Tuesday, June 24, 2014

BACK PAIN (All you need to know)

Back pain is one of the most common medical problems, affecting 9 out of 10 people at some point during their lives. Back pain can range from a dull, constant ache to a sudden, sharp pain. This pain or discomfort can happen anywhere in your back, the most common area affected is your low back. This is because the low back supports most of your body's weight. Acute back pain comes on suddenly and usually lasts from a few days to a few weeks. Back pain is called chronic if it lasts for more than three months.

                                                 

Acute Low Back Ache

Acute low back pain is most often caused by a sudden injury to the muscles and ligaments supporting the back. The pain may be caused by muscle spasms or a strain or tear in the muscles and ligaments.

Causes of sudden low back pain include:

1. Compression fractures to the spine from osteoporosis
2. Cancer involving the spine
3. Fracture of the spinal cord
4. Muscle spasm (very tense muscles)
5. Ruptured or herniated disk
6. Sciatica (numbness/ tingling running down the leg)
7. Spinal stenosis (narrowing of the spinal canal)
8. Spine curvatures (like scoliosis or kyphosis), which may be inherited and seen in children
9. Strain or tears to the muscles or ligaments supporting the back



chronic low back ache

It may result from arthritic (wear and tear  that occurs over the year) changes, which may be due to -

1. Heavy use from work or sports
2. Past injuries and fractures
4. Surgical intervention of the spine in the past
5. Discal changes over the years resulting from herniation of disc which once upon a time was an acute problem

other causes can be..

6. long standing cases of scoliosis and kyphosis
7. Medical problems, such as fibromyalgia, rheumatoid arthritis, and psoriatic arthritis


Symptoms

Low back pain can vary widely. The pain may be mild, or it can be so severe that you are unable to move.A variety of symptoms depending upon the cause can appear in the back, buttock region, thigh and at times till toes. You may have a tingling or burning sensation, a dull achy feeling, or sharp pain, weakness in your legs or feet.



You are at greater risk for low back pain if you:

1. Are over age 30
2. Are overweight
3. are pregnant
4. Do not exercise
5. Feel stressed or depressed
6. Have a job in which you have to do a lot of heavy lifting, bending and twisting, or that involves whole body vibration (such as truck driving or using a sandblaster)
7. Smoke



                                                      BACK CARE AT HOME

A common myth about back pain is that you need to rest and avoid activity for a long time. In fact, doctors do not recommend bed rest. If you have no sign of a serious cause for your back pain (such as loss of bowel or bladder control, weakness, weight loss, or fever), stay as active as possible.

                                                

Here are tips for how to handle back pain and activity:

1. Stop normal physical activity for only the first few days. This helps calm your symptoms and reduce swelling (inflammation) in the area of the pain.
2. Apply heat or ice to the painful area. Use ice for the first 48 to 72 hours, then use heat.
3. Take over-the-counter pain relievers such as ibuprofen or acetaminophen.
4. Sleep in a curled-up, fetal position with a pillow between your legs. If you usually sleep on your back, place a pillow or rolled towel under your knees to relieve pressure.
5. Do not do activities that involve heavy lifting or twisting of your back for the first 6 weeks after the pain.
6. Do not exercise in the days right after the pain begins. After 2 to 3 weeks, slowly begin to exercise again.

A physiotherapist can teach you which exercises are right for you.

                                                           

A complete exercise program should include aerobic activity (such as walking, swimming, or riding a stationary bicycle), as well as stretching and strength training. Follow the instructions of your physiotherapist.

Begin with light cardiovascular training. Walking, riding a stationary bicycle, and swimming are great examples. These types of aerobic activities can help improve blood flow to your back and promote healing. They also strengthen muscles in your stomach and back.

Stretching and strengthening exercises are important in the long run. Keep in mind that starting these exercises too soon after an injury can make your pain worse. Strengthening your abdominal muscles can ease the stress on your back. A physiotherapist can help you determine when to begin stretching and strengthening exercises and how to do them.

