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Total Knee Replacement Rehabilitation
Total Knee Replacement Rehabilitation aims at preventing hazards of bedrest, assist with adequate functional ROM and strengthening knee musculature to obtain independent activities of daily living.
Indications for Total Knee Arthoplasty
disabling knee pain with functional impairment radiographic evidence of significant arthritic involvement failed conservative measures including ambulatory aids (canes), NSAIDS, and lifestyle modification.
Contraindications for Total Knee Replacement Absolute
Goals Of Total Knee Replacement Rehabilitation Prevent hazards of bedrest like DVT, pulmonary embolism, pressure ulcers. Assist with adequate and functional range of motion. Strengthen the knee musculature. Assist patient in achieving functional independent activities of daily living.
joint infection sepsis or systemic infection neuropathic arthropathy painful solid knee fusion (usually due to RSD. RSD is not helped by additional surgery)
severe osteoporosis debilitated poor health nonfunctioning extensor mechanism significant peripheral vascular disease
A total knee replacement (TKR) is usually done as the surgical treatment option for advanced osteoarthritis of the knee joint.During the surgery, the knee joint is replaced with artificial material. The knee joint is made up of the femur (thigh bone), the tibia (shin bone), the patella (knee cap) and cartilage (usually worn out because of OA).The end of the femur is removed and replaced with a metal surface and the top of the tibia is removed and replaced with a plastic piece that has a metal stem. If the knee cap has also degenerated, a plastic piece may be added to the back surface to create a smoother joint surface.
Independent ambulation with an assistive device.
Perioperative considerations for Total Knee Replacement Rehabilitation Component design, fixation method, operative technique (osteotomy, extensor mechanism technique), bone quality will all affect perioperative rehabilitation. Implant can be posterior cruciate ligament (PCL) retaining, PCL sacrificing, or PCL sacrificing with substitution. Rehabilitation of Patients with Hybrid Ingrowth Implant versus those with Cemented knee Implant Cemented Total Knee Arthroplasty
Hybrid or Ingrowth Total Knee Arthroplasty
Touch down weight bearing (TDWB) only with walker for first 6 weeks. Next 6 weeks, begin crutch walking with weight bearing as tolerated. Surgeon's preferences may be different. Total Knee Replacement Rehabilitation Outline Preoperative Physical Therapy
Review bed to chair transfers, bathroom transfers, tub transfers with tub chair at home. Teach postoperative knee exercises and give patient handout. Teach ambulation with assistive devices TDWB or WBAT at the discretion of the surgeon. Review precautions.
Inpatient Total Knee Replacement Rehabilitation Goals
FOLLOW THE VIDEOS FOR BETTER UNDERSTANDING OF THE EXERCISES IN Total Knee Replacement Rehabilitation Ankle pump
Initiate isometric exercises.
0-90 degree ROM in the first 2 weeks before discharge from an inpatient setting. Rapid return of quadriceps control and strength to enable patient to ambulate without knee immobiliser. Rapid mobilisation to minimize risk of bedrest.
Quads sets Lie on your back with legs straight, together, and flat on the bed, arms by your side. Perform this exercise one leg at a time. Tighten the muscles on the top of one of your thighs. At the same time, push the back of your knee downward into the bed. The
Ability for weight bearing as tolerated (WBAT) with walker from 1 day postoperative.
3 result should be straightening of your leg. Hold for 5 seconds, relax 5 seconds; repeat 10 times for each leg.
SLRThis exercise helps strengthen the quadriceps muscle also. Bend the uninvolved leg by raising the knee and keeping the foot flat on the bed. Keeping your involved leg straight, raise the straight leg about 6 to 10 inches. Hold for 5 seconds. Lower the leg slowly to the bed and repeat 10-20 times. Once you can do 20 repetitions without any problems, you can add resistance (ie. sand bags) at the ankle to further strengthen the muscles. The amount of weight is increased in one pound increments.
Ice: Ice may be used during your hospital stay and at home to help reduce the pain and swelling in your knee. Pain and swelling will slow your progress with your exercises. A bag of crushed ice may be placed in a towel over your knee for 15-20 minutes. Your sensation may be decreased after surgery, so use extra care. Day 2-2 weeks
Continue isometric exercises throughout Total Knee Replacement Rehabilitation. Perform vastus medialis oblique (VMO) strengthening by terminal knee extension-Lie on your back with a blanket roll under your involved knee so that the knee bends about 3040 degrees. Tighten your quadriceps and straighten your knee by lifting your heel off the bed. Hold 5 seconds, then slowly your heel to the bed. You may repeat 10-20 times. Begin gentle passive ROM exercises for knee- knee extension, knee flexion, heel slides, wall slides. Begin patellar mobilization techniques when incision stable to avoid contracture. Perform active hip abduction and adduction exercises. Continue active and active assisted knee ROM exercises. Continue and progress these exercises until 6 weeks after surgery. Give home exercises with outpatient physical therapist following patient 2-3 times per week. Plan discharge when ROM of involved knee is from 0-90 degrees and patient can independently execute transfers and ambulation.
Continue previous exercises.
Ambulate twice a day with knee immobilizer, assistance, and walker. Cemented prosthesis: Weight bearing as tolerated (WBAT) with walker. Noncemented prosthesis: TDWB with walker. Transfer out of bed and into the chair twice a day with leg in full extension on stool or another chair. CPM machine- Do not allow more than 40 degrees of flexion on settings until after 3 days. Usually 1 cycle per minute. Progress 5-10 degrees a day as tolerated. Initiate active ROM and active assisted ROM exercises. During sleep place a pillow under the ankle to help passive knee extension.
or agility to step over tub for showering.4 Continue walking with walker until otherwise instructed by surgeon. In revision surgery. m ar Many patients lack sufficient strength. Place tub chair as far back in tub as possible. Obtain pain free range of motion within safe limits. Gain functional strength. Expansion osteotomies allow the insertion of a larger prosthesis. Perform cone walking with progression. These patients should avoid SLR (straight leg raise) and side-leg-lifting until. ROM. For example. Caution should be exercised in rehabilitation in these circumstanses. and then lifts the leg over. Driving is not allowed for 4-6 weeks. Orient family to patient's needs. . sits on the chair. Patient backs up to the tub. weight-bearing should be delayed until some union is present. Begin closed chain knee exercises on total gym and progress over 4-5 weeks for bilateral lower extremities.Treatment may also have to be adjusted according to difficulty of initial fixation. Similarly.Posterior Approach Goals of Hip Replacement Rehabilitation Guard against dislocation of the implant. In patients with these osteotomies. Prescribe prophylactic antibiotics for possible eventual dental or urological procedures. Hip Replacement Rehabilitation Protocol. Perform wall slides and lunges. abilities. and reduction osteotomies allow narrowing of the proximal femur normally. Ku Begin weight bearing as tolerated with ambulatory aid. Abduction brace may be used to prevent adduction and flexion of more than 80 degrees for upto 6 months in case of recurrent dislocations. facing the faucets. Tub mats and nonslip stickers for tub floor traction also are recommended. Review tub transfers in Total Knee Replacement Rehabilitation 6 weeks onwards in Total Knee Replacement Rehabilitation Hip Replacement Rehabilitation Vi Hip Replacement Rehabilitation might also have to be adjusted because ofstability. leg shortening through a hip at the time of revision with or without a constrained socket should be protected with an abduction brace until the soft tissues tighen up. Perform step ups. na y The Hip Replacement Rehabilitation protocols mentioned here for are general and should be tailored to specific patients. weight bearing should be limited to toe touch in osteotomy of the femur. Progress to stationary bicycling. if this has not already begun. surgeon agrees that it is safe to do so. a stable press-fit acetabular component may be difficult to achieve and multiple-screw fixation may be required. and limitations.
Preoperative Instructions Postoperative Hip Replacement Rehabilitation Regimen Patient should be made to come out of bed in stroke chair twice a day with assistance within 1 or 2 days postoperatively. Isometric and bed Exercises (Hip Replacement Rehabilitation) Vi na y Straight Leg Raise (SLR). pneumonia. pulmonary embolism. with higher part at the back. Avoid crossing legs while sitting. keeping the knee straight. Begin ambulation with assistive device (walker) twice a day. decubitus ulcer.Pump ankle up and down repeatedly. this can be achieved by placing a cushion in the wheelchair seat with highest cushion point posterior. Quadriceps Sets. Isometric hip abduction with self resistance while lying. Rehabilitation Considerations in Cemented and Cementless Techniques > In cemented total hip Weight Bearing To Toleranance (WBTT) with walker should be started immediately after surgery. Avoid deep chairs. to aid in rising. The patient should be turned 30 degree towards prone to Ku Instruct on precautions for hip dislocation (mentioned later). Teach transfers and ambulation independently or with assistive devices. Flex the opposite knee to aid this exercise. Perform this exercise while lying on one side (56 weeks postoperatively). Hip abduction adduction. m ar . Prevent bedrest hazards (eg. While lying on the back patient can slide the leg to the side. then use cane in the contralateral hand for 4-6 months.Squeeze buttocks together and hold for a count of 5. Chair should not be of low height. Cementeless Prosthesis: Touch down weight bearing with walker for 6-8 weeks.5 Strengthen hip and knee musculature. While rising from a chair scoot to the edge of the chair and then rise. Also instruct the patient to look at the ceiling as they sit down to minimize trunk flexion. > Weight bearing recomendations in Hip Replacement Rehabilitation Cemented Prosthesis: Weight bearing as tolerated with walker for atleast 6 weeks.Tighten knee and lift leg off the bed.(Prevent initially if patient had a trochanteric osteotomy). Provide instructions for transfers in and out of bed and chair.Tighten quadriceps muscles by pushing knee down and holding for a count of 5. Use elevated commode seat. In standing this can be done by moving the leg out to the side and back. For ambulation instruct on use of anticipated assistive device. Wheelchair must be used for long distances with careful avoidance of excessive hip flexion greater than 80 degrees while in wheelchair. thrombophlebitis). then use a cane in contralateral hand for 6 months. Elevated seat is placed on commode at a slant. Ankle Pumps. Gluteal Sets.
Bed to Chair. Slowly thrust the pelvis forward and the shoulders backward for a sustained stretch of the anterior capsule. Until successful completion of a full arc on the bicycle. Slide hips forward to the edge of the chair first. If available hold the handrail. >Assistive devices used in Hip Replacement Rehabilitation Transfer Guidances Vi Stair training in Hip Replacement Rehabilitation Going up stairs. Perform extension stretching of the anterior capsule in standing by extending the involved leg while the uninvolved leg is mildly flexed at the hip and knee. The seat may be progressively lowered to increase hip flexion within safe parameters. 5-6 times a day. secure transfers. Pull the uninvolved leg to the chest while lying supine on the bed. push the involved leg against the bed. Always use elevated commode seats. Ku m 1 to 2 days postoperative.6 utilize gluteus maximus and medius muscles. na y >Use "reacher" or "grabber" to help retrieve objects on the floor. begin Thomas stretch to avoid flexion contracture of the hip. At the same time. thus abducting with the tensor fascia femoris. then bring both crutches up on the step. This stretches the anterior capsule and the hip flexors of the involved leg. it may then be safely discontinued. Bathroom. Bathroom Rehabilitation : Permit bathroom privileges with assistance and an elevated commode seat. Perform this stretch 5 times per session. Use the abductor pillow while asleep or resting in bed for 5-6 weeks. supported by the walker.Avoid leaning forward to get out of chair or off bed. Do not cross legs when pivoting from supine to bedside position. Therapist or nurse assists until able to perform safe. ROM and Stretching Exercises (Hip Replacement Rehabilitation) Abduction Pillow Keep an abduction pillow between the legs while in bed. Continue assistance until able to perform safe. secure transfers. Shoe horn and loosely fittings shoes or loafers. Most patients would otherwise tend to rotate towards the supine position. ar . Do not bend to put on slippers. Patient may start with exercising on stationary bicycle depending on trunk stability with a high seat 4-7 day postoperative.Step up first with the uninvolved leg. then come to standing. the seat should be set as high as possible.Use elevated toilet seat with assistance. keeping crutches on the step below until both feets are on the step above. Teach bathroom transfers when the patient is ambulating 10-20 feet outside of room.
hold the rail. If possible. Make the patient stand on involved leg with flexed opposite knee. have patient try to lift and hold in an effort to reeducate and work gluteus medius muscle. Ensure home physical therapy has been arranged. Initiate general strengthening exercises. narrow doorways. stairways. Review rehab specific for home situation. ar . Perform Thomas Stretch 30 times a days. Ku Continue with the previous exercises and ambulation activities. Evaluate leg-length discrepancy.7 Going down stairs. Perform prone lying extension exercises of the hip to strengthen the gluteus maximus. develop endurance and perform cardiovascular exercises. m At 5-6 week. Progress hip abduction exercises until the patient exhibits a normal gait with good abductor strength. and then with the uninvolved leg. then step down with the involved leg. if clinically safe. If opposite hip drops. Continue to observe precautions. Walking backward helps stretch flexion contracture.steps. as well as lateral step ups with a low step. These may be performed with the knee flexed (to isolate the hamstrings and gluteus maximus) and with the knee extended to strengthen the hamstrings and gluteus maximus. sports cords or weights. AVOID na y Concentrate on hip abduction exercises to strengthen abductors. like. Avoid placing pillow under the knee after surgery.Place crutches on the step below. Install elevated toilet seat at home. Precautions After Total Hip Replacement Following points must be explained clearly during Hip Replacement Rehabilitation. Also may perform side stepping with a sports cord around the hips. Avoid driving for minimum 6 weeks. Exercise Progression in Hip Replacement Rehabilitation : Instructions for Home in Hip Replacement Rehabilitation Managing Problems After Total Hip Replacement : 1-Trendelenburg Gait(weak hip abductors) 2-Flexion Contracture of the Hip Vi The above mention Hip Replacement Rehabilitation Protocol should be tailored to individual patients need and performed in guidance of a physical therapist. begin standing hip abduction exercises with pullys. Supply walker for home. Patient should have prescription of prophylactic antibiotics that may be needed eventually for dental or urologic procedures.
