes superior migration of humerus resulting in impingement.

3.Outlet impingement due to subacromial osteophytes, hooked or beaked acromion shape, thickened or calcified coracoacromial ligament.

TREATMENT GOALS

1-Decrease the inflammation

*Cryotherapy-Use ice packs for a maximum of 15 minutes, 3 times a day
*Anti inflammatory medication
*Relative rest-Avoiding aggravating and loading activities like overhead reaching and lifting heavy weights in order to prevent further injury to the rotator cuff.

2-Improve posture and shoulder ROM

*Gentle stretching exercises and ROM
-Downward and backward pulling of both the arms with the hands clasped behind the back
-Scapular retraction exercises
-Codman pendular exercises
-Horizontal adduction stretch
-Triceps stretching
-Corner stretch-to stretch the front of the shoulder and the pectorals muscles by pushing against a wall in the corner of the room.
-Biceps stretch

* Sit with back fully supported and work with shoulders being close to the body.

3-Strengthen the rotator cuff muscles and scapular stabilizers.

*Bilateral shoulder extension exercises in prone or standing position.
*Resisted shoulder external and internal rotation in the gravity eliminated plane.
*Supraspinatus strenthening by resisting shoulder abduction in empty can position of the hand.
*Bilateral shoulder abduction in prone
*Supine press
*Biceps curls

Peripheral Neuropathy and Physiotherapy

2010-10-05T15:27:00.000-07:00

Peripheral neuropathy is a disorder of the peripheral nervous system due to damage to the peripheral nerves resulting from a variety of causes like trauma,
infections, autoimmune disorders, systemic infections,inherited disorders, metabolic or endocrine disorders, toxic causes and vitamin deficiency especially vitamin B12.

Peripheral Neuropathy is of four types mainly-

1.Sensory neuropathy, in which part of the sensory system is damaged causing pain, tingling, numbness, or loss of sensation. It usually progress from distal to proximal i.e. it first starts in fingers or toes.

2.Motor neuropathy is characterized by damage to the motor nerves resulting in motor weakness and atrophy. Also symptoms of tiredness, heaviness,cramps, tremor, muscle twitch (fasciculations) and gait abnormalities are present.

3.Autonomic neuropathy is characterized by damage to the autonomic nervous system which affects blood pressure, heart rate, sweating, digestion, and bowel and bladder function.Symptoms may include urinary incontinence, constipation, diarrhea, dizziness and fainting.

4.Mixed neuropathy, in which two or more of the above mentioned types are present.

The objectives of Physiotherapy management for peripheral neuropathy includes-

(a)Pain Relief-TENS, Transcutaneous Electrical Nerve Stimulation therapy has shown to be effective and safe in the treatment of diabetic peripheral neuropathy

(b)Flexiblity or stretching exercises-They are important for improving muscle mobility, function and blood circulation in the affected area.It also helps in
maintaining range of motion.

(c)Strengthening of muscles-It improves muscle strength and reduces the feeling of numbness and tingling.It can be done by using weights or strengthening bands to target the necessary muscle.

(d)Braces or splints- To improve balance and posture.It can be used for compression neuropathies like carpal tunnel syndrome.

(e)Practicing functional activities are also important.

(f)Treatment through vibrations or ultrasound.

(g)Balance training to improve gait and posture.

Safety is an important consideration for patients with peripheral neuropathy.Muscle weakness and loss of sensation increase the risk of falls.It can be prevented by following measures

* Testing water temperature before bathing
* Avoiding open toes or high heels and not to walk barefoot.
* Take care while cooking by using heat resistant ladles and pot holders
* Inspect your feet regularly for any cut,bruise or blister
* Wear socks and gloves when needed
* keep the skin moisturised.
* Make environment safe by removing obstacles in home, use adequate light at night, use handrails while ascending or descending stairs,Use non slip bath mats in bathroom.

Physical Therapy and Parkinson's disease

2010-09-23T10:52:00.000-07:00

Parkinson's disease is a chronic progressive neurological disorder resulting from deficiency of dopamine in the brain.It manifest with the triad of-
1. Rigidity or stiffness in the body
2. Bradykinesia or slowness of the movements
3. Resting tremors and postural instability.