Avoid these exercises during recovery, unless your doctor or physiotherapist say it is okay:

Jogging
Contact sports
Racquet sports
Golf
Dancing
Weight lifting
Leg lifts when lying on your stomach
Sit-ups

TAKING MEASURES TO PREVENT FUTURE BACK PAIN

To prevent back pain, learn to lift and bend properly. Follow these tips:

If an object is too heavy or awkward, get help.
Spread your feet apart to give you a wide base of support.
Stand as close as possible to the object you are lifting.
Bend at your knees, not at your waist.
Tighten your stomach muscles as you lift or lower the object.
Hold the object as close to your body as you can.
Lift using your leg muscles.
As you stand up while holding the object, do not bend forward.
Do not twist while you are bending to reach for the object, lifting it up, or carrying it.

Other measures to prevent back pain include:

Avoid standing for long periods. If you must stand for your work, place a stool by your feet. Alternate resting each foot on the stool.
Do not wear high heels. Wear shoes that have cushioned soles when walking.
When sitting, especially if using a computer, make sure that your chair has a straight back with an adjustable seat and back, armrests, and a swivel seat.
Use a stool under your feet while sitting so that your knees are higher than your hips.
Place a small pillow or rolled towel behind your lower back while sitting or driving for long periods.
If you drive long distance, stop and walk around every hour. Do not lift heavy objects just after a long ride.
Quit smoking.
Lose weight.
Do exercises to strengthen your abdominal muscles. This will strengthen your core to decrease the risk of further injuries.
Learn to relax. Try methods such as yoga, tai chi, or massage.



(courtesy-NIH-US)


If the symptoms doesn't improve contact PAIN FREE PHYSIOTHERAPY CLINIC.

Dr. Roshan Jha(PT)
Sr. Physiotherapist
Pain Free Physiotherapy Clinic

Saturday, June 21, 2014

Role of Physiotherapy in Elderly People (Geriatric Population)

                                                   
Physiotherapy keeps elderly physically active

Regular physical activity has been shown to have important beneficial effects on physical and mental well being across all age groups. There are very few medical conditions that regular exercise doesn't help to prevent, reduce the risk of developing, or improve symptoms.
Physical activity in older adults can benefit from participation in regular physical activity. The potential effects of exercise on the health of older adults include:

1. Reduced risk of developing coronary heart disease, stroke, certain types of cancers and diabetes,  these       problems come under non communicable disease (NCDs),
2. Prevention of post-menopausal osteoporosis and protection against osteoporotic fractures by reducing the     risk of falls,
3. A reduction in accidental falls,
4. A reduction in loneliness and isolation, along with a reduction in depression, which may be as effective as       antidepressants,
5. A reduction in the complications of immobility, such as deep vein thrombosis and pressure sores.

                   


Being active from an early age can help prevent many diseases just as regular movement and activity can help relieve the disability and pain associated with these conditions.  Importantly, the benefits of physical activity can be enjoyed even if regular practice starts late in life. It has been suggested that older adults engaged in regular physical activity demonstrate improved:

1. Balance
2. Strength
3. Coordination and motor control (better control over daily activities)
4. Flexibility
5. Endurance (carry out activities for longer duration without much fatigue)

Consequently, physical activity can reduce falls risk, a major older age cause of disability.



Physical activity has also been shown to improve mental health and cognitive function in older adults and has been found to contribute to the management of disorders such as depression and anxiety. Active lifestyles often provide older people with regular occasions to make new friendships, maintain social networks, and interact with other people of all ages.


Type of exercise recommended for older adults:

1. Aerobic activity depending upon older adult's aerobic fitness,
2. Activities that maintain or increase flexibility are recommended, and
3. Balance exercises are recommended for older adults at risk of falls.

                                             

Implications of maintaining physical activity in older adults:

Reducing and postponing age-related disability is an essential public health measure and physical activity can play an important role in creating and sustaining well-being at all ages.