These bloopers are hilarious Relaxation Relaxed Passive Mobilization Vi The patient is placed in supine position with the affected shoulder in maximum possible abduction and neutral rotation and elbow in 90 degree of flexion. The physiotherapist grasping the arm above the shoulder joint carries out relaxed passive gliding movement of head of humerus on glenoid. Slow and rhythmic circumduction at the glenohumeral joint. in forward stoop position effectively induces relaxation and promotes mobility. Axial traction and approximation is carried out along with antero-posterior glide and abduction. Restorative Programme : The basic aim of frozen shoulder exercises are: i) Relaxation ii) Passive mobilization technique iii) Specific frozen shoulder exercises to offer graduated stretching. To increase extensibility of the thickened and contracted capsule of the joint at the anteroinferior border and at the attachment of the capsule to the anatomical neck of humerus. The reduction in pain occurs because of the neuro-modulation effect on the mechanoreceptors with in the joint. Ku Mobilization is attained by 3 basic approaches: m To reduce pain. ar . Bringing the knee too close to your chest. However ultrasound. To induce relaxation.8 Crossing your legs or bringing them together(adduction). Shoulder Rehab Exercises You Can Do with The Rotater .adduction glide.extreme hip flexion ( you can bend until your hand gets to your knee). Gentle relaxed passive movements reduces pain and pathologic limits of motion. To improve mobility of the shoulder. always begin with slow rhythmic movement. one may use the heat modality suitable to the patient's response. and improve strength of the rotator cuff muscles. Frozen Shoulder Exercises Frozen Shoulder Exercises aim to reduce pain. beside deep heating. has the added advantages of increasing excitability of the contracted soft tissue and is therefore performed. However it may be remembered that strengthening of muscle is secondary to mobilization. increase extensibility of the capsule. na y Though prior heating of the joint has been found to facilitate relaxation and mobilization. To improve strength of the muscle.
abduction and external rotation. manipulation and mobilising techniques are given by "MAITLAND". Patient having diabetes responds very slow to the treatment and also feel much more pain as compared to those who are non-diabetic. While planning the frozen shoulder exercises one must give due importance to the fact that contracted soft tissue when objected to repeated prolong mild tension show extensibility and plastic elongation. the patient uses his normal or contralateral arm for gradually stretching the affected shoulder. sterno-clavicular and/or scapulothoracic joint articulation is also extremely helpful. The importance or necessity of regular stretching must be explained to the patient even after he had recovered from stiffness and pain to avoid the recurrence of periarthritis or stiffness. adduction and elbow flexion i. Ku The specific Frozen shoulder exercises should include the maximum number of combination of various movement by minimising the number of exercises. Frozen Shoulder Exercises for Home and Cautions: Vi na y By weight and pully.Tolerable weight must be used. The above mentioned Frozen shoulder exercises can be done in two ways: Passive Mobilization Technique For this. Shoulder Pain Pendulum Exercise . Graduated relaxed sustained stretching based on the PNF pattern are following types: m An increase in the movement following the session of prolonged stretching was usually associated with a corresponding increase in the other movements too.9 Mobilization by accessory movements of acromio-clavicular. ar . By self assisted stretching.Click here for more amazing videos Exercise Programme Frozen shoulder exercises plays an important role in management of the condition. Shoulder elevation with flexion. However improvement in the range of other movements is not always at the same rate. Shoulder internal rotation with extension. This may be done in supine or sitting position.Method of performing is. Patient who are complaining of pain in the night (nocturnal pain) should be treated by heat therapy or thermo therapy. By this patient respond very well for acquiring full range by properly guided simple and specific Frozen shoulder exercises which ensures relaxed graduated stretching of the contracted capsule.e attaining "hand to lumbar position".
Adhesive capsulitis is associated with medical conditions such as diabetes. moving the patient from the frozen stage into the thawing phase. Neviasernamed the condition "adhesive capsulitis" based on the radiographic appearance with arthrography. or a global loss of GH joint motion. and indeed there is some controversy over the criteria for diagnosing "frozen shoulder". Often. The onset of an idiopathic frozen shoulder has been associated with extended immobilization. a specific traumatic event is difficult for the patient to recall. Frozen Shoulder Introduction: Codman introduced the term "frozen shoulder" in 1934 to describe patients who had a painful loss of shoulder motion with normal radiographic studies. Stiffness occurs in a variety of conditions- na y Ku m The condition is common in people of 40-60 years age group. Most significant association is with Insulin dependent diabetes. with a higher incidence in females. Most patients will position the arm in adduction and internal rotation. This position represents the "neutral isometric position of relaxed tension for the inflamed glenohumeral capsule. and the final stage from 3-6 months. This stage is characterized by a slow recovery of motion. closed manipulation or surgical release may accelerate recovery. The final stage is the resolution or thawing phase. biceps.10 The contralateral or normal shoulder should always be examined and given regular stretching exercise programme as a precautionary measure to maintain its functional capacity. but typically the first stage lasts for 3-6 months. ischemic heart disease. ar . In 1946. Pain at night is a common complaint and is not easily treated with medications or physical modalities. The first stage is the freezing phase. Diagnosis: Vi Not every stiff or painful shoulder is a frozen shoulder. inflammatory arthritis and cervical spondylosis. which suggested "adhesion" of the capsule of th GH joint limiting overall joint space volume. As symptoms progress. characterized by onset of an aching pain in the shoulder. the second stage from 3-18 months. hyperthyroidism. Aggressive treatment with physical therapy frozen shoulder exercises. especially breast and chest wall procedures. there are fewer arm positions that are comfortable. a sharp acute discomfort can occur as the patient reaches the restraint of the tight capsule. leaving the patient with a shoulder that has restricted motion in all planes Activities of daily become severely restricted." The second stage is the progressive stiffness or frozen phase. When performing activities. The pain is usually more severe at night and with activities. and may be associated with a sense of discomfort that radiates down the arm. The stage can last from 3-18 months. Pain at rest usually diminishes during this stage. Adhesive Capsulitis is characterized by 3 stages: Length of each stage is variable. and rotator cuff. Patients with adhesive capsulitis have a painful restriction of both active and passive GH joint motion in all planes. and surgical trauma. relatively mild trauma.
the judicious use of GH joint corticosteroid injections. Ku Even though adhesive capsulitis is believed to be a "self limiting" process. Intra-articular corticosteroid injections help to abort the abnormal inflammatory process often associated with this condition.11 arthritic. Phase 1: Weeks 0-8 Goals No restriction or immobilization. as a result. For patients in the initial painful or freezing phase. and post operative. and a natural progression through three successive phases. the loss of external rotation with the arm at the patient's side is a hallmark of this condition. Initial treatment should include an aggressive frozen shoulder exercises to help regain shoulder motion.first line medication for pain control GH joint injection: corticosteroid/local anesthetic combination Oral steroid taper. corticosteroid injection and physical therapy. Pain Control Vi na y Relieve pain Restore Motion Frozen Shoulder Exercises (Rehabilitation Protocol): Medications NSAIDS. post-traumatic. post traumatic stiffness.for patients with refractive or symptomatic frozen shoulder. pain relief may be obtained with a course of anti-inflammatory medications. requires aggressive treatment once the diagnosis is made. Therapeutic modalities Ice. Frozen Shoulder Treatment: Operative intervention is indicated in patients who show no improvement after a three month course of aggressive management that includes medications. ultrasound. The loss of passive external rotation is the single most important finding on physical examination that helps to differentiate the diagnosis from a rotator cuff problem because problems of the rotator cuff generally do not result in a loss of passive external rotation. The diagnosis of frozen shoulder is clinical resting on two characteristic features. it can be severely disabling for months to years and. . m ar When the patient is seen first. diffuse stiffness and reflex sympathetic dystrophy. Painful restriction of movement in the presence of normal x-rays. a global loss of active and passive motion is present. rheumatic. HVGS Apply moist heat before therapy and ice pack at the end of session. a number of conditions should be excluded: infection. or therapeutic modality treatments. In general.
Motion: Frozen Shoulder Exercises Muscle strengthening Start with rotator cuff strengthening exercises 3 times per week. Active ROM exercises. active assisted and passive range of motion exercises to obtain around 140 degree of forward flexion. abduction and forward flexion. of 15-30 seconds. Progress to open chain strengthening exercises with theraband for same greoup of muscles. A sustained stretch. Active assisted ROM exercises. Improve shoulder motion in all plane Improve strength and endurance of rotator cuff and scapular stabilizers Pain Control by same means as used in 1st 8 weeks. external rotators. In home these Frozen Shoulder Exercises should be performed 3-5 times per day.12 Motion: Frozen Shoulder Exercises Phase 1: Weeks 8-16 Criteria for progression to Phase 2 Improvement in shoulder discomfort. Closed chain isometric strengthening with the elbow flexed to 90 degrees and the arm at the side. 8-12 repetitions for three sets. Deltoid strengthening. abductors and forward flexors. Perform strengthening of scapular stabilizers. Vi Phase 3: 4 months and beyond Criteria for progression to Phase 3 na y Perform active. Satisfactory physical examination. . 45 degree of external rotation and internal rotation to twelfth thoracic spinous process. Ku Goals m ar Initially focus on forward flexion and internal and external rotation with the arm at the side. Perform internal rotation. Improvement in shoulder motion. and the elbow at 90 degrees. Progress to light weight dumbbell exercises for internal rotators. external rotation. at the end ROMs should be part of all ROM routines. Passive ROM exercises.
Goals Please check with your Physical Therapist before starting with this frozen shoulder exercises. ROM exercises 2 times a day. Scapular stabilizer strengthening 3 times a week. patients may require surgical intervention Manipulation under anesthesia Arthroscopic release Vi na y Ku Treatment of Complications: m ar Home maintenance frozen shoulder exercises. Rotator cuff strengthening 3 times a week. . Satisfactory physical examination. Resolution of painful shoulder.13 Significant functional recovery of shoulder motion. Successful participation in activities of daily living. Warning Signs: Loss of motion Continued Pain These patients may need to move back to earlier routines May require increased utilization of pain control modalities as outlined above If loss of motion is persistent and pain continues.
m Heat Modalities Neck Exercises Manipulative Therapy Hydrotherapy Postural Awareness Relaxation cervical traction neck support ar . Treatment of cervical spondylosis. later osteophytes are formed in the periphery. this pain is along with tingling. The other terms used for this condition are Vi It is very common in persons above 50 years of age and those who have got to do work like typing or persons who have to keep the neck in one position as in reading. Generally. It starts with degeneration of disc resulting in. Cervical Osteoarthritis can be treated in physiotherapy department by various means like: Aims of Cervical Spondylosis Treatment Cervical Osteoarthritis refers to the degenerative condition of the cervical spine including the intervertebral joints in between the vertebral bodies and the vertebral discs. writing and other table works. This is followed by involvement of the posterior intervertebral joints resulting in pain in the posterior part of the upper limb. also known as Cervical Osteoarthritis by physical therapy modalities. reduced space in between two vertebrae.14 cervical spondylosis. na y Degenerative disc disease Degenerative spondylosis Osteopytosis Spondylitis deformans Cervical Osteoarthritis Introduction Ku To relieve pain To provide support to the neck To restore the neck movements in full range To re-educate the patient for posture correction To strengthen the cervical muscles To analyse the basic precipitating causes of the patient's problem and aim at alleviating those causative factors. numbness and radiating in nature.
They are: upper cervical spine flexors.Radiating pain. lower cervical spine extensors and side flexors. Predisposing Factors For Cervical Osteoarthritis Faulty posture adapted is associated with wrong habits. a) Upper cervical spine. e) Habit of holding phone on one shoulder while talking. anxiety or depression. 4)Sensation: There occurs paraesthesia that means. aching pain. The sections of society prone to stress and strain area) Officers. The segments commonly affected in the cervical region are C4 to T1. It occurs gradually due to faulty posture. Clinical Feature Of Cervical Osteoarthritis 1)Onset: The condition gets precipitated by fatigue. Usually. Ku Sites m ar Occupational stresses causes continous pressure on the cervical segments. worries. pain in shoulder girdle. stabbing pain and frequently occurs as cramping type. other parts of spine are also affected due to compensatory adjustments. using inappropriate pilows. sometimes gets exaggerated as sharp. pins and needles or altered sensation of the particular dermatome which is supplied by the impinged nerve root.15 The osteophytes formed may also compress the cord which will produce weakness of whole of the limb. Built of the body Persons having thick neck with a Dowager's Humpand long backs are much prone to spondylosis. the postural muscles of the neck are weak. either unilateral or bilateral. mental tensions. 3)Muscle weakness: Depending on which nerve root gets compressed. . b) Drivers prone to prolonged driving. d) Persons involved in occupations including lifting and carrying things on their head. anxiety and mental tension. Vi na y 2)Pain: The region of pain depends on the site where the cervical spine is affected by the pathology.Neck pain c) Region from C4 to T2. f) Sleeping in awkward positions. c) Coal miners and divers. typists and others working on poorly and wrongly positioned desks and tables. the concerned muscles that are supplied by that nerve root gets affected and weakened. 5)Nature of pain: Usually described as dull. Along with these sites. shoulder and arm.Headache b) Mid cervical spine.
The movement which gets very much limited is flexion of the upper cervical spine and extension of the lower cervical spine. 9)Postural disturbance: The posture gets disturbed in cervical osteoarthritis as follows 10) Cervical spondylosis is usually associated with headache. . Once the pain subside to a tolerable limit. The modalities that can be used are:a)Hot packs for moist heat. Early and proper diagnosis is necessary for Treatment Of Cervical Spondylosis/Cervical Osteoarthritis. The X-ray finding reveals that there is: Treatment for Cervical Spondylosis Heat Modalities Vi Heat is an effective mean of reducing and relieving pain in cervical osteoarthritis.16 6)Limitation of movement: All the neck movements get limited. Flexion of elbows and hand. As the middle and lower fibres of trapezius get lengthened and reduced in tone. 7)On palpation: It is detected that there is loss of mobility of soft tissues along with loss of movements of the accessory intervertebral structures. often bilateral but is unilateral in case of acute onset of pain. so tightness of upper cervical spine extensors. Imbalance results causing the upper trapezius to bear increased tone and hence there occurs muscle spasm and muscle tightness. Investigations The only investigation which can easily confirm the diagnosis apart from the symptoms of the patient is radiograph. Ankles dorsiflexed. then exercises should be started and progressed gradually according to the conditions and requirements of the patient. Kyphosis of thoracic spine.C6. m ar 8)Muscle spasm: There is spasm mostly of the scalene muscle usually unilaterally. Tight pectorals. na y Osteophyte formation at the margin of the apophyseal joints Reduced space between the vertebral bodies Lipping of the vertebral bodies Ku Stress at C5. vertigo and loss of balance which is due to postural changes. Flattened. Hip flexed and knee flexed. sometimes lordotic lumbar spine. Chin placed forward. b)SWD (pulsed or continous) for dry heat. Backward tilt of pelvis.