Other manifestations include- Intellectual impairment in form of dementia, communication problems due to dysarthria and hypophonia, dysphagia and silorrhea, muscuoskeletal problems due to disuse and inactivity and festinating gait pattern.

Physical therapy management of Parkinson's disease include-

1.Increasing activity levels-Increase overall mobility, do some stretching exercises to elongate muscles and involve patient in a regular walking program.

2.Decreasing rigidity and bradykinesia-Incorporate PNF patterns(specially D2F for upper extremity and D1E for lower extremity) with emphasis on trunk rotation patterns and rhythmic initiation technique.Relaxation exercises in form of gentle rocking can be used to reduce muscle tension.Deep breathing exercises can also be used.Daily stretching and ROM exercises are important.

3.Improving gait pattern-Emphasize high stepping, broad based gait with arm swing and contralateral trunk rotation.Toe wedge can be used to counteract festination.

4.Improving balance-Weight shifts in standing,stepping movements forward and backward, walking and marching in place can be helpful.

5.Improve strength-Focus on lower extremity strengthening in order to improve gait and posture.Trunk extension exercises are also important.

6.Walking aids in form of canes can be used to improve gait and balance

POST NATAL EXERCISES

2010-04-16T08:42:00.000-07:00

Post Natal exercises focus on strengthening of weak muscles which mainly includes

1. Pelvic floor muscles
2. Abdominals

Pelvic floor muscles
Strengthening of pelvic floor muscles is extremely important in the post partum phase as these muscles becomes lax and weak due to stretching with vaginal delievery.Their weakness can lead to leakage of urine with coughing or frequent urge to pass urine.

Kegel Exercises can be done for these muscles by squeezing the pelvic muscles as if trying to stop urine flow.The feeling is one of ‘squeeze and lift’. Hold it for 10seconds, release, rest for a few seconds and repeat 10 times. Practice it 3-5 times a day.

Avoid pulling in your tummy, squeezing your legs together, tightening your buttocks or holding your breath while doing kegel exercises.

Abdominals

Abdominal muscles like Rectus abdominis, Transverse abdominis and Obliques (External and Internal) also become lax after delivery. These needs to be strengthened for toning them up.
Following exercises can be one for this purpose.

1. Posterior Pelvic tilts- In crook lying position i. e. lying down with hip and knee flexed to 45 degrees and feet flat on the bed—Draw in your tummy and press lower part of your back into the bed to flatten your back. Hold this position for 5 -10 seconds, release and repeat 10 times.

2. Abdominal Curls- In crook lying position,lift your head and shoulders just to clear shoulder blades off the bed trying to reach towards your knees. Hold this position for 10 seconds, release and repeat 10 times.

3. Sit ups- This exercise can be done in advanced stages of strengthening.

4. Working for obliques- In crook lying position, lift your head and shoulders to reach with one hand towards opposite ankle. Repeat this with both sides.

5. One leg SLR( Straight Leg raising)-Raise between 30- 45 degrees for lower abdominals workout with other leg being flexed at hip and knee.

Note- Progression of these exercises must be guided by a Physical therapist depending on the the progress you have made.

Other important aspects-

1. Maintaining good posture is very important- keep your back straight, stand tall with tummy tucked in and relaxed knees. Use good body mechanics while bending and getting out of bed so as not to stress your back.
2. Continue with prenatal breathing exercises and foot and ankle movements to improve your circulation.
3. Hip adductors isometrics is also a good exercise.

Precautions
1.Consult with your doctor before starting any post natal exercise program. Every post natal exercise program vary depending on whether you have delivered vaginally or by C- section and how much you have recovered post delivery.
2.Stop exercise if it hurts, pains or if you are tired or unwell.
3.Keep yourself hydrated.

Therapeutic Modalities - ULTRASOUND

2010-04-14T09:27:00.000-07:00

Ultrasound(US) is a sound wave that has a frequency greater than 20 KHz.
It is generated by applying an alternate current to a piezoelectric
crystal (found in the transducer in the sound head). This crystal
contracts and expands at the same frequency at which current changes
polarity. The sound field generated by this crystal in turn makes the
molecules in the sound field vibrate and oscillate.
The crystal commonly used in US units is synthetic plumbium
zirconium titanate (PZT), lead zerconate.