Move for health’ is WHO’s world health initiative and response to the fact that:

1. Each year at least 1.9 million people die as a result of physical inactivity.
2. At least 30 minutes of regular, moderate-intensity physical activity on 5 days per week reduces the risk of     several non-communicable diseases (NCDs).
3. Physical inactivity is an independent modifiable risk factor for common NCDs.
4. More than 35 million people died of NCDs in 2005 - this represented 60% of all deaths worldwide.
5. 80% of deaths from NCDs occur in low- and middle-income countries.
6. Without action to address the causes, deaths from NCDs will increase by 17% between 2005 and 2015.


Feel free to contact PAIN FREE PHYSIOTHERAPY CLINIC for management of fall, increase flexibility and control, endurance and strength and exercises for osteoporosis in elderly people.

Dr. Roshan Jha (PT)
Sr. Physiotherapist
Pain Free Physiotherapy Clinic

Sunday, June 15, 2014

Neck Pain

The cervical spine (neck) consists of several pairs of joints which makes the cervical spine particularly vulnerable to injury because it sits between a heavy head and a stable thoracic spine and ribs. 

Pain is felt in the neck itself but it may also be referred to the shoulders or arms. If it starts suddenly after exertion and it is exaggerated by coughing and straining. think of a disc prolapse. Chronic or recurrent pain in older people is usually due to chronic disc degeration or spondylosis. These symptoms are often a result of nerves becoming pinched in the neck.
                                                           

It is always necessary to enquire if any posture or movement makes it worse or better. Stiffness may be either continuous or intermittent.Sometimes it is so severe that the patient can scarcely move the head. Deformity usually appears as a wry neck, occasionally the neck is fixed in  flexion. Numbness, tingling and weakness in the upper limb may be due to pressure on a nerve root; weakness in the lower limbs may result from cord compression in the neck.

Headache sometimes emanates from the neck, but if this is the only symptom other causes should be suspected. Tension is often mentioned as a cause of neck pain and occipital headache. Sometimes pain in the neck is worsened with movement of the neck or turning the head.

Other symptoms associated with some form of neck pain are tenderness, sharp shooting pain, difficulty swallowing, pulsations,dizziness or light headedness and lymph node(gland) swelling.

Diagnosis

In diagnosing the cause of neck pain, it is important to review the history of the symptoms such as location, intensity, duration and radiation of the pain, any past injury of the neck as well as the aggravating and relieving factors. Further testing can be done through X-ray, CAT scan, bone scan, MRI, EMG, NCV etc.

Treatment

Treatment depends on its precise cause. Treatment options include rest, heat or cold application, traction, physical therapy (ultrasound, massage, manipulation, mobilisation etc.), application of anaesthetic creams, topical pain relief patches and muscle relaxants.
                                                     

Home remedies 

Neck pain can be relieved by exercises and stretches, proper neck posture maintenance, neck pain can relief through products such as cervical pillows which are used during sleep. Hot pads can be very beneficial for relief of some forms of neck pain.

                                               

For further assistance/query contact PAIN FREE PHYSIOTHERAPY CLINIC (8800299652)

Dr. Aryasmita Mohapatra (PT)
MPT (Ortho), MIAP
PAIN FREE PHYSIOTHERAPY CLINIC

Sunday, June 1, 2014

Flexible Flatfoot in Adults

                        The Flexible Flatfoot in the Adults

The adult acquired flatfoot deformity is characterized by flattening of the medial longitudinal arch with insufficiency of the supporting posteromedial soft tissue structures of the ankle and hindfoot.

Aetiology

                                                      


Although the etiology of this deformity can be arthritic or traumatic in nature, it is most commonly associated with posterior tibial tendon dysfunction (PTTD). Developmental etiologies also may be responsible for a flexible flatfoot deformity. These include conditions associated with soft tissue laxity (Ehlers-Danlos and Marfan syndromes), accessory navicular, and neuro-muscular diseases. Extrinsic factors are less common but can result from trauma involving the medial structures in an eversion type injury.