Continuous traction is used to relieve nerve root pressure. shoulder girdle should be stabilised so as to avoid trick movements. Picking up. This also stimulates the muscles and the receptors of the neck and shoulder joint to hold the head in a good position. This depends on the frequency of remissions and exacerbations of the condition. thus from the initial stage itself. wringing and skin rolling also helps in relieving the tightness of scalene muscles. Traction Oscillatory traction is considered to be effective in mobilizing the stiff neck. feet properly supported and arms resting on a pillow over the lap or on the arms of the chair. The traction can be given either in the form of manual traction or positional traction. The ideal posture is straight neck with chin tucked in and back straight with no compensatory actions or any trick movements. paravertebral muscles and trapezius. interspinous ligaments. neck and shoulder supported. postural awareness through proper advice and education should be planned and initiated by the physiotherapist. Postural Awareness Vi As the condition progresses. It can be given in sitting or lying position. a small pillow in the lumbar spine. na y Ku m ar .17 Static Contractions and Strengthening Exercises Isometric contractions of the cervical muscles improve the muscle endurance and tone as the contractions improve the blood supply thereby the nutrition to the muscle is increased and hence muscle strengthening is done. The pressure can be applied by the physiotherapist or by the patient himself after teaching him the technique properly. During all the movements. While sitting a high backed chair is provided to the patient with head. sitting on the float with both hands holding down the float is the preferred position. the abnormality of posture also increases. To relax the upper fibres of trapezius. patient is taught to push one hand then the other towards the feet in the float support lying position. The basic technique of this exercise is that both Physiotherapist and patient exert equal pressure so that static. Traction is always given in comfortable position with minimum weight which should be graduated slowly as for the patient's recovery. For the lower fibres of trapezius and serratus anterior. Hydrotherapy Float support lying in warm water is best for total relaxation and hence gain relief of muscle spasm. Soft tissue technique Kneading helps to release tightness of upper fibre of trapezius. non dynamic action takes place in the cervical muscles.
and diffuse idiopathic skeletal hyperostosis. side lying is the most preffered position. While relaxing the whole body should be fully supported by pillows. Heel spurs and plantar fasciitis can occur alone or be related to underlying diseases which cause arthritis (inflammation of the joints) such as Reiter's disease. Vi Heel Spur Causes Heel Spur or Calcaneal Spur is one of the most common causes of heel pain. supine lying is also adviced. A firm neck collar is very beneficial especially during activities or during travelling. Support Relaxation Due to pain and spasm of cervical muscle. . While patient is resting or sitting.18 While sleeping. While lying on bed. Continued overstrain of plantar fascia results in stripping of periosteum from its origin at the calcaneus. A single pillow under head for head support is allowed. It should be the last resort as there is always a risk factor involved. relaxation techniques are taught in various positions that is during rest. patient is always in discomfort and uneasiness. the collar should be removed but then also the neck should be supported by pillows or head rest. He is then encouraged to think of something pleasent which will facilitate comfortable and relaxed sleep. So to alleviate these undesirable situations. Thus calcaneal spur is a late sequale of plantar fascitis. as it is flattened in the middle where the head rests and the elevated ends support the head on the sides. The gap thus formed is filled by the proliferation of bone resulting in formation of a bony spur to secure the detached attachment. work or play. Surgery may be necessary for a patient suffering from cervical osteoarthritis if he/she has severe pain that does not improve from other conservative treatments. na y Ku Calcaneal Spur m ar Support for the neck are of great importance to keep the neck steady and to relieve the pain. ankylosing spondylitis. A Butterfly pillow is the best support for a patient of cervical osteoarthritis. patient is adviced to loosen his entire body and stretch for few times so as to reduce the muscular tension to a minimum.
When painful a sharp. ar The calcaneal spur may not be always painful. Ku m Heel bone spurs can be diagnosed with an X-ray foot where a bony outgrowth can be seen at the calcaneal bone near the attachment of plantar fascia. Relieve pain and inflammation: Use of ultrasound and contrast bath help reduce pain and inflammation. For chronic heel pain management or surgical advice consult a podiatrist. As a rule of thumb. The pain can become so severe that it becomes difficult to continue your daily work. Medications: Pain Relief Medications like analgesics and anti-inflammatory are advisable in acute as well as chronic cases. Radiological proof helps exclude other conditions like arthritis. . Resting on lateral border of the foot with cupping of the foot by curling of toes is effective in moulding longitudinal arch. performed even with shoes on provide an excellent technique of resistive exercises. The pain is typically relieved during rest. Exercises: The workout regimen should consist of mild stretches for strengthening of foot and calf muscles so as to reduce the tension on the heel mechanically. such as a suitcase. Strengthening exercises to the intrinsic muscles as sustained toe curling. Weight loss: Losing weight can reduce the extra pressure that plantar fascia bears with every step. but is worse after getting up again. Arch Supports and heel cups cushion to the heel. it is most painful first thing in the morning. Exercises to the intrinsic muscles in warm water in the morning before initiating weight bearing. stress fractures etc. Stimulation: Faradism can be an effective measure to induce contractions in the intrinsic muscles improving their tone. The pain is made worse by walking on a hard surface or carrying something heavy. Steroids and anesthetic injectables at the site of spur may be advised in severe ceases. Heel Spur Treatment Vi na y Rest: The intensity and duration of activity and weight bearing should be reduced. Staying off the feet can help a lot ( For example. Avoid walking barefoot: Shoes are a must to support the arch of the foot even when at home. this spur is permanent and attempts to remove it results in its recurrence. power and circulation.19 Heel Spur Symptoms Heel Spur Diagnosis Once formed. stabbing pain under or on the inside of the heel. and reduce the weight bearing on the foot during activities.heel raise walking while getting down from bed in morning or after long sitting ).
The degree of deformity is measured by the distance between the two medial femoral condyles when the patient is lying. When the patient is able to walk. Paget's disease and severe degree osteoarthritis of the knee. This is usually due to defective growth of the medial side of the epiphyseal plate. hamstrings and gluteus muscles are given. Strengthening exercises for quadriceps. or progressive worsening of the curvature. balancing. Treatment is indicated when its persists beyond 3 and half years old. he is given correct training for standing. It is commonly seen unilaterally and seen in conditions such asRickets. no treatment is required for idiopathic presentation as it is a normal anatomical variant in young children. During childhood. Unilateral presentation. Ku Mild degree of deformity can be treated by wearing surgical shoes with 3/8" outer raised and with a long inner rod extending to the groin and leather straps across the tibia and the knee. It is a deformity wherein there is lateral bowing of the legs at the knee. Some heat modalities may be given for relief of pain. weight transferring and walking. assure the proper intake ofvitamin D to prevent rickets.20 Genu Varum Genu Varum is also known as Bow Leg. m ar . Post operative Physiotherapy Vi na y Gradual knee mobilization is the main part of the treatment. The person would need to wear casts or braces following the operation. if necessary. Corrective operations can also be performed. Treatment of Bow legs Generally.
The pathology is identical in de Quervain seen in new mothers. Signs and symptoms of De Quervain tenosynovitis Patients with De Quervain tenosynovitis note pain resulting from thumb and wrist motion. The irritation causes the lining (synovium) around the tendon to swell. out of the plane of the hand -palmar abduction). Signs of De Quervain's tendinitis: na y Pathology of De Quervain tenosynovitis Ku The tendons of the abductor pollicis longus and the extensor pollicis brevis are tightly secured against the radial styloid by the overlying extensor retinaculum. This is particularly noticeable when forming a fist. such as rheumatoid disease. It may be found in inflammatory arthritis. redness. The inflammatory response occurs following injury and leads to the symptoms of pain. Vi The two tendons concerned are the tendons of the extensor pollicis brevis and abductor pollicis longus muscles. Also known as: . the speculative rationale for this is that women have a greater styloid process angle of the radius. m Radial styloid tenosynovitis de Quervain disease de Quervain's stenosing tenosynovitis mother's wrist and mommy thumb washerwoman's sprain ar . or when turning the wrist. This makes it difficult for the tendons to move as they should. grasping or gripping things. De Quervain is potentially more common in women. Evaluation of histological specimens shows a thickening and myxoid degeneration consistent with a chronic degenerative process. which contain them and allow them to exercise their function whatever the position of the wrist. Tendinitis may be caused by overuse. which changes the shape of the compartment. swelling and loss of function. De Quervain's tendinitis is usually most common in middle-aged women. along with tenderness and thickening at the radial styloid. The tendons run. which run side by side. It can be seen in association with pregnancy. have almost the same function: the movement of the thumb away from the hand in the plane of the hand—so called radial abduction (as opposed to movement of the thumb away from the hand. Crepitation or actual triggering is rarely noted. These two muscles.Etiology of De Quervain tenosynovitis De Quervain's tendinitis is caused when tendons on the thumb side of the wrist are swollen or irritated. Any thickening of the tendons from acute or repetitive trauma restrains gliding of the tendons through the sheath. heat. It is an inflammatory condition affecting the tendon sheaths (tenosynovitis) that pass over the wrist joint. in synovial sheaths. as do all of the tendons passing the wrist.21 De Quervain Tenosynovitis What is De Quervain tenosynovitis? : De Quervain tenosynovitis is an entrapment tendinitis of the tendons contained within the first dorsal compartment at the wrist.
If these interventions do not work. ice massage) to reduce the inflammation and edema ultrasound (ie. Physical therapy may also be used to retrain movements to avoid or change the method of those daily actions that caused the inflammation. Pain is felt in the wrist and can travel up the forearm. m The first dorsal compartment over the radial styloid becomes thickened and feels bone hard. A "catching" or "snapping" sensation may be felt when moving the thumb. This is the main symptom. ice and NSAIDs may provide relief and reversal of this condition. Tenderness and pain on axial loading are absent at the carpometacarpal (CMC) joint unless the patient has arthritis in that joint. Usually. Pain and swelling may make it difficult to move the thumb and wrist. What can a physical therapist do to help in De Quervain tenosynovitis? In acute stage Vi na y Provide a variety of hand splints to support the thumb and the wrist Help identify aggravating activities and suggest alternative postures Massage cryotherapy (eg. This is especially true when forcefully grasping objects or twisting the wrist. This swelling may occur together with a fluid-filled cyst in this region. ar Pain may be felt over the thumb side of the wrist. Numbness may be experienced on the back of the thumb and index finger. Treatment of De Quervain tenosynovitis Rest. Splinting with a thumb-spica splint may be necessary to reduce the movement of the wrist and lower joints of the thumb. Following the surgery physical therapy may still be required to retrain the movements that caused the injury. cold packs. especially if it is caught early enough. .22 Examination Tenderness is absent over the muscle bellies proximal to the first dorsal compartment. about an in inch below the wrist). The pain is usually worse when the hand and thumb are in use. DeQuervain's syndrome is likely. the examining physician grasps the thumb and the hand is ulnar deviated sharply. then a cortisone shot into the irritated area may be the next course of action. phonophoresis) or electrically charged ions (ie. This is caused as the nerve lying on top of the tendon sheath is irritated. The final step. iontophoresis) Ku Finkelstein's test is used to diagnose de Quervain syndrome in people who have wrist pain. If sharp pain occurs during Finkelstein test along the distal radius (top of forearm. if all other interventions fail. Swelling may be seen over the thumb side of the wrist. The pain may appear either gradually or suddenly. the area becomes tender. is surgery to release the tendons and provide more space for them to move. To perform the test. the compartment's thickening so distorts the sparsely padded skin in this area that a visible fusiform mass is created.
Splinting Sensory evaluation Therapeutic exercises—starting with ROM exercises. and as the patient progresses. or adhesions in the scar can cause neuritis in this high-contact area. Subluxation of released tendons is possible. Persistent entrapment symptoms are possible if the tendon slips of the abductor pollicis longus are mistaken for the tendons of the abductor pollicis longus and the extensor pollicis brevis. adding strengthening exercises Ergonomic workstation assessment as needed Educating the patient to either avoid or decrease repetitive hand motions. greatly limiting hand and wrist function. such as pinching. This complication is best avoided by carefully limiting the release to the thickest mid – 2 cm of the first dorsal compartment or by reconstructing a loose roof to the released sheath. turning. the tendons of a widely released first dorsal compartment snap over the radial styloid. This complication is best avoided through careful blunt dissection of the subcutaneous tissue and gentle traction. Ku m Thermal modalities Transverse friction massage Cold laser treatments are becoming more common with a high success rate for reducing localized swelling of tendons (tendonitis). Sharp injury. wringing. careful surgical re-exploration may allow a previously overlooked tendon to be released. Preventive measures for De Quervain tenosynovitis Vi na y Although de Quervain tenosynovitis features a simple tendon entrapment and the treatment is quick and straightforward.23 suggest activity modifications In chronic stage Surgical Treatment for De Quervain tenosynovitis Surgery may be recommended if symptoms are severe or do not improve. the extensor pollicis brevis tendon may remain entrapped within the septated first dorsal compartment. twisting or grasping and A home-exercise program ar . Should repeat cortisone injections fail to relieve symptoms. More and more physical therapy and hand centers are finding this modality to be useful for De Quervain's syndrome. In such a case. Careful attention to surgical technique at the initial release is paramount to avoiding complications. The goal of surgery is to open the compartment (covering) to make more room for the irritated tendons. complications can be profound and permanent. With wrist flexion and extension. traction injury. Complications Superficial radial nerve injury is the most irksome complication. Reconstruction of the sheath with a slip of local tissue may relieve symptoms.