Therapeutic ultrasound has a frequency range of 0.75 and 5.0 MHz.
Most modalities have 1 MHz and 3 MHz sound head

Ultrasound energy is absorbed mostly in tissues with high collagen
content (bone, periosteum, cartilage, ligaments, capsules, tendons, fascia,
scar tissue and tissue interface i.e. bursa & synovium).

Physiological effects of Ultrasound:
1. Enhance inflammatory response and tissue repair
2. Heat soft tissue

Common uses for pulsed non-thermal ultrasound
· Facilitate healing in the inflammatory and proliferative phase
following soft tissue injury (tendonitis, bursitis, acute soft tissue
injuries)
· Bone healing

Common use for continuous ultrasound:
· Prior to stretching at tight structure (tendon, capsule, ligaments,
fascia, scar)
· Pain control in chronic pain
· Chronic inflammatory conditions

CONTRAIDICATIONS
· Undiagnosed pain
· Cancer
· Active tuberculosis
· Psoriasis
· Decreased circulation
· Infection
· Pregnancy
· Central nervous system tissue
· Joint cement (cannot use continuous mode, but may use pulsed
mode 50% or less)
· Plastic components
· Pacemakers
· Thrombophlebitis
· Uncontrolled bleeding or blood-thinning medication (coumadin)
· Eyes
· Reproductive organs
· Heart

PRECAUTIONS
· Acute inflammation (use non-thermal settings only)
· Epiphyseal plates (use pulsed, low intensity <0.5w/cm2)>

EXERCISES FOR TYPE 2 DIABETES MELLITUS

2010-04-14T08:52:00.000-07:00

Type 2 diabetes is growing at an alarming rate. With so many prevalent risk factors and morbidity associated with type 2 diabetes, its essential to prevent it and retard its progression.

According to the relevant research done in the field of type 2 diabetes and exercises, its proven that physical activity or exercise is one such modality which can be helpful. The main hypothesis supporting the results is the increased uptake of glucose in muscles as a result of exercise.

Various types of exercises are advocated for the same which can be broadly categorized into two:
1.- Aerobic exercises in the form of walking- 90 minutes of moderate intensity walk per week is sufficient.
2.- Resistance exercises- With moderate amount of resistance involving the major muscle groups of the body.
For example,
-Biceps Curls
-Triceps Curls
-Front and Back lateral pull downs
-Hamstring curls
-Knee extension exercises
-Abdominal curls.
8-10 repetitions of each exercise 3 times per week is sufficient to achieve the desired effect.

The long term benefits of these exercises are as follows-

Improved glucose tolerance
Decreased level of fasting blood glucose and HbA1c levels
Improved quality of life
Increased muscle strength with resistance exercises
Improved cardiovascular fitness
Decreased morbidity associated with Type 2 diabetes
Improved balance
Improved lipid profile
Improved resting blood pressure levels and heart rate
Improved body composition- more of muscle mass and less of fat with resistance exercise

Precautions for doing exercise.

Get a resting ECG done
Take care of fasting blood glucose levels. Avoid exercise if its <70>250mg/dl
Avoid resistance training if hypertensive.
Avoid exercising the muscle in which insulin is being injected. Timing of injection and exercise has to be scheduled with help of your physician and physical therapist.
Avoid hypoglycemia.
Be aware of the signs and symptoms of hypoglycemia.
Keep an orange candy or juice handy.
Take care of your feet. Keep them clean and dry.
Maintain your hydration levels.
Incorporate a period of warm up and cool down in your exercise program.

NOTE: Consult your physician before embarking on any exercise program

EXERCISES FOR FLAT FOOT

2009-01-17T23:38:00.000-08:00

Flat foot / Pes planus

Flat foot/Pes planus is a condition where the arch or instep of the foot collapses and comes in contact with the ground.