Two potential mechanical causes of an acquired flatfoot deformity include medial column instability and a contracture of the Achilles tendon or gastrocnemius fascia. With the former, medial column instability results in forefoot varus and a compensatory hindfoot valgus. With the latter, a tight Achilles tendon or gastrocnemius fascia results in transmission of dorsiflexion forces from the ankle to the transverse tarsal joint and midfoot. This leads to midfoot collapse and hindfoot valgus with lateral peritalar subluxation of the navicular and subfibular impingement.

Pathology

An acquired flexible flatfoot deformity is most often associated with Posterior Tibial tendon (PTT) dysfunction. Biomechanic overloading as described above can lead to chronic microtrauma in the tendon. With advancing age, the tendon’s elastic compliance decreases because of changes in collagen structure, thus creating a pathologic sequence where tendon weakening results in failure of the static stabilizers of the arch. Poor blood supply may initiate this process or may prevent an adequate healing response, resulting in chronic inflammation, tenosynovitis, and tendinosis.

Clinical Examination

Patients usually complain of medial ankle and hindfoot pain that radiates to the arch of the foot or proximally to the leg. As the deformity progresses, there may be a complaint of lateral or sinus tarsi pain caused by subfibular impingement. Although some patients will attribute a nonspecific traumatic event to the pain, most patients will relate a gradual onset of the pain with loss of the medial plantar arch over recent months or years.

On physical examination, it is helpful to evaluate the patient in short pants with both shoes off. This allows the clinician to note the alignment of not only the foot and ankle, but also the knee. With genu valgus, an individual’s center of gravity may be altered and more load may be placed on the medial ankle and PTT. Comparison of tread wear on the shoes may reveal more posteromedial wear than the opposite side. On examination of the standing patient from behind, the presence of hindfoot valgus can be noted and measured, and the “too many toes” sign can be identified. The patient should be asked to perform a double leg heel rise so that the presence or absence of hindfoot inversion can be identified. Next, the patient is asked to perform a single leg heel rise on the affected side noting that inability to do so is consistent with PTTD.
Examination sitting should include assessment of ankle and subtalar range of motion. Ankle motion should be measured with the knee extended and flexed with the transverse tarsal joint locked and unlocked. This will allow the examiner to assess for Achilles tendon and gastrocnemius contractures. Palpation of the posteromedial ankle and hindfoot may reveal tenderness, swelling, or fullness. The sinus tarsi, talar dome, and navicular tuberosity should be palpated. Callus formation over the subluxated talar head may be noted. For patients who have a flexible flatfoot, reduction of the talonavicular joint and correction of the hindfoot valgus/forefoot abduction is possible. Lastly, the PTT strength is tested with resistance against the inverted and plantarflexed foot.
                                                         


Diagnostic Imaging

Clinical examination and radiographs (in weight bearing Position) are usually sufficient to establish the diagnosis of PTTD. In certain instances, however, the use of MRI can be helpful to confirm the diagnosis, evaluate the amount of pathology in the PTT and spring ligament complex, and detect bone edema.

                                                 


STAGES of PTTD

Stage I consists of painful synovitis of the tendon. Nevertheless, tendon length and function are maintained so there is no deformity.
Stage II disease, there is progressive tendon dysfunction and a flexible flatfoot deformity develops.
Stage III involves a rigid deformity with stiffness and often arthritis of the midfoot and hindfoot.
Stage IV consists of tibiotalar valgus, usually with associated arthritic changes.

Conservative Treatment


The stage and progression of the flatfoot deformity will generally determine the degree and duration of the conservative treatment. The initial treatment of the adult flexible flatfoot deformity (stage II PTTD) focuses on improving symptoms by decreasing the forces transmitted through the posteromedial hindfoot. The patient should be encouraged to lose weight, modify repetitive loading activities, and use supportive shoes.
(Eric Giza, MDa,*, Gerard Cush, MDb, Lew C. Schon, MD)