People working in constructions carry heavy loads like hollow blocks. sand. or it can be the result of an accident or sports injury. It can seemingly come from out of nowhere. pinched nerve in shoulder occurs when too much pressure is applied to the shoulder nerve by the surrounding tissue. find another activity or action that accomplishes the same task without the pain. Pinched Nerve In Shoulder What is a pinched nerve? Vi The neck is a complex place when it comes to nerves. and others are the ones who are having pinch nerve in shoulder. Nerve compressions can be caused by muscles. This is typically where problems can occur and result in symptoms like a pinched nerve in the shoulder. however. and neck pain can stem from all manner of things. Typically it comes from the disc area in your neck. factories. a pinched nerve results in severe pain and disability in the shoulder and upper arm. shoulder.>:Avoidance of activities that cause pain is a common sense prevention method that often gets ignored. tendons. wood are the once having pinch nerve in their shoulder. It usually happens around C6 and C7. generally the nerve is not actually being pinched by a muscle in the shoulder. grasping or holding for extended periods may prepare the tendons for the task and prevent some of the strain placed on them. Disc herniation in the cervical spine can also cause pinched nerves leading to shoulder and neck pain. These nerves exit the spinal column and then branch off and rejoin in various patterns to innervate the musculature of the chest. While pinched nerves may occur anywhere in the body. rocks.:>>A proper warm up before doing any lifting. tendons. Exercise therapy is one of the first courses of treatment. A pinched nerve in the shoulder is a complaint that you will hear often. pain and a tingling sensation that radiates along the shoulders and into the neck or spine. a very painful one at that.24 Prevention of overuse injuries commonly requires breaking up sessions of work or practice involving a particular area into shorter periods with more frequent breaks to allow that area to rest and avoid the overuse.Symptoms include muscle weakness. ar . as it is quite typically disguised as a shoulder problem. and hands. Causes of pinched nerve in shoulder Usually. Ku A pinched nerve in shoulder can cause debilitating pain. but it is something you need to look out for. Nerves can become trapped in the shoulder itself. na y A pinched nerve is a term that is quite common to hear. people who work in construction. bones and muscles. If a movement causes pain. Often people can get a pinched nerve in the shoulder region when they have tight muscles. waking you up from a night's sleep. m Typically. A pinched nerve in the shoulder that originates in the neck is not always the actual diagnosis. arms. numbness. however not totally correct. they most commonly affect the neck. The nerves that run through C6 and C7 travel down through your shoulder blades. In many cases. shoulder and lower back. and can cause chronic pain and muscles spasms. due to the cramped conditions in an area called the brachial plexus. such as cartilage. but most of us don‘t really know what it means. The brachial plexus has a number of cervical nerves travelling through it to the upper limbs. delivering packages. consult your physician. including a pinched nerve in the shoulder. After treating the pain with moist heat. bones and cartilage that surround the nerve and branches of it.
C7 . and even coldness and weakness in the fingers. and occurs in different parts of the arm depending on the nerve location. Weakness: Since the nerve are what activates muscles. C6 . and your physician will isolate the problem by assessing your symptoms and then. The trouble could be rooted in another medical problem. Other less common symptoms include weakness in the biceps and wrist muscles. depending on which nerves have been impacted. especially one that is originating in the neck area. Pinched Nerve In Shoulder Symptoms Numbing: Numbness or tingling can occur due to a pinched nerve in shoulder. especially their shoulders. or when you touch it you don‘t feel as much. In obese people. diabetes. Other causes of pinch nerve are due to swelling of some parts of your body because of pregnancy.arthritis. the sheer mass of excessive tissue surrounding a nerve can be the cause.The main result of a pinched C6 nerve is pain radiating down your arm and into your thumb. Vi Diagnosis Of A Pinched Nerve In Shoulder In the majority of cases a pinched nerve in the neck happens at C6 or C7. Sometimes a fairly innocuous repetitive motion which taps on the front of the shoulder can lead to inflammation in the area and cause a pinched nerve in the shoulder. we can still have pinch nerves. Ku Pain: Pain is a common symptom of a pinched nerve in shoulder.25 Same for factory workers and delivery men carry heavy loads of their products. and any minor trauma to the shoulder can result in neck pain. C8 . it could cover the whole shoulder area. along with the possibility of a numb sensation in the shoulder area.The main result of a pinched C8 nerve is a numb sensation or pain felt in the outside of the hand.The main result of a pinched C7 nerve is pain and numbness radiating down the arm and into the middle finger.The main result of a pinched C5 nerve root is shoulder pain. You may experience it when you are reaching above your head to try to grab something. The problem may also stem from poor posture that causes tissue surrounding the nerve to "push" into the nerve. This depends on the location of the nerve. Muscle Spasms: Muscles spasms and twitching can occur as a result of a pinched nerve. If it is close to the spinal cord and originating from the neck then neck movements may agitate it as well. family history and many more. if one is being compressed. It may occur any place between your hand to your neck and depends on where the nerve is being compressed. m ar . most often. You will therefore experience muscle weakness as a result of a pinched nerve in shoulder. the signal to your muscle will be weak. weakness in the deltoid muscles. If you have an extra ‗cervical‘ rib this can put more stress on an already cramped area. It might be sharp or burning. or a specific spot. Pins and needles is another common complaint. You might get a feeling that your shoulder is dead. So even though we‘re careful. sending you for an na y C5 . They have been putting pressure on their bodies. arm pain. there is less sensation. such as a herniated spinal disc.
Put your arms on a pillow and try not to stretch your shoulder out. so try to loose weight. One cause of pinch nerve is over working. Some patients may experience a widespread pain. Exercising regularly is a big help. They do not remove the cause of the pain. It helps strengthen and stretch the muscles. go buy it for your pharmacist or any other health equipment shop. alleviate stiffness and improve the range of motion. you can start physiotherapy. Again. and weakness in the deltoids and bicep muscles. Pain can be both sharp and acute. Cases that do not respond to conservative treatment need surgery. The massage should be light and gentle. Massage the neck and shoulder. MRI or CT scan. Obesity is also one cause because it increases the pressure on the nerves with the heavy weight in your body. ar . Rest your arms and shoulder in a relax position. Then let your body rest after a long work. over time. Heat can greatly relieve the muscular tension and therefore apply less pressure on the nerve. Treatment for Pinched Nerve In Shoulder Stuff To Do At Home 3. After about 10 -12 days. jogging or biking. Make sure that you don‘t apply too much pressure. relieve pain and pressure. physical therapist or massage therapist to treat you. Apply a heat pack onto your shoulders and neck. Apply heat cream or herbs onto the affected area. numbness. and a feeling of pins and needles in the shoulder can indicate a trapped nerve and lead to muscle weakness and. 4. you can buy a shoulder posture shoulder brace online or if you want immediately. If you are hunching forward. the doctor may prescribe over the counter analgesics to allay pain quickly. this doesn‘t remove the cause of the problem but can give you plenty of relief. Use anti-inflammatory drugs (NSAID – Non-Steriod Anti-inflammatory drugs). Do not carry heavy loads using your back but use your legs to carry it. One of the reasons you have pain is because your shoulder muscles might be too tight and therefore compressing the underlying nerve. you are likely to develop shoulder pain. These can give you a bit of relief but be sure that you know the possible side effects are. try swimming. To correct your shoulder posture. Useful Tips to overcome Pinched nerve in shoulder There are many factors that contribute to pinch nerve in shoulder but they can be prevented to. Moving your arms can stretch the nerve and therefore aggravate the condition. muscle atrophy (wasting).26 X-Ray. Don‘t try to massage yourself and get a health professional like a chiropractor. Also. Numbness. If the nerve at C5 is pinched. 6. Vi na y Ku 2. however. 5. Correct your shoulder and back posture. The way that you are sitting now can cause more compression of the nerves. whereas for others it is isolated to a smaller spot and can produce a burning sensation. m 1. this can cut the blood flow to the nerve so it is best to keep your shoulders back. or a dull aching pain in the neck or shoulder.
keep your stomach in and chest out. Not applying cold therapy and compression immediately after the injury. If you have a bad muscle strain or contusion (dead leg!) and it is neglected then you could be unlucky enough to get Myositis. formation of bone may not be observed. simple severe blow or series of repeated minor traumas. Try to avoid slouching. Having intensive physiotherapy or massage too soon after the injury. Also in early phase of evolution. The bone will grow 2 to 4 weeks after the injury and be mature bone within 3 to 6 months. so term ossificans is not always applicable. Region of elbow is a favorite site. Myositis Ossificans Prodyut Das localized non neoplastic bone myositis ossificans traumatica myo-osteosis myositis ossificans circumscripta traumatic ossifying myositis ossifying haematoma Most people if not all.27 Try doing stretches. It is significant that these muscles gain attachment to bone over a wide surface area. and when the process appears to restrict elbow motion progressively. it can help after a long day of work. and try to lessen the use of very high heeled shoes. periosteal or parosteal. Haematoma seems to be necessary prerequisite. suggesting that periosteum participates to some extent in the process. But take note that you should always ask your doctor about these especially when your pinch nerve is severe. ar . And lastly. osseous and cartilaginous proliferation and by metaplasia. Bone will grow within the muscle (called calcification) which is painful. The term myo and itis is a misnomer because skeletal muscle is often not involved and inflammatory changes are rarely evident. Muscles most often involved are brachialis. quadriceps femoris and adductor muscles of thigh. always have proper posture. These are some tips that can help in improving pinched nerve in shoulder. What causes myositis ossificans? Vi na y It is characterized by fibrous. Stand up straight and sit down properly. Use someone who is properly qualified and insured. Condition may be classified according to its location as extra osseous. Commonly young athletic men are predisposed with Myositis. ill advised forcible manipulation will cause a widespread involvement. It is usually as a result of impact which causes damage to the sheath that surrounds a bone (periostium) as well as to the muscle. Ku Also known as m Myositis Ossificans is extra-skeletal ossification that occurs in muscles & other soft tissues. have a history of trauma.
e. Process is peculiar alteration within the ground substance of connective tissue. autosomal dominant pattern.g.28 Returning too soon to training after exercise. Early edema of connective tissue proceeds to tissue with foci of calcification and then to maturation of calcification and ossification. disrupted muscle fibers retract. which then assume the morphological characteristic of osteoblasts. in case of muscle. suggesting some type of edema. it becomes oriented and covered by a cartilaginous cap. Pathophysiology of myositis ossificans traumatica Myositis Type Vi Symptoms of Myositis include Restricted range of movement Pain in the muscle when you use it na y The specific cause and pathophysiology are unclear . Ground substance becomes homogeneous or glassy or waxy. associated with striking proliferation of undifferentiated mesenchymal cells. All joint motion is finally lost and patient dies of inter current infection. calcifications occur at the site of injured muscle. Intense cellular proliferation of fibroblasts and mesenchymal cells produces a histological picture that may be erroneously diagnosed as fibrosarcoma or myosarcoma. large toe and spine are liable to fuse. Ku m ar . In the first. severely damaged area. This is called post traumatic osteochondroma and is common in region of knee joint. The basic mechanism is the inappropriate differentiation of fibroblasts into bone-forming cells (osteoblasts). is responsible for bone formation. At the same time. This events typically takes place first within least damaged part i. it is known as "Prussian's disease". a reserve of available calcium in adjacent skeletal tissue or soft tissue edema. It is passive stretching then active exercise. In 3 to 4 days. myositis ossificans progressiva (also referred to as fibrodysplasia ossificans progressiva) is an inherited affliction.. fibroblasts from endomysium invade damaged area and rapidly form broad sheets of immature fibroblasts. vascular stasis tissue hypoxia or mesenchymal cells with osteoblastic activity) and unknown systemic factors. and fascia. When myositis is not removed and is allowed to mature.it may be caused by an interaction between local factors (e. It increases in amount and encloses some of mesenchymal cells. tendon and periosteum can also be the site. and by far most common type. The second condition. most commonly in the arms or in the quadriceps of the thighs. and typically grows in a predictable pattern. primitive mesenchymal cells proliferate within injured connective tissue. periphery. The term myositis ossificans traumatica is sometimes used when the condition is due to trauma. Mineralization follows and bone is formed. nonhereditary myositis ossificans (commonly referred to simply as "myositis ossificans"). in which the ossification can occur without injury. because of muscle action over the lesion. If the ossification is located in the adductor muscles. Pathogenesis of Myositis Ossificans Muscle is commonly but not invariably involved. This condition is very rare.IP joint of thumb. Initially there is degeneration and necrosis. it progressively extends towards the central. As the process of osteoid formation and mineralization changing in mature bone evolves.
although success of such therapy is limited. In occasional cases. iontophoresis with 2 % acetic acid solution. physiotherapy management of myositis ossificans includes Vi Surgical Management na y Rest Immobilization Anti-inflammatory drugs physiotherapy management surgical debridement Rest Immobilization pulsed Ultra sound and phonophoresis Maintain available range of motion but avoid stretching and massage. and others will have minimal symptoms. as some patients' calcifications will spontaneously be reabsorbed. Treatment is initially conservative. is characteristic of myositis . until maturation. reverse of that seen in a malignant tumor. surgical debridement of the abnormal tissue is required.29 A hard lump in the muscle An X-ray can show bone growth Radiographs: Bone Scan: active myositis appears as intense para-osseous accumulation of tracer activity in acutely damaged muscle on delayed images. Prognosis: over time. the volume of heterotopic bone will diminish. extra corporeal shock wave therapy Ku m CT Scan: calcification of the heterotopic ossification proceeds from the outer margin and progresses centrally ar soft tissue ossification not attached to bone is common x-rays show round mass w/ distinct peripheral margin of mature ossification & a radiolucent center of immature osteoid & primitive mesenchymal tissue this peripheral maturation. Treatment of myositis : Radiation therapy subsequent to the injury or as a preventive measure of recurrence may be applied but its usefulness is inconclusive.