The Exercises for the treatment of Flat Feet are-

Toe clawing: The toes of the foot are flexed fully; hold in that position and then release again…extend them fully. Repeat this 10-15 times, thrice a day to develop intrinsic muscles of the foot.
Toe spreading-The toes are pulled away from each other and then towards one-another
Rising the inner border of the foot-The foot is slightly inverted (the internal arch is raised), but the sole is not turned upwards. The height of the arch is increased, whilst the toes are still gripping the ground.
Foot-closing-Making fist with foot, relax and then repeat it again.
Active foot rolling. The patient tries to draw an 'O' with his/her big toe in sitting position. For the right foot clockwise; for the left foot anti-clockwise.
Picking up small logs (of different sizes) through foot, releasing them and then picking up again.
Standing on the outer borders of the foot, hold it for 10 seconds, relax and then repeat it again.
Toe flexion and extension while sanding on the edge of the stairs with toes of the stairs.
Walk on a straight line
Walking on the lateral border of the foot
Curved foot walking: It involves walking with the foot in arched position and touching the heel and the toe on the ground with the center in arched position. This will help the foot developing the arch.
Heel walking: It involves walking on the heels with the whole body weight on the heels.
Toe walking: It involves walking on the toes to strengthen the intrinsic muscles of the foot.

OSTEOPOROSIS

2009-01-01T00:34:00.000-08:00

Osteoporosis means "porous bones," Osteoporosis is defined as a systemic skeletal disease characterized by by the loss of the normal density of bone and microarchitectural deterioration of bone tissue leading to bone fragility and increased risk of fracture.

Osteoporosis is one of the most common disease conditions affecting older people and women. Any bone can be affected by osteoporosis, but the most common sites are bones in the hip, spine, wrist, ribs, pelvis and upper arm. Osteoporosis is a chronic condition of multifactorial etiology and is usually clinically silent until a fracture occurs.

Primary causes

· Estrogen deficiency

· Changes associated with aging

Risk Factors

1. Age : > 45 yrs in Female and

2. 60 yrs in Male

3. An inactive and sedentary Lifestyle - lack of exercise

4. Low Vitamin D in take

5. Low calcium intake

6. Low estrogen levels resulting from Surgical menopause with the removal of the ovaries which accelerates the process of bone loss to a rapid level.

7. Either an Asian or Caucasian. White women and Asian women face the greatest risk of osteoporosis

8. Under certain medications such as diuretics, steroids, and anticonvulsants

9. Thin and small body frames;

10. Family history of osteoporosis

11. Excessive alcohol consumption;

12. Chemotherapy can cause early menopause due to its toxic effects on the ovaries;

Symptoms

The osteoporosis condition can be present without any symptoms for decades, because osteoporosis doesn't cause symptoms unless bone fractures.

Fractures of the Hip, Spine, Wrist are common.

Fractures of the spine can cause severe "band-like" pain that radiates around from the back to the side of the body. Over the years, repeated spine fractures can cause chronic lower back pain.

Hip fractures typically occur as a result of a fall.

Aches and pains

Loss of height or curving of the spine, which gives the individual a hunched-back appearance of the upper back, often called a "dowager hump”

Diagnosis

A dual energy x-ray absorptiometry scan (DEXA) measures bone density in the hip and the spine .The bone density is then compared to the average peak bone density of young adults of same sex and race. This score is called the "T score," and it expresses the bone density in terms of the number of standard deviations (SD) below peak young adult bone mass. Osteoporosis is defined as bone density T score of -2.5 SD or below. Osteopenia (between normal and osteoporosis) is defined as bone density T score between -1 and -2.5 SD.

Management of osteoporosis

· Life style changes including quitting cigarette smoking, curtailing alcohol intake, exercising regularly, and consuming a balanced diet with adequate calcium and vitamin D;

Take calcium everyday

Calcium > 1200 mg/day + Vitamin D 400-800-I.U./day

Milk 240 ml 300 mg

Curd 240g 400 mg

Paneer 25 g 300 mg

+ 250mg from non dairy sources like Egg yolk/

Salt water fish/Liver

Vitamin D helps the absorption of calcium from the intestines. An adequate calcium intake and adequate body stores of vitamin D are important foundations for maintaining bone density and strength.