aspiration and surgery. It is surrounded by fibrous capsule and it posseses small pseudopodia. Myxoid degeneration of fibrous tissue of capsule. According to some.30 Growth should not be removed in premature stage as it will likely reoccur. infiltrates beyond the original site. Synovial herniation is the probable cause of ganglion has been rejected. ganglion arrises from small bursa within the substance of the joint capsule or the fibrous tendon sheath. Pathology: Ganglion is a cystic swelling containing clear gelatinous fluid or viscious fluid. it may be safely removed. Causes for Ganglion Cyst: The aetiology is yet to be known. abductor pollicis longus and extensor pollicis brevis (surrounded by a common sheath) extensor carpi radialis longus and extensor carpi radialis brevis (surrounded by a common sheath) extensor pollicis longus extensor indicis extensor digitorum extensor digiti minimi extensor carpi ulnaris Ku m ar . It may be possible to prevent myositis by aspirating the original haematoma. Ganglion Cyst Treatment Ganglion Cyst Treatment include ultrasonic therapy. When after serial x-rays the mass is dense. Other probable sites are Front of the wrist.immobilization using splint. when it may compress a nerve causing numbness or weakness Dorsum of the foot Palmer aspect of the hand Flexor aspect of the fingers. What is ganglion cyst: A Ganglion cyst is a localised. tense cystic swelling in connection with the joint capsule or tendon sheath. The tendons on the dorsum of the wrist from lateral to medial are Vi na y Sites: The commonest site is on the dorsum of the wrist. well delineated. and compresses the soft tissues around beyond hope of repair. ligaments and retinaculae has been suggested. and at a stand still. where small ganglions may develop. The ossification becomes exuberant. This is sometimes initiated or excited by injury. This bursa becomes distended possibly following trauma giving rise to a ganglion. It contains clear gelatinous fluid.
and the ganglion may return anyway. which may help shrink the cyst. This injection may be repeated followed by crepe bandaging. As the cyst shrinks. Rubbing the ganglion gently but often during the day may help move the fluid out of the sac. Aspiration of the cyst and injection of sclerosing solution ( 3% sodium murrhuate or 5% phenol in almond oil) or hydrocortisone is another well known treatment of this condition. On Examination: the lump is well defined . You may break a bone or otherwise injure your wrist by trying this folk remedy. such as ibuprofen (Advil. In most cases. This helps your hand and wrist to rest. But with this ganglion cyst treatment recurrence is common. others) or naproxen (Aleve. swelling or discharge. Naprosyn. Ganglion Cyst Treatment: Consevative Ganglion Cyst treatment Complete excision is the best ganglion cyst treatment. After surgery Vi na y Operative Ganglion Cyst treatment Keep the affected limb elevated for up to 48 hours to help reduce swelling. Change your bandages (dressings) as directed. which is often seen in case of ganglion on the flexor aspect of the finger. Your doctor may recommend analgesics. This has also not succeeded to claim cure in majority of the cases m ar . it may release the pressure on your nerves. but is often felt firm or even hard (as the cyst is very tense). relieving pain. Ku Ultrasonic therapy helps to reduce swelling and inflammation Immobilization" Because activity can make the ganglion cyst grow larger. others). A strike on the cyst will cause rupture on the cyst with apparent belief of cure (previously it was done with the holy bible in the west). such as acetaminophen (Tylenol. moving the affected area soon after surgery is recommended. Occasionally there may be considerable pain. the swelling becomes fixed as the tendon is made taut. though it can be moved with great difficulty sideways. for pain relief. including redness. The ganglion is removed completely. however.31 Clinical features of Ganglion Cyst: The patient often is a young adult. your doctor may recommend wearing a wrist brace or splint to immobilize the area. Massaging the ganglion. it's important to watch for signs of infection. particularly synovioma. You may experience discomfort. others). It is immobilise along the axis of the tendon. Depending on the location of the cyst. your doctor may recommend temporarily wearing a splint or brace to help minimize postoperative pain. Care must be taken to remove all the pseudopodia and the fibrous layer from which they arrise. When it arrises from the fibrous sheath of a tendon. Mobility is not much. Motrin. The excised specimen should be sent for biopsy as very occasionally there may be some neoplastic change. swelling and tenderness for two to six weeks. This is usually done by using a tourniquet. cystic swelling. The most common presenting symptom is a painless lump. As the incision heals. or nonsteroidal anti-inflammatory drugs (NSAIDs). Do not smash a ganglion with a book or other heavy object.
this medical specialty developed criteria for the diagnosis of this illness. Your therapist will teach you exercises to mobilize your joints. stiffness. When the joints and ligaments are na y 1) body or joint pain above and below the waist. immune system or endocrine system disorders. there are risks to be considered. Ku m ar Therapy is sometimes utilized after surgical and non-surgical treatment. and 3) 11 out of 18 possible tender points. These could result in weakness. muscle weakness and sleep disturbances and other disease consequences. migraine headaches. fatigue. even after surgery. physical therapy is aimed at managing fibromyalgia consequences such as pain. injury to nerves. Your doctor can help you decide the best treatment for you . 2) axial pain (most often neck or low back pain). The goal of therapy is to restore maximum function to the wrist and hand. fatigue. deconditioning. This may be helpful for reducing swelling and discomfort. increased tenderness to palpation and additional symptoms such as disturbed sleep. Though rare. or fiber cells. and together with the Latin word for pain. and on the right and left side of the body. Connective tissues contain fibrocytes. You will also learn exercises to increase your hand strength. The American College of Rheumatologists (ACR) defined fibromyalgia (FMS) in 1990 as the presence of Vi Patients most often have associated fatigue.32 Managing Fibromyalgia an urban ache What is Fibromyalgia? Fibromyalgia (FMS) refers to a condition with a constellation of symptoms that include widespread aching. stiffness. fatigue and psychological distress.‖ the word fibromyalgia is constructed. including those beyond the muscles and fibrous tissues. blood vessels or tendons may occur. but it is likely many factors. It is a syndrome of unknown etiology characterized by chronic wide spread pain. And as with all surgeries. Unfortunately. While medication mainly focus on pain reduction. or muscle cells. flexibility. irritable bowel syndrome. ―algia. muscles contain myocytes. Since many patients with joint and ligament pain have been referred to rheumatologists. numbness or restricted motion. there's no guarantee that a ganglion cyst won't recur. The exact physiological process has not been determined. and coordination. sleep disorders. and the presence of specific body tender points. play a role. The presence of pain originates in the muscles and connective tissues of the body. to check whether inflammation is present that would respond to antiinflammatory drugs.
and rest. Other remedies for symptoms may also be used in managing fibromyalgia. and stress. However. spasms. Occiput: (back of the neck) at suboccipital muscle insertions. FMS trigger points exist at these nine bilateral muscle locations: Is there a prescription medication that help managing fibromyalgia pain ? Managing Fibromyalgia Pain for tender points with involves a multifaceted treatment program that employs both conventional and alternative therapies. To get a medical diagnosis of FMS. muscle and ligament examinations from biopsy samples characteristically show no unusual patterns of disease or inflammation. Knee: (knee area) at the medial fat pad proximal to the joint line. and depression. daily stress management. therapeutic massage can manipulate the muscles and soft tissues of the body to help ease pain. Lateral epicondyle: (elbow area) 2 cm distal to the lateral epicondyle. Trapezius muscle: (back shoulder area) at midpoint of the upper border. What are tender points? Tender points are pain points or localized areas of tenderness around joints. hydrotherapy using heat and ice. such as the area over the elbow or shoulder. the standard treatment for managing fibromyalgia (Chronic fatigue syndrome) and tender points involves medications. widespread deep muscle pain. These tender points hurt when pressed with a finger. About 2-5% of the general population is considered to have FMS. How many tender points are important for FMS? There are 18 tender points important for the diagnosis of fibromyalgia (see picture below). Greater trochanter: (rear hip) posterior to the greater trochanteric prominence. the symptom of widespread pain must have been present for three months. muscle tension. FMS is a common disorder characterized by multiple tender points. While the reason is not entirely clear. fatigue. they are superficial areas seemingly under the surface of the skin. What at-home treatments might help in managing fibromyalgia tender point pain? Alternative treatments or home remedies are important in managing fibromyalgia and the pain of tender points. physiotherapy. Supraspinatus muscle: (shoulder blade area) above the medial border of the scapular spine. Second rib: (front chest area) at second costochondral junctions. Gluteal: (rear end) at upper outer quadrant of the buttocks. Vi na y Low cervical region: (front neck area) at anterior aspect of the interspaces between the transverse processes of C5-C7. Instead. FMS pain and fatigue sometimes respond to low doses of antidepressants. Tender points are often not deep areas of pain. but not the joints themselves. As an example. exercise. Ku m ar . there is surprisingly little inflammation present for the amount of pain that is experienced. In addition. 11 of 18 tender point sites must be painful when pressed. In fact.33 examined by clinicians. These tender point are located at various places on your body. for a diagnosis of fibromyalgia.
In addition. or the relaxation response to manage how you respond to stress. certain foods. With chronic fatigue syndrome. arms. depression. hands. nausea. or a heat "cozy" that you warm in the microwave. Staying on a regular bedtime routine is also important. To benefit from moist heat. They include: What Are the Symptoms of Fibromyalgia? Symptoms of FMS include: Vi na y Chronic muscle pain. muscle spasms or tightness. bloating. regular exercise is vital to managing fibromyalgia pain. medications.for example. or feet Increase in urinary urgency or frequency (irritable bladder) Reduced tolerance for exercise and muscle pain after exercise A feeling of swelling (without actual swelling) in the hands and feet Painful menstrual periods Dizziness Ku Anxiety Changes in weather -. and leg cramps Moderate or severe fatigue and decreased energy Insomnia or waking up feeling just as tired as when you went to sleep Stiffness upon waking or after staying in one position for too long Difficulty remembering. Avoid making too many commitments that can increase stress and fatigue. it's extremely important to manage your schedule and to control your level of stress. noise. and performing simple mental tasks Abdominal pain. bright lights. you can do relaxation exercises such as guided imagery.34 Twice daily moist heat applications are also helpful in easing the deep muscle pain and stiffness. deep-breathing exercises. and other symptoms of fibromyalgia. Be sure to block time each day to rest and relax. warm shower. Doing so allows your body to rest and repair itself. and constipation alternating with diarrhea (irritable bowel syndrome) Tension or migraine headaches Jaw and facial tenderness Sensitivity to one or more of the following: odors. legs. you can use a moist heating pad. cold or humidity Depression Fatigue Hormonal fluctuations such as PMS or menopause Infections Lack of sleep or restless sleep Periods of emotional stress Physical exhaustion Sedentary lifestyle m ar . and cold Feeling anxious or depressed Numbness or tingling in the face. A number of factors can make FMS symptoms worse. concentrating. In addition.
or other emotional factors. Patients experience pain in response to stimuli that are normally not perceived as painful. viral causes such as the Epstein-Barr Virus. If the condition is not diagnosed and treated early. na y Doctors don't know what causes fibromyalgia. tends to be the best time. Ku Other researchers believe fibromyalgia is caused by a lack of deep sleep. trauma. Some illnesses appear to trigger or aggravate FMS. while 11 a. hormonal fluctuations (such as just before your period or during menopause). and evening tend to be the worst times. Even though they may sleep for a long period of time. an aberrant immune response to intestinal bacteria. and erosion of the protective chemical coating around sensory nerves. tension. Because FMS tends to run in families. They may also get worse with fatigue. inactivity.morning. due in part to a lack of abnormalities on physical examination. stress. called substance P. they get poor quality sleep. Infections. These may include: Genetics. depression. Still another hypothesis regarding the cause of fibromyalgia symptoms proposes that affected individuals suffer from vasomotor dysregulation resulting in sluggish or improper vascular flow. Also. there may be certain genetic mutations that may make you more susceptible to developing the disorder. What causes fibromyalgia? Vi Diagnosis Fibromyalgia is considered a controversial diagnosis. patients with fibromyalgia have impaired non-Rapid-Eye-Movement. cold or drafty conditions. and infection. with some authors contending that the disorder is a ‗non-disease‘. The onset of FMS has been associated with psychological distress. m The exact cause is not known. Researchers have found elevated levels of a nerve chemical signal. or nonREM. but it most likely involves a variety of factors working together. Scientists note that there seems to be a diffuse disturbance of pain perception in patients with FMS. The brain nerve chemical serotonin is also relatively low in patients with chronic fatigue syndrome.35 FMS symptoms may intensify depending on the time of day -. Stress-induced pathophysiology Consequence of sleep disturbance Central dopamine dysfunction (hypodopaminergia) Deficient human growth hormone (HGH) secretion Other hypotheses-Other hypotheses have been proposed related to various toxins from the patient's environment. Studies of pain in fibromyalgia have suggested that the central nervous system (brain) may be somehow supersensitive. overexertion. Post-traumatic stress disorder has been linked to FMS. sleep phase (which likely explains the common feature of waking up fatigued and unrefreshed in these patients).m. Physical or emotional trauma. Sleep studies show that as people with FMS enter stage 4 sleep. It is during stage 4 sleep that muscles recover from the prior day's activity.m. or they may disappear for months and then recur. changes in the weather. they become more aroused and stay in a lighter form of sleep. and nerve growth factor in the spinal fluid of fibromyalgia patients. late afternoon. and the body refreshes itself. ar . to 3 p. symptoms can go on indefinitely.
Diagnostic Criteria A proper history and physical exam coupled with blood work and/or x-rays may be done to rule out: Electrical nerve and muscle testing. A definite diagnosis of fibromyalgia syndrome should only be made when no other medical disease can explain the symptoms. known as electromyography (EMG) or nerve conduction velocity (NCV). ar . exercise. patient education and reassurance along with sleep-enhancing medications like low dose tricyclic antidepressants. This is to say. exercise. Emergency physicians often see trigger points associated with simple self-limiting regional myofascial pain syndromes which appear to arise from muscles. in most cases. While historically considered either a musculoskeletal disease or neuropsychiatric condition. including medications. Thyroid-stimulating hormone levels should be checked routinely because this condition can mimic many of the symptoms of Chronic fatigue syndrome Polymyalgia rheumatica Ku m The difficulty with diagnosing FMS lies in the fact that. or tendon-bone junctions. may also be done to check the muscles and nerves.36 objective laboratory tests or medical imaging studies to confirm the diagnosis. True FMS is a chronic condition requiring long term effort in managing fibromyalgia that may include physical therapy. secondary hypothyroidism. Treatment may provide only partial symptomatic relief. laboratory testing appears normal and that many of the symptoms mimic those of other disorders. patient education. When symptoms recur or persist after na y Hormonal imbalance Anemia Infection Muscle disease Bone disease Nerve disease Joint disease Cancer Rheumatoid arthritis Hypothyroidism (including primary hypothyroidism. iodine deficiency goiter. evidence from research conducted in the last three decades has revealed abnormalities within the central nervous system affecting brain regions that may be linked both to clinical symptoms and research phenomena. Discussion Vi Although the pathophysiology of fibromyalgia is unknown it is a very real syndrome. Hashimoto‘s thyroiditis. and genetic thyroid enzyme defects). but typically in a limited distribution and without the systemic feature of fatigue. FMS is a diagnosis of exclusion. and behavioral interventions. there are treatments that have been demonstrated by controlled clinical trials to be effective in managing fibromyalgia symptoms. muscle-tendon junctions. Myofascial disease can result in severe pain. Although there is as yet no generally accepted cure for fibromyalgia.
And milnacipran (Savella) was recently approved by the Food and Drug Administration for managing fibromyalgia symptoms. The reason for this is the muscle's proximity to the flank and abdomen as well as its attachment to the 12th rib. or are accompanied by generalized complaints. Duloxetine (Cymbalta) may help ease the pain and fatigue associated with FMS. Your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs) — such as aspirin.37 the basic therapy above. others) or naproxen sodium (Aleve. classes. and passive stretching of this muscle reproducing symptoms. Medications designed to treat epilepsy are often useful in reducing certain types of pain. can create pleuritic symptoms. while pregabalin (Lyrica) is the first drug approved by the Food and Drug Administration for managing fibromyalgia. its effectiveness varies. with palpation. ibuprofen (Advil. NSAIDs haven't proved to be as effective in managing fibromyalgia pain when taken by themselves. Therapy is provided through individual counseling. Tramadol (Ultram) is a prescription pain reliever that may be taken with or without acetaminophen. abdominal. Gabapentin (Neurontin) is sometimes helpful in reducing FMS symptoms. Your doctor may prescribe amitriptyline to help promote sleep. Acupuncture/acupressure. Relaxation/biofeedback techniques Osteopathic manipulation. which when tender. Managing Fibromyalgia In general. m ar . Anti-seizure drugs. others) may ease the pain and stiffness caused by fibromyalgia. others) — in conjunction with other medications. can save this patient from a multitude of laboratory and x ray studies. and with tapes. or pulmonary ailment. Cognitive behavioral therapy seeks to strengthen your belief in your abilities and teaches you methods for dealing with stressful situations. Acetaminophen (Tylenol.and may help managing fibromyalgia. Specific exercises can help restore muscle balance and may reduce pain. Trigger point injections with lidocaine. The emphasis is on minimizing symptoms and improving general health. Ku Analgesics. Antidepressants. Medications Medications can help managing fibromyalgia pain and improve sleep. Stretching techniques and the application of hot or cold also may help. treatments for fibromyalgia include both medication and self-care. Common choices include: Therapy Vi na y Physical therapy. Motrin. Therapeutic massage. Counseling. However. refer the patient to a rheumatologist or primary care physician. A careful physical exam. Chiropractic care. active contraction. Fluoxetine (Prozac) in combination with amitriptyline is effective in some people. When the quadratus lumborum muscle is involved there is often confusion as to whether or not the patient has a renal.
. Healthy muscles are flexible. na y Your first order of business is to start SLOWLY. Yoga . it is crucial to get your muscles healthy which can offer some relief. Other activities you might enjoy are: Swimming . That's normal! Setting small goals (i. Even walking feels like a chore so you may only be able to exercise for minutes at a time. Besides helping with tenderness. before you do anything check with your doctor and get a referral to a physical therapist so you know exactly what to do. regular exercises can also boost energy levels and help with sleep. Your goal should be to improve your health (so forget about weight loss for now). Take care to keep movements easy.e. and biking rather than muscle-straining exercises such as weight training. strength training exercises for managing fibromyalgia can include: Pushups-Do them against a wall instead of on the floor Lifting weights-Use very light weights or even canned food for resistance Resistance Bands-Use a light resistance and take your time. water aerobics. which can increase your range of motion and the stronger you are... and so is strength training.This 'moving meditation' helps you get back in touch with your body and stay active without impact or jarring movements. the more you can move around each day. Keeping muscles conditioned and healthy by exercising three times a week decreases the amount of discomfort.some postures may be too difficult so talk to your instructor about modifications. Machines-Make sure you get instructions on how to use them and start with NO weight. low-impact exercise. In general. Tai Chi . walk two minutes today and add a minute every day after) can help you slowly increase your exercise time. Exercising With Fibromyalgia Exercise Can Help. No impact means your joints are protected.This is a great way to condition your heart and body while getting full and gentle support from the water. But. and massage. The most important therapy for muscle pain is regular. It is important to try low-stress exercises such as walking. Other benefits include: Better sleep Reduced stress and depression Improved your energy levels More endurance Weight control Vi Cardio is important.Increase your flexibility and de-stress by learning how to relax and breathe. Ku m ar . stretching exercises (Pilates is one form of exercise that may be beneficial). Other home-care techniques that can help managing fibromyalgia include these: heat applied to sore muscles. swimming.38 Gentle exercise program.
They show them ways to get relief from deep muscle pain. Aquatic therapy enables aerobic conditioning and also flexibility. and therapeutic heat. which your physical therapist will help you with. That includes people with fibromyalgia. That results in your being able to avoid undue fatigue and pain. (1) Based on a British study. The patients' target exercise regimen is 4-5 times a week for at least 20-30 minutes each time. this may take the patient months to achieve. Give yourself at least one day (preferably two) of rest before going back to weights. the Ku Numerous modalities. Aquatic exercise is well tolerated and is especially helpful for some patients. relaxation. not only physically but emotionally. Some patients with fibromyalgia may never be able to achieve this level of exercise. can reduce pain. m The goal of physical therapy is to maximize function and reduce impairment to limit disability in patients with musculoskeletal conditions. Taking control of your health can provide tremendous relief. and energy conservation and fatigue management. Physical therapists can help managing fibromyalgia by relieving symptoms of pain and stiffness in everyday life. education about correct posture and functional activity. cryotherapy. The hardest part of exercising with FM is the frustration--knowing that you used to be able to do more and now you can barely get out of bed. The goal is to exercise safely without increased pain. positional release methods.39 Condition your body slowly and only do as much as you can. Teach patients how and when to use therapeutic modalities as part of their maintenance program. PHYSIOTHERAPY FOR MANAGING FIBROMYALGIA Vi na y According to the American Physical Therapy Association. One investigator recommends muscle energy treatments. physical therapists most commonly use exercise. Some investigators believe that aquatic exercise may be the safest and gentlest aerobic conditioning exercise available for this group. (2) For this review. reminding yourself that every time you move around you are improving. Patients should begin with gentle warm-up. Subsequent clinical trials have confirmed the benefits of aerobic exercise and muscle strengthening on mood and physical functioning. ar . In addition. and massage as part of the rehabilitation program to decrease stiffness and pain. Some investigators have found that daily aerobic and flexibility exercises are an essential component of the rehabilitation program. Try channeling that frustration into your workouts. Proper posture. These health care professionals teach people with FMS how to build strength and improve their range of motion. allows efficient muscle function. physical therapy is defined as a treatment program that includes patient education and supervised exercise. including electrotherapy (transcutaneous electrical nerve stimulation). And they can help in managing fibromyalgia by teaching people how to make sensible decisions about daily activities that will prevent painful flare-ups. encourage them to exercise at the highest level possible without worsening their symptoms. and stretching exercise. physical therapists teach selfmanagement skills to people with all types of conditions. Patients should always start at low levels of exercise and progress slowly. strengthening. Low-impact aerobic exercise is necessary at least 3 times weekly. flexibility exercises and progress to stretching all of the major muscle groups.
radiation therapy. Physical therapists use a wide range of resources to support exercise. and movement patterns when doing "homework" or exercises at home. and move their joints through range-of-motion exercises. na y Ku m ar . Classification of Avascular Necrosis of Femoral Head It can be classified into two types Vi 1. physical therapists can help people with FMS use their muscles. Anatomy : Avascular necrosis of the hip occurs when blood flow to the top portion of the thigh bone (femur) is interrupted. That increases the flow of blood. physical therapy may help in managing fibromyalgia pain. 2.Secondary: due to some underlying cause which may include alcohol abuse. It can also help reduce stiffness and fatigue. stretch for flexibility. While there is no known cure for fibromyalgia. cold compresses reduce swelling by constricting blood vessels. oxygen and other nutrients and speeds the elimination of toxins. alignments.death of the femoral head following partial or complete obliteration of its blood supply. moist compresses on painful areas dilate blood vessels. vascular Necrosis of Femoral Head A Patient's Guide to Avascular Necrosis of Femoral Head : Avascular Necrosis of femoral head can cause hip joint pain. Gouchers disease. When it‘s deprived of blood. The therapist documents your progress and gauges whether you're practicing good therapy habits. It is defined as. The affected portion of the bone consists of the head (the ballshaped piece of bone that fits into the socket of the hip) and neck (the portion of the thighbone just below the head). These resources range from deep tissue massage to ice and heat packs for hydrotherapy. Thus hydrotherapy also helps in managing fibromyalgia. renal osteodystrophy. For instance.Primary or Idiopathic: in which no cause can be established. this part of the bone begins to ―die. With these tools. The benefit of physical therapy is that it allows a person with fibromyalgia to work closely with a trained professional who can design a fibromyalgia-specific treatment program. That helps control minor internal bleeding. Gout. Conversely. Hydrotherapy with moist heat or cold packs works by stimulating your body's own healing force.‖ breaking down and causing the cartilage on top of it to collapse.40 therapist may use slow stretching exercises to help you improve muscle flexibility. warm. Relaxation exercises that the therapist will show you will help you reduce muscle tension.
The pressure causes tiny bubbles to form in the blood stream which can block the blood vessels to the hip. A clear link exists between AVN and alcoholism. Sometimes there is no choice. Eventually. and your medication use. as it becomes more intense. and it can even become a problem up to two years following this type of injury. A dislocation of the hip out of the socket can tear the blood vessels. knowing full well that AVN could occur. Excessive alcohol intake somehow damages the blood vessels and leads to AVN. between the age of 40 to 60 years. the pain will be slight. or to prevent rejection of an organ transplant. Your doctor will want to know about your occupation. such as one or two injections into joints to treat arthritis or bursitis. Or you may feel groin pain that radiates down your thigh. AVN has not been proven to be caused by short courses of treatment with cortisone. m Injury to the hip itself can damage the blood vessels. such as advanced arthritis. X-rays will most likely be ordered. This is usually only a problem in patients who must take cortisone every day due to other diseases. At first. Cortisone is the most common drug known to lead to AVN. and cortisone has to be prescribed to treat a condition. Fractures of the femoral neck (the area connecting the ball of the hip joint) can damage the blood vessels. you‘ll probably develop a limp and start to lose mobility. Vi na y Ku Some medications are known to cause AVN. In up to 60% of cases both the hips may be involved. pain accompanies any movement or activity and joint motion becomes restricted. Symptoms of Avascular Necrosis of femoral head Although avascular necrosis often affects both hips. It usually takes several months for AVN to show up. Next. There are many causes of AVN. what other medical problems you have. You'll be asked whether you drink alcohol. Then. Primary disease is more common in men. A physical examination will be done to determine how much stiffness you have in the hip and whether you have a limp. hip pain at nightdevelops. sickle cell anaemia. Diagnosis for Avascular Necrosis of femoral head The diagnosis of AVN begins with a history and physical examination. you may feel pain in only one. ar Causes for Avascular Necrosis of femoral head . Anything that damages the blood supply to the hip can cause AVN. Once this is done. damaging the blood supply.41 injectable steroid use. Caisson disease. Deep sea divers and miners who work under great atmospheric pressures also are at risk for damage to the blood vessels.
This causes osteoarthritis of the hip joint. the hip joint will be very arthritic.42 X-rays will usually show AVN if it has been present for long enough. following which progression toosteoarthritis is inevitable. You may work with a physical therapist who will show you ways to safely move and stretch your hip. Prognosis This means that the dead bone in the head of femur becomes weak and breaks down. the surgeon drills out the damaged section of bone up to the head of the femur. Eventually almost all patients develop subchondral collapse. In this procedure. joint mobilization. They may also use modalities such as electrical stimulation. in some cases it can help slow the progression of the disease and decrease the associated pain. A physical therapist can teach the correct way to use the appropriateassistive device (such as a cane or walker) to decrease weight bearing on the joint . Your therapist will also instruct you to use a walker orcrutches. Vi na y Rehabilitation role in Avascular Necrosis of femoral head Ku m Treatment for Avascular Necrosis of femoral head ar Prognosis of avascular necrosis of femoral head is poor. Keeping weight off your hip while you are standing or walking may help the bone to heal while protecting the femur from further damage. In as many as 80% of patients with early disease. Although rest and exercise can sometimes heal the affected portion of bone. . Hip pain is relieved. osteotomy may hinder bone healing. osteotomy has been used to redistribute weight and prevent collapse and deformation of the femoral head. The goal is to keep your hip mobile and to avoid losing range of motion. and heat to attempt to increase bloody supply to the area and help decrease pain. Nonsurgical Physical Therapy Rehabilitation While physical therapy cannot cure avascular necrosis. ultrasound. and as many as 75% of patients avoid joint replacement later on. This causes the the hip joint to become incongruous. the treatment is basically the same. surgery is usually needed. however. They can provide proper exercises to help increase the strength of the muscles around the affect area (which will also decrease the weight on the joint). This opens up channels for blood vessels to reach the diseased area and foster the production of new bone. In those patients—as well as for those with osteoarthritis or pain unrelieved by other treatments—total hip replacement is most often the treatment of choice. In patients with large areas of dead bone. Either way. an operation called core decompression can spark regeneration of the bone. Early in the disease. it may not show up on X-rays even though you are having pain. and it may be hard to tell whether the main problem is AVN or advanced osteoarthritis of the hip. In the very early stages. In the advanced stages.