Regular physical activity on a long-term basis has a particularly important role in maintaining healthy bones. Exercise can maintain and increase bone strength by increasing bone mass or by slowing age-related bone loss. Muscle strength is also increased, which is important for supporting the joints and preventing falls. Exercise has also been shown to improve co-ordination and balance, which helps to prevent falls and to improve general physical health and well-being. Exercise at least 3 hours per week

Medications that stop bone loss and increase bone strength, such as calcitonin. Anti-resorptive medications inhibit bone removal (resorption), thus tipping the balance in favor of bone rebuilding and increasing bone density.

Medications that increase bone formation such as Forteo.

Hormone therapy (menopausal hormone therapy)

Recommended exercises for people with osteoporosis

Strength training Strength training includes the use of free weights, weight machines, resistance bands or water exercises to strengthen the muscles and bones in your arms and upper spine. Strength training can also work directly on your bones to slow mineral loss. Exercises that gently stretch your upper back, strengthen the muscles between your shoulder blades and improve your posture can all help to reduce harmful stress on your bones and maintain bone density. Resistance exercises - weight machines, free weights, calf raises, knee flexion, hip flexion, hip extensions, resistance bands

Weight-bearing aerobic activities Include walking, dancing, low-impact aerobics, elliptical training machines, stair climbing. These types of exercise work directly on the bones in your legs, hips and lower spine to slow mineral loss. They can also provide cardiovascular benefits

Flexibility exercises. Stretches are best performed after your muscles are warmed up — at the end of your exercise session, for example. They should be done gently and slowly, without bouncing.

Balance exercises- Balance training is an important part of looking after your bones. Working on your balance can improve your stability and help prevent falls, which is important because falls can cause fractures For example-standing on one leg; sitting on an exercise ball; and balancing with a rocker board under your feet. yoga, double leg press, exercise ball, tai chi

Movements to avoid

If you have osteoporosis, don't do the following types of exercises:

1. High-impact exercises, such as jumping, running or jogging.

2. Exercises in which you bend forward and twist your waist, such as touching your toes, doing sit-ups or using a rowing machine.

Some Sample Exercises For Target Areas

· Spine — Back extensions
A simple back extension exercise: Lie on stomach with forehead resting on floor or rolled up towel. Extend arms straight in front of head. Raise head off the floor a few inches. Hold for several seconds. Do three sets of 10 repetitions.

· Hip — Squats, hip adduction/abduction exercises with elastic bands or weights

· Forearm — Bicep curls, wrist curls, reverse wrist curls

Include a variety of exercises for all major groups to promote well-balanced muscle development. Improved muscle strength also enhances coordination and balance to protect against falls.

ASTHMA

2008-12-16T07:46:00.000-08:00

ASTHMA or HYPERACTIVE AIRWAY DISEASE
Asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role, in particular, mast cells, eosinophils, T lymphocytes, macrophages, neutrophils, and epithelial cells. In susceptible individuals, this inflammation causes recurrent episodes of wheezing, breathlessness, chest tightness and coughing, particularly at night or in the early morning. These episodes are usually associated with widespread but variable airflow obstruction that is often reversible either spontaneously or with treatment. The inflammation also causes an associated increase in the existing bronchial responsiveness to a variety of stimuli.
Factors predisposing asthmatic symptoms-
Allergic-pollens, animals, feathers, molds, food, household dust.
Non allergic-Inhaled irritants, dust, cigarette smoke, pollution, chemical.
Ambient environment-High humidity, cold air
Respiratory Infections-common cold, bacterial bronchitis
Drugs-aspirin
Emotions-stress, excitement
Exercise
During an asthma attack, the lumen of the airways is narrowed or occluded by a combination of bronchial smooth muscle spasm, inflammation of the mucosa and overproduction of viscous, tenacious mucus.
Clinical Features-
Patient has a rapid rate of breathing and uses the accessory muscles.
Expiratory phase of breathing is prolonged with audible wheezing.
Frequent unproductive cough
Feeling of tightness in the chest.
Lung volume and flow rates are reduced.
X-ray findings-Lungs may appear hyperinflated or show small atelectatic areas.
Arterial Blood Gas analysis-Partial pressure of oxygen decreases, partial pressure of carbon dioxide increases and pH,7.3 (if attack progresses)
Treatment –
Acute cases-Bronchodilators, Corticosteroids
-supplemental oxygen
-breathing control
-avoid bronchial irritants
-controlled unforced coughing manuovers in optimal body positions.
Reduce the overall oxygen demand including that associated with an increased work of breathing.
Reduce activity
Body positioning improving breathing efficiency
judicious sleep and rest periods
Restricted diet
adequate hydration
Maintainance of a thermal environment
Rest
Reduced arousal and environmental stimulation.
Sensitive indicators of ensuing compromise in oxygen transport-Bedside spirometry and Peak Expiratory Flow Rate (PEFR)
DURING EXERCISE-Focus on low intensity warm up and prolonged cool down.