Clinical features of Spondylolisthesis Classification of slip Slip in Spondylolisthesis is measured by measuring the anterior slip of vertebral body. There is exaggeration of lumbar lordosis. you will probably use crutches for six weeks or so. The pain usually starts after an injury and the symptoms are rare before adolescence. There may be some associated neurological symptoms in the lower limb. which is worst after some activity and is relieved by rest. It is very commonly seen at L5 and S1 vertebra level. The movements of spine are grossly not limited. The pain may radiate down to one or both legs. The most probable cause is due to congenital abnormality in the development of the neural arch.slip from 50-75% upto 3/4 length Grade 4. Grade 1.slip from 0-25% upto 1/4 length Grade 2. m ar . Using crutches allows the bone to heal safely and reduce the risk that you may fracture your hip. Patients who require artificial hip joint replacement follow a structured program of physical therapy beginning shortly after surgery. Spondylolisthesis It is more commonly seen in females than males. When you are safe in putting full weight through the leg. making it possible to fracture the hip. Patients who have had bone and blood vessels grafted are required to limit how much weight they place on the hip for up to six months.43 After Surgery Physical Therapy Rehabilitation After a simple drilling operation. A depression is seen above the 5th lumbar vertebra.Meyerding classified the slip into 4 grades: Vi Fillard discovered a formula for calculation of the percentage of slipPercent slip= The displacement of L5 over S1/Width of S1 na y Patient complains of low backache.slip from 25-50% upto 1/2 length Grade 3. your doctor may have you work with a physical therapist to help regain hip range of motion and strength. The drill holes weaken the bone around the hip.slip more than 75% Ku Spondylolisthesis is a condition in which the affected vertebra slips on the adjacent vertebra below it.
44 Spondylolisthesis Treatment Treatment is given according to the grades of the slip. Grade 1 and 2 can be managed conservatively, while grade 3 and 4 require surgical intervention. Spondylolisthesis Treatment is given with the aim to achieve maximum correction of the exaggerated lordosis and then maintain the correction. Conservative Management usually comprises of Physical Therapy
1. Some heat modality like SWD(Short wave diatheramy) is given for pain relief. 2.Spondylolisthesis Exercises to correct the deformity
3.The patient is given guidelines for correction of posture and its maintenance. 4.Stretching of hamstrings is done at regular intervals. 5.Patient is adviced to lie prone to control the advancement of lordosis. 6.A thoraco-lumbar-sacral orthoses is given to prevent the lordosis. The brace has to be worn continuously. In spondylolisthesis surgery is indicated when there are neurological symptoms, slip is progressing or if the pain is very intense. Spinal fusion is done with or without the reduction of slip, postero-lateral fusion is very common. Spinal fusion prevents further progression of the slip. The spine may be internally stabilized with the help of rods and plates. Physiotherapy Management after Surgery During Immobilization
Gradual mobilization of spine is initiated. The patient is encouraged to perform functional activities and to perform all the activities of daily living.
Deep breathing exercises Early ankle, foot and arm movements are also encouraged Assisted movements to knee joints are given Isometric exercises of gluteal muscles Gradually hip flexion is encouraged, but it should not exceed 60 degrees.
Exercises to induce relaxation are given Strong abdominal exercises are given for abdominal muscles Flexion exercises for the spine, for example: sitting on a chair with back resting, then gradually bending the trunk forward from the lumbar region Active posterior tilting is tought to the patient to compensate the exaggerated lumbar lordosis.
Physical therapy is important for kyphosis treatment. It's especially useful for cases of postural kyphosis because a physical therapist can help correct posture and strengthen spinal muscles. However, physical therapy may also be recommended for patients with structural kyphosis, including Scheuermann's kyphosis and kyphosis caused by spinal fractures. Kyphosis Kyphosis is an abnormal posterior curve, usually found in the thoracic region of the spine. As such, it is an exaggeration of the normal posterior curve. If used without any modifying word, it refers to a thoracic kyphosis. In the low back, there is, occasionally, a lumbar kyphosis which is a reversal of the normal anterior curve. Since kyphosis is natural in the spine, we have to identify what excessive kyphosis is, which is generally the problem. Generally speaking, a normal for a thoracic kyphotic curve measures between 30 to 35°. In excessive kyphosis would be greater than 35°. Rounded Back or Increased Kyphosis : This posture is characterized by an increased thoracic curve, protracted scapulae (round shoulders), and usually an accompanying forward head. Potential Sources Of Pain
Stress on posterior longitudinal ligament. Fatigue of the thoracic erector spinae and scapular retractor muscles. Thoracic outlet syndrome Cervical posture syndromes
Potential Muscle Impairments
Faulty upper quadrant posture leads to an imbalance in the length and strength of the scapular and glenohumeral musculature and decreases the effectiveness of the dynamic and passive stabilizing structures of the Glenohumeral(GH) joint. Typically with increased thoracic kyphosis, the scapula is protracted and tipped forward, and the GH jointis in an internally rotated posture. With this posture, the pectoralis minor, levator scapulae, and the shoulder internal rotators are tight, and the lateral rotators of the shoulder and upwards rotators of the scapula test weak and have poor muscular endurance. There is no longer the stabilizing tension on the supirior joint capsule and the coracohumeral ligament or compressive forces from the rotator cuff muscles. Therefore, the effect of gracity tends to cause an inferior force on the humerus.
Decreased flexibility in the muscles of the anterior thorax (intercostal muscles), muscles of the upper extremity originating on the thorax (pectoralis major and minor, latissmus dorsi, and serratus anterior), muscles of the cervical spine and head attached to the scapula (levator scapulae and upper trapezius), and muscles of the cervical region. Stretched and weak thoracic erector spinae and scapular retractor muscles (rhomboids and middle trapezius).
46 Common Causes of Kyphosis are
Classifications of Kyphosis
Kyphosis can be manifest as part of the clinical picture of a number of generalized conditions. Children with high-level myelodysplasia generally develop lumbar kyphosis due to the absence of posterior structures. Two of the more malevolent mucopolysaccaridoses, Hunter and Hurler syndromes, may present with kyphosis in infancy. Thoracolumbar kyphosis also commonly affects infants with achondroplasia. Fortunately, most resolve with walking. Other unusual causes include Gaucher's disease, juvenile osteoporosis, and pseudoachondroplasia. Kyphosis in conditions accompanied by ligamentous laxity such as Ehlers Danlos syndrome andMarfan syndrome commonly affect the thoracolumbar or lumbar spine. Lumbar or thoracolumbar kyphosis is difficult to treat as junctional kyphosis above or below the instrumented portion of the spine often occurs unless excellent sagittal plane alignment is achieved. Kyphosis accompanyingneurofibromatosis often is accompanied by severe rotatory deformity and can be very difficult to treat. Cervical kyphosis can be a part of diastrophic dysplasia or Larsen's syndrome . In parts of the world, where tuberculosis is prevalent, screening of children for kyphosis can aid earlier diagnosis.As children with cystic fibrosis live longer into adult life, kyphosis accompanying this condition is more often being reported. For conditions such as juvenile osteoporosis or Maroteaux-Lamy syndrome, in which the kyphosis is flexible and radiographically corrects when the patient is placed supine over a bolster, bracing can be effective. Scheuermann's Kyphosis A thoracic kyphosis of more than 40°
Postural Scheuermann's Congenital Neuromuscular Myelomeningocele Traumatic Post-surgical Post-irradiation Metabolic Skeletal dysplasias Collagen disease Tumor Inflammatory
Postural-It is usually seen in tall individuals. Bad posture in school or mental and physical tension can also lead to faulty posture. If due to some reason, there is exaggeration of lumbar lordosis then there is compensatory kyphosis in the thoracic spine. Kyphosis may result due to Scheurmann's disease which is the osteochondritis of the vertebral bodies. Ankylosing spondylitis is another major cause of kyphosis. It produces a stiff kyphotic spine. In adolescent age group, it may be due to arthritis or rheumatism.
Treatment is given according to the degree of deformity. First Degree Kyphosis Treatment It is usually due to poor posture. Ku m ar An adult presenting with low back pain or a teenager with poor posture with or without pain Physical examination usually reveals a sharp. Using mirror. Breathing exercises especially diaphragmatic and lateral costal breathing are taught to the patient. Its important to realize. however. irregular endplates. Increased veterbral anterior/posterior diameter at the apex Clinical Findings According to the severity and the extent of disease. stretches. there are three degrees: 1-First degree 2-Second degree 3-Third degree Kyphosis Treatment Early diagnosis help prevent the progression of the severity. increased pelvic tilt and associated hamstring tightness Sagittal plumb line should cross C7-T1. that correction of kyphotic posture takes time. Further. Gluteal and abdominal contractions are also very useful. Vi Kyphosis Treatment-Stretches:- na y Whole relaxation of the body is done.47 Three or more adjacent vertebra that are wedged 5° Characterized by schmorl‘s nodes. as well as continual postural correction. rigid kyphosis Kyphosis is increased with flexion and incompletely corrected with extension Lumber hyperlordosis. and a narrowing of verterbral disc space. and posterior sacrum normally Normal thoracic kyphosis : 30º-40º. Hencestretching of hamstring is done. It involves exercises. mean = 34º Normal lumbar lordosis : 55º-65º(two-thirds of lordosis at L4-L5 and L5-S1) Lumbar lordosis should be about 30ºgreater than thoracic kyphosis 30% have associated mild scoliosis. the patient must make a conscious effort to work toward correcting and maintaining proper posture. Strengthening exercises are given for abdominal muscles and back extensors. . the patient is made aware of his poor posture and proper instructions are given accordingly to correct the posture. Postural Kyphosis Treatment include certain physical therapy exercises to strengthen the patient's paravertebral muscles. mobilizations. There may be associated tightening in hamstring muscles. T12-L1. Mobilizing exercises are given for whole spine.
but to prevent more fractures. exercises also play role in improving mobility of the spine. you are mobilizing your spine. the muscles may not be able to support the spine very well. as well as the diaphragm. The physical therapist also help with flexibility and range of motion. because at the same time you stretch them. Physical Therapy in Kyphosis Treatment Caused by Spinal Fractures Physical therapy won't correct the kyphotic curve caused by spinal fractures. so a PT can develop an exercise plan that may involveweight-bearing exercises (such as walking or tennis) and strengthening exercises (such as weight lifting). but can improve quickly over about 2 weeks with consistent work on the roller. A physical therapist can also help with safe exercises. One of the best ways to stretch your abs is by laying over a swiss ball. some believe that wearing the brace can weaken the muscles. Basically this means stretching it backwards over the roll. it may be useful to learn good (or better) posture. Physical therapy can help alleviate those tight muscles. Second and third Degree Kyphosis Treatment Physical Therapy in Scheuermann's Kyphosis Treatment Physical therapy is often used at the same time as bracing. This technique can be quite tender on your spine at first. Along with bracing. Because the brace supports so much of the spine. Surgical Procedure for Structural Kyphosis Treatment The surgical procedure for structural kyphosis treatment involves halo traction for several weeks. bone graft may be required to maintain the correction. Sometimes spinal decompression and stabilization may also be required. Abdominal stretching: Stretching your abs can help tremendously in reducing thoracic kyphosis. when the brace comes off. A physical therapist can also help strengthen spinal muscles so that spine is better supported—taking some of the weight and pressure off vertebrae. and breath naturally. Foam rolling the thoracic spine: This technique involves laying over a foam roll. Many patients with Scheuermann's kyphosis also have very tight hamstring muscles. m ar . as this will serve to improve the release you get.48 While it is essential to strengthen the muscles that are causing the slouching of the thoracic spine to occur. Physical Therapy help avoid this. Exercise is important to bone health. Otherwise. Two muscles that can significantly contribute to excess thoracic flexion include the abdominals. for the purpose of mobilizing your spine. particularly at those spinal segments that are not moving very well. and the spine may still curve too much. it is also important to stretch the muscles that are holding the postural dysfunction in place.Spinal Instrumentation and Fusion are surgical procedures that may be used to correct spinal deformity and to provide permanent Vi na y Ku The Deformity is in advanced stage. Its important to make sure you relax as you do this stretch. Hence to correct it brace is given to the patient. In some cases.