VESTIBULAR REHABILITATION

2008-11-25T07:36:00.000-08:00

Physical therapy for dizziness and imbalance is called as vestibular rehabilitation, or more generally, balance rehabilitation.

Symptoms of vestibular dysfunction include but are not limited to imbalance, nausea, dizziness, true vertigo, and blurry vision, and poor depth perception, loss of balance when walking, falling, confusion, and disorientation.

Vestibular rehabilitation therapy (VRT) has been a highly effective modality for disorders of the vestibular or central balance system. It includes combined specific head and body movements with eye exercises. If the exercises are correctly performed, muscle tension, headaches, and fatigue will diminish, and symptoms of dizziness, vertigo, and nausea will decrease.Most VRT exercises involve head movement, and head movements are essential in stimulating and retraining the vestibular system.

Goals of VRT (Vestibular Rehabilitation Therapy)

Improve balance
Minimize falls
Decrease subjective sensations of dizziness
Improve stability during locomotion
Reduce overdependence on visual and somatosensory inputs
Improve neuromuscular coordination
Decrease anxiety and somatization due to vestibular disorientation

These conditions can benefit from Vestibular Rehabilitation Therapy:

• BPPV (Benign Paroxysmal Positional Vertigo)
• Bilateral & Unilateral dysfunctions
• Otolith Dysfunction
• Vestibular Labyrinthitis
• Acoustic Neuroma or vestibular neuritis.
• Ototoxicity
• Meniere’s Syndrome
• Neurologic Disorders (stroke, brain injury, multiple sclerosis)

VOR stimulation exercises

Gaze stabilization is the ability to hold the visual world steady while the head and/or body are moving. The vestibulo-ocular reflex (VOR) helps to provide gaze stability when the head moves.

Balance exercises

Static balance activities used for training include Romberg position and standing on one leg. Exercises are made more challenging and incorporate the use of the vestibular system as patients improve by altering the surface they stand on (e.g.: foam, trampoline, tilt board), performing activities with eyes closed and lastly incorporating head motions while maintaining balance.

Dynamic balance is trained by performance of activities including ambulation with head turns, full body turns and marching in place. Dynamic activities are made more challenging as the patient improves by altering the surface (e.g.: balance beam, treadmill), and performance with eyes open and eyes closed.

Cawthorne Cooksey Exercises

In bed or sitting

Eye movements -- at first slow, then quickly -up and down, from side to side and diagonally. Focusing on finger moving from 3 feet to 1 foot away from face

Head movements at first slow, then quick, first with eyes open and later with eyes closed -bending forward and backward and turning from side to side, tilting from side to side and moving diagonally.

Sitting

Eye movements and head movements as above

Shoulder shrugging and circling

Bending forward and picking up objects from the ground

Standing

Eye, head and shoulder movements as above.

Changing from sitting to standing position with eyes open and closed.

Throwing a small ball from hand to hand above eye level

Throwing a ball from hand to hand under knees

Changing from sitting to standing and turning to one side and then to another.

Moving about

Walk across room with eyes open and then closed

Walk up and down slope with eyes open and then closed

Walk up and down steps with eyes open and then closed

Sit up and lie down in bed

Sit down in a chair, then stand up

Recover balance when pushed in a specific direction.

Throw and catch a ball

Engage in any game involving stooping or stretching and aiming, such as bowling, volleyball, or shuffleboard.

Plantar fascitis/heel pain/bone spur/exostosis

2008-10-08T04:10:00.000-07:00


Plantar fascitis/heel pain/bone spur/exostosis Plantar Fasciitis is a very common cause of heel pain. It is inflammation of the plantar fascia of the foot. It causes heel pain which may radiate to the toes. It can occur as a result of repetitive microtrauma. It’s an overuse injury. Plantar fasciitis is commonly caused by a heel spur which is a bony growth that occurs at the attachment of the plantar fascia to calcaneum. The Plantar Fascia is a broad, thick band of tissue that runs from medial tubercle of calcaneum of the heel to the front of the foot. It forms the longitudinal arch of the foot. SYMPTOMS · Pain is usually on the medial side of the heel and under the heel. · Pain is usually severe in the morning and decreases as the day progresses. Pain is worse on walking bare-foot. A limp may be present. · Tenderness is present on the medial side of the calcaneum at the origin of the plantar fascia. CAUSES 1. Tightness of calf muscles which can lead to pronation of the foot. This in turn produces repetitive over stretching of the plantar fascia leading to inflammation and thickening of the tendon. 2. Foot arch problems- pes cavus and pes planus 3. Excessive stress on the plantar fascia due to excessive running or obesity. TREATMENT – 1. Use NSAIDS and take rest. 2. Ice therapy can be applied to reduce pain and inflammation, 3. Taping of plantar fascia can be done to support it and to reduce stress on plantar fascia. 4. Stretching of plantar fascia and calf muscles is also important. 5. Strengthening of intrinsic muscles of the foot. 6. Silicon heel pads/cushioned heels can be used. PREVENTION It is possible by maintaining good flexibility of calf muscles, avoid prolonged standing.

Lowback Pain - Precautions

2008-08-06T04:15:00.000-07:00

Precautions to be taken in Low Back Pain

1. Avoid any activity that increases low back pain like bending forward, lifting heavy weight etc.

2. Correct body posture. Maintain the lumbar curve.

3. Take back support while sitting, adjust the chair height so that feet should be placed firmly on ground or use a foot rest or foot stool.

4. Avoid stooping; always bend your knees while keeping the back straight while lifting anything from the ground or lower surface.

5. While exercising for back muscles also work for abdominal muscles to avoid any muscle imbalance.

6. Use firm mattress for sleeping.

7. While getting out of the bed, first take a side turn, then brings your legs down and then finally raise the upper body.

8. Do use a lumbar corset especially during traveling.

9. Avoid prolonged use of a corset as it makes your back muscles weak and decondition them.

10. Avoid continuance of same posture for prolonged periods of time.

LOW BACK PAIN

2008-08-06T03:53:00.000-07:00

Low Back pain is a musculoskeletal problem encountered by most of the adults at some time in their life. It’s a most common medical problem. There can be variety of causes of low back pain ranging from minor ligamentous sprain to spinal tumour or fracture.
Etiology of low back pain can be categorized as follows-
1. Mechanical Low Backache
• Ligamentous Sprain
• Muscle Strain
2. Degenerative
• Lumbar Spondylosis
• Disc prolapse / slip disc
• Spondylolisthesis
• Spinal stenosis
3. Inflammatory
• Ankylosing spondylitis
• Rheumatoid arthritis
• Osteomyelitis
4. Neoplastic
• Tumors
5. Metabolic
• Osteoporosis
• Osteomalacia
The diagnosis of Low back pain is based on medical history, physical examination including range of motion of back and hip, tests of neurological involvement, muscle strength testing and diagnostic tests like X ray and MRI.
The treatment options depend on the nature of the pain, whether acute or chronic and cause of the pain and accordingly may vary from conservative to surgical. Our focus here is on conservative treatment which includes-
• Analgesics and anti-inflammatory drugs/NSAIDS
• Muscle relaxants
• Various electrotherapeutic modalities like SWD (short wave diathermy), MWD (microwave diathermy), Ultrasound, IFT (interferential therapy), TENS (transcutaneous electrical nerve stimulation).
• Moist heat- Hot packs.
• Lumbar corsets.
• Spinal manipulation
• Exercises to strengthen stretch and condition the back muscles- It is generally recommended in chronic cases. Usually exercise is not performed in acute cases of low back pain. Commonly performed exercises include-
Spinal extension exercises, pelvic tilts, abdominal curls, back rotation exercises.