. Gradual mobilizing and strengthening exercises for the spine are given. which reduce physical na y The most important mode of spread of Mycobacterium leprae is by dropletsfrom the sneeze of leprosy patients. It is not certain whether the organism enters by inhalation or through the skin. The patient continues physical therapy on an outpatient basis for a period of time. and screws. and increase range of motion. We know that it is much less infectious than small-pox and many other diseases. ar Proper chest physiotherapy is given to avoid complications Movements to lower limb and neck should be given twice daily to the patients who are on the tractions. Some people have such high resistance that they do not get infected by leprosy disease.49 stability to the spinal column. These procedures join and solidify the level where a spinal element has been damaged or removed (e. bars. Tropical Africa. Instrumentation uses medically designed hardware such as rods. It is diagnosed and treated with drugs and it can be controlled with little precautions. wires. intervertebral disc). flexibility. Great majority of leprosy patients cannot infect other people. Mode of spread The leprosy disease is common in tropical countries like Asia. Additionally. no matter how closely they are in contact with any infectious person. The disease is still endemic in Southern Europe. the therapist provides the patient with a customized home exercise program for kyphosis treatment. Infectivity Vi It is not absolutely sure how leprosy spreads from one person to another. an acid and alcohol fast bacillus. Leprosy which is also calledHansens Disease is the commonest cause of peripheral neuritis and about 20 million of the population is affected by it.g. Far East. whose nasal mucosa is heavily infected. disabling disease which attacks nerve and skin. It is one of the most serious. It is a chronic infectious disease of only man and attacks mainly nerves and skin. North Africa and the middle East. Central and South America and in some Pacific Islands. . Even the few infectious patients are no longer infected if they have been taking adequate treatment for 3-6 months. The incubation period is between 2-5 years. Post Surgical Physiotherapy Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae. This fact shows that leprosy is not dangerous as most of the people think. These devices hold the spine straight during fusion. Ku Leprosy Disease m Physical therapy is added post-operatively enabling the patient to build strength. though they do need to continue drug treatment for a very long time.
cases have good resistance. Types of Leprosy Disease All types of leprosy are caused by mycobacterium leprae. Areas affected by this rash are numb because the bacteria damage the underlying nerves. Damage to hand and feet can occur in all three types. and testes. Borderline leprosy: Features of both tuberculoid and lepromatous leprosy are present.50 damage or disability from occuring. Infection of the nerves makes the skin numb or the muscles weak in areas controlled by the infected nerves. or it may worsen and become more like the lepromatous form. may be affected. Leprosy disease may cause great emotional distress to the patient and their families. nose. Without treatment. if the mycobacterium leprae damages nerve trunk. Borderline cases have only fair resistance and lepromatous cases have little or no resistance. Leprosy disease affects mainly the skin and peripheral nerves Characteristic rashes and bumps develop. whitish areas. they progress slowly. borderline leprosy may become less severe and more like the tuberculoid form. symptoms usually do not begin until at least 1 year after people have been infected. when treating neuritis it is necessary to divide borderline leprosy into 3 types making five types in all. The three main types of leprosy are: Tuberculoid Borderline Lepromatous However. including the kidneys. In tuberculoid. consisting of one or a few flat. Vi na y Tuberculoid leprosy: A rash appears. On average. Once symptoms begin. The amount of patient's resistance determines whether he/she can get leprosy at all and if he can. There are more areas of numbness than in tuberculoid leprosy. and it may seiously affect the social life of the patient. Lepromatous leprosy: Many small bumps or larger raised rashes of variable size and shape appear on the skin. Ku Tuberculoid Leprosy(TL) Borderline Tuberculoid(BT) Borderline Borderline(BB) Borderline Lepromatous(BL) Lepromatous Leprosy(LL) m ar . symptoms appear 5 to 7 years after infection. Much of the skin and many areas of the body. then which type he will get. and certain muscle groups may be weak. Symptoms of Leprosy Disease Because the bacteria that cause leprosy multiply very slowly. These five types are: According to the type and difference in resistance the skin sign changes.
which takes six months to a year or more. but rifampin is a key component of either regimen. kidney failure may occur. the immune system may produce inflammatory reactions. Nose: Damage to the nasal passages can result in a chronically stuffy nose and nosebleeds and. or otherwise harm themselves.51 The most severe symptoms result from infection of the peripheral nerves. doctors can feel them. Certain cases may be treated with two antibiotics. Muscles may become too weak to flex the foot—a condition calledfootdrop. enlarged nerves. testes. and clofazimine -. the WHO recommended the use of a combination of three antibiotics -. Since 1995. rifampin. Repeated damage may eventually lead to loss of fingers and toes. and deformities that result from muscle weakness) provide strong clues to the diagnosis of leprosy. Eyes: Damage to the eyes may lead to glaucoma or blindness. peripheral nerves. the WHO has provided these drugs free of charge to all leprosy patients worldwide. and eyes. making walking painful. liver. The infection can reduce the amount of testosterone and sperm produced by the testes. For example. and the bumps may form open sores. the lymph nodes.usually dapsone. complete erosion of the nose. and. Also. Sexual function: Men with lepromatous leprosy disease may have erectile dysfunction (impotence) and become infertile. na y Diagnosis of Leprosy Disease Ku Feet: Sores may also develop on the soles of the feet. People may have a fever and swollen lymph glands. joints.for treatment. Other areas of the body may be affected by Leprosy Disease: During the course of untreated or even treated leprosy disease. cut. the fingers may be weakened. which causes deterioration of the sense of touch and a corresponding inability to feel pain and temperature. Blood tests to measure antibodies to the bacteria have limited usefulness because antibodies are not always present. kidneys. Leprosy Treatment Vi The good news is that leprosy is curable. The skin around bumps may swell and become red and painful. Symptoms (such as distinctive rashes that do not disappear. Kidneys: The kidneys may malfunction. damage to peripheral nerves may cause muscle weakness that can result in deformities. In severe cases. Skin infection can lead to areas of swelling and lumps. less commonly. loss of the sense of touch. Examination of a sample of infected skin tissue under a microscope (biopsy) confirms the diagnosis. causing them to curve inward (like a claw). People with peripheral nerve damage may unknowingly burn. Infected nerves may enlarge so that during a physical examination. which can be particularly disfiguring on the face. if untreated. m ar . culture of tissue samples is not useful. In 1981. These reactions can cause fever and inflammation of the skin. Because leprosy bacteria do not grow in the laboratory.
Depending on the severity of the infection and the doctor's judgment. To preserve all posible movements of hands and feet.52 During the course of treatment. doctors prescribe more than one drug. Because some leprosy bacteria are resistant to certain antibiotics. Paucibacillary: People take rifampin once a month with supervision and dapsone once a day without supervision for 6 months. Ku m ar Multibacillary: The standard combination of drugs is dapsone. deformity and disability in body through Physical Therapy. prevention of complication. Some doctors recommend lifelong treatment with dapsone for people with lepromatous leprosy. antibiotics must be continued for a long time. This is treated with pain medication. feets and eyes. deformities and disabilities. This regimen is continued for 12 to 24 months. . depending on the severity of the disease. To protect their own anaesthetic hands. People take rifampin and clofazimine once a month under a health care practitioner's supervision. To keep their joint flexible. To keep their skin soft and supple. and minocycline. What the disease of leprosy is? The possible complications and deformities resulting from leprosy. They take dapsone plus clofazimine once a day on their own. rifampin and clofazimine. in daily work. To respect themselves enough to take medication regularly and to take care of complications. treatment continues from 6 months to many years. prednisone or thalidomide (under special conditions). The drugs chosen depend on the type of leprosy: Because the bacteria are difficult to eradicate. People who have only a single affected skin area are given a single dose of rifampin. To use their hands. Goals of Physical Therapy for Non-Surgical patients Of Leprosy Disease the major aim is to prevent or reduce complication. By treating and helping the patient. feet and eyes safely. To keep their muscles strong. ofloxacin. Means The ways of reaching these Goals are Teachings Treating and Helping Vi na y By teaching the patient. the body may react to the dead bacteria with pain and swelling in the skin and nerves.
Muscle re-education after tendon transfer. Teach home self care. Arthrodesis: Elimination of unstable and deformed joints. The tendon then act as ligament. Clean supple skin in areas of surgery.Transfer of fore-arm muscle to make finger movements. Tenodesis: Attach a piece of tendon across the joint to reduce the movement. To improve strength specially in tendon transfer: Active exercise in all part in which surgery is performed. Example.Tendo Calcaneus lengthening. Protect tissue during healing: Rest. For increasing/regaining ROM: ROM can be increased by soaking the skin or part in warm water and then performing passive movement to the part affected. hand. feet. Example. active and passive exercise. Capsulotomy: To loosen tight joint capsule often done with tendon lengthening and tendon transfer to improve range of motions. Surgical Techniques used in Leprosy Disease Physical Therapy Goals: Physical Therapy Technique: Vi na y To increase and regain range of motion. Home care: teaching skin. To improve and restore function. face and eyes. foot and eye care to groups and individuals and teaching the patients actual home care. self massage and protecting the part from infection. eye and foot protection. Muscle Re-education after tendon transfer: Teaching new restored skills in movements provided by tendon transfer. Prevent/reduce swelling. To improve appearance of hands. Example. rubbing off thick skin. Tendon Lengthening: Lengthening the tendon of a muscle to permit more movement and reduce contracture.53 Goals of Physical Therapy for Surgical patients Of Leprosy Disease To protect and prevent further damage and deformity. Ku Tendon Transfer: Moving the distal end of the tendon to a new place so that contraction of muscle belly will produce a needed movements used to replace paralysed muscles. Improve muscle strength perticularly in muscles to be transferred.Tenodesis of MCP joint to prevent hyperextension. Self restored skills in daily work: Teaching patient ot use any new skill safely in specific task. oiling. Clean supple skin: It is provided by soaking the part in soap water. body position and POP cast. Protect tissue during wearing. Prevent/Reduce swelling: Elevation. Providing hand. m ar . Safe use of any new restored skill in work. Tighten the loose joint capsule using suture.
and becomes rough and the bony erosion occurs. the spine becomes like a solid rod of bone between the skull. Later in the disease process. Around the joint there is loss of cortex and erosions with consequent widening of joint space. AS results in bony ankylosis beginning with ossification of ligaments and tendons of the spine. It starts with back pain and a general feeling of ill health which eventually leads to stiffening and inability to bend the spine. In worst cases. firstly from the sacroiliac joints followed by the other region of the spine. The cartilage of the joint gets destroyed. in white population it is between 1-10 patients per 1000 persons. The first degree relatives of the patient of AS have more chances to develop this condition. there is sclerosis and finally ankylosis. which may be identical histologically to that in rheumatoid arthritis(RA). Mostly commonly the synovitis starts. Over 90% of patients are HLA-B27 positive. males are more commonly affected than females. Capsular Inflammation Cartilage Destruction and Bony Erosion This occur due to synovitis and the inflammation of the ligament and the capsules. Environmental factors. Epidemiology Prevalence varies in different races. the inflammation of the synovium occur.54 Ankylosing Spondylitis (AS) Ankylosing Spondylitis (AS) is a sero negative. The age of onset is commonly in 18-30 but can start at any age. neck and pelvis hence named as POKER'S BACK. usually the ratio is 3:1. ossification usually starts at the dorso lumbar region or sacro iliac joint. m ar . Pathology The pathology of AS include the following processSynovitis Initially. Vi na y Ku Genetic Factors. particularly at junctions with bones. Enthesopathy This term refers to an inflammatory reaction at the enthesiswhich is the zone of ligamentous attachment to the bone. and this is the characteristic feature of AS that occurs commonly in the spine and near the pelvis. Over 90% of patients possess HLA-B27 (Human Leucocyte Antigen). Etiology The exact cause of Ankylosing Spondylitis (AS) is unknown but there are two factors which are thought to be the cause of this condition. progressive chronic inflammatory disease.
Ankylosis All the features of the above and most important the ossification part.Heart disease conduction defects. usually from the edge of one body to that of the next. Ankylosing Spondylitis Symptoms The severity of symptoms can vary from mild to very severe. and this condition is called bamboo spine. Ossification also occurs in the anterior and posterior longitudinal ligament and also in other ligaments of the spine. Aortic regurgitation. leaving the spine permanently stiff. na y Stiffening and pain (arthritis) of the: Lower back Sacroiliac joint. visual changes. Myelopathy secondary to atlanto-axial subluxation. along the outer layer of the disc. Common symptoms may include: Less common symptoms may include: Vi Associated Conditions Iritis. After bony fusion the pain may subside. This typical phenomenon is known as the marginal syndesmophyte formation. possibly radiating down the legs Pain that is often worse at night Stiffness that is worse in the morning Symptom improvement with exercise or activity Occasionally. heart valve (aortic insufficiency). pain and stiffness in other joints: Knee Upper back Rib cage Neck Shoulders Feet Chest pain. increased tearing which may suggest eye involvement (uveitis) Fatigue Loss of appetite or weight loss Fever Numbness (if arthritic spurs compress the spinal nerves) Ku m ar . Apical pulmonary fibrosis. or lung involvement Eye pain. which may suggest heart. The formation of the syndesmophytes starts usually from the dorso-lumbar region. results into fusion of all the vertebrae of the spine. Inflammatory bowel disease.55 Ossification All the above factors lead to the formation of new bones at these areas. and bridging takes place between the vertebral bodies.
before standard changes are present. Hazziness of the joint margins which later on show erosions. ar Neurological involvement/cauda equina syndrome. due to the fact that the symptoms of ankylosing spondylitis are so similar to other. Haemoglobin Normochromic or normocytic anaemia may occur but in contrast to RA. Pulmonary Function Tests In patients with thoracic involvement usually show diminished vital and total lung capacity. can often detect areas of active inflammation in AS.56 Complications of Ankylosing Spondylitis Ankylosing Spondylitis Diagnosis and Investigation HLA-B27 test This is positive in about 95% of patients. When ankylosis is complete. Painful heel or achilles tendinitis. Nuclear scans Technitium stannous pyrophosphate bone scans. Radiological Study Vi a)Sacro-iliac joint: The features of different sites are: na y Rheumatoid Factor Rheumatoid factors are absent. Making an accurate diagnosis for ankylosing spondylitis can be difficult. Romanus lesions. Spinal fracture. Reduced chest expansion and vital capacity. Flow measurements are usually normal. Amyloidosis. . Sclerosis of the ilium and sacrum on either side of the joint. Ku Erythrocyte Sedimentation Rate The sedimentation rate is generally raised in proportion to the inflammatory activity in about 70% of patients. Sometimes leaving the evidence of the previous joint line. patients with active disease often have a normal haemoglobin and blood film. Possibility of chest infection. Narrowing of joint space which may progress to fusion. however. Synovial Fluid Contains a moderate number of mononuclear leucocytes in contrast to the increased polymorphonuclear leucocyte count of RA fluid. more common back problems and the symptoms and signs occur slowly over a period of years. Spinal cord compression. the periarticular sclerosis fades. known asGhost joint. m Early diagnosis is important in order to start on the Ankylosing Spondylitis treatment program. increased residual volume and functional residual volume.
which become progressively destroyed and causes angulation of the spine. Ankylosing Spondylitis Treatment include: Vi Drugs used in Ankylosing Spondylitis Treatment na y Drug Therapy . Calcification of the paraspinal ligaments. Hip involvement is prognostically important. the disease is mild and although it may show periods of exacerbation with increased pain and stiffness. Prevent deformity.57 b)Spine: Spinal changes include In Advance Disease Most patients who maintain disciplined exercise. posture programme and take anti-inflammatory medications i. Erosive changes in the anterior vertebral bodies adjacent to the disc. ar Squarring of the vertebral bodies i. Ankylosing Spondylitis Treatment There is no specific therapy or cure for AS. The aim of Ankylosing Spondylitis Treatment are:1. In some individuals.e loss of normal anterior concavity on the lateral view. Less than 10% develop crippling disease. AS shows a wide range of severity.e proper Ankylosing Spondylitis treatment plan are able to lead relatively normal and active life with minor adjustments in life style. because it adds to the difficulty in mobility and further impairs functions.3. The appearance may resemble infection or trauma