CERVICAL HEADACHE

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Headache is a very common symptom experienced by 90% of the population at least once in their lifetime. There can be many causes of headache, out of which cervical headache is the one. Cervical headache originates in the neck or suboccipital region and radiates upwards in the head, more commonly in frontal, temporal and retro orbital region. It can be unilateral or bilateral and can be accompanied by nausea or lightheadedness. In benign cases, there are intermittent bouts of headache with painfree periods in between. It relates more commonly to sustained neck posture, postural stresses, degenerative joint disease or trauma. Accurate diagnosis of cervical headache is a must; it must be differentiated from tension headache and migraine. Often many treatment modalities have been recommended for its cure, physiotherapy is one such treatment for the same.

Gaining full range of painfree motion in the cervical region, with tonically active cervical muscles, deep neck flexors and scapular muscles is the goal of the physiotherapy treatment program. Postural correction is an important component of this program aimed at efficient recruitment of the postural stabilizers and decreasing the activity in other muscles like levator scapulae.

HEALTHY 10 FACTS ABOUT EATING

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About 55% of our total calorie intake per day should come from carbohydrates and
1gm of carbohydrate gives 4
calories.
Complex carbohydrates
i.e. starchy food helps in staving off hunger pangs. They include Breads,
cereals, oatmeal, noodles, rice, millet, pasta and crackers
etc.
Fibre is a detox ingredient,
curbs craving for snacks, decreases risk of blood sugar and cancer, decreases
cholesterol levels and keeps gut
healthy.
Increase fiber intake
with fluids to let them pass the gut more
easily.
High fibre food-At least
6gms fibre/100gms.
Take at least
2-5 servings of fruit per day.
For weight loss, decrease intake of starchy vegetables and
vice-versa.
Cheese and peanuts
decrease acid on out teeth’s. Acid levels are increased by
raisins/toffees/caramels.
Milk
and cheese provides protection against
caries.
Lemon, oranges and lime
contribute to erosion of teeth enamel.

PRENATAL EXERCISES

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Regular exercise (at least three times per week) during pregnancy is extremely beneficial as exercise leads to potentially easier pregnancy and labour, improves cardiovascular fitness, decrease risk of gestational diabetes and promotes faster recovery from labour. It also helps in prevention of low back pain during pregnancy and weight gain. It also counteracts the post partum depression.
But certain precautions are to be taken care of while doing exercise in pregnancy like-

Avoid any vigorous exercise in hot and humid weather or during a period of febrile illness.
Avoid jerky, bouncy motions.
Exercise should be done on a wooden floor or tightly carpeted surface to reduce shock and provide a sure footing.
Exercise should include a five minute warm up period of muscle warm up and should follow a cool down period at the end of exercise session.
Maintain adequate hydration levels during exercise.
Ensure proper body mechanics of posture and lifting.
After first trimester of pregnancy, avoid exercise in supine or back lying position.
Women with a history of sedentary lifestyle should begin with low intensity exercises and progress gradually.

RECOMMENDED EXERCISES

· Leg sliding exercises.
· Pelvic tilts
Postural exercises
· Stretching at various joints of the body.
· Modified upper and lower limb strengthening exercises.
Pelvic floor exercises
· Kegel exercises
· Pelvic clock exercises
Breathing exercises
· Diaphragmatic and abdominal breathing.

Before starting any exercise program it’s important to get permission from your doctor to rule out any CONTRAINDICATIONS

WARNIG SIGNS to stop exercise-
· Shortness of breath
· Dizziness
· Headache
· Calf swelling
· Chest pain
· Bleeding/Amniotic fluid leakage.
· Unusual abdominal, back or pubic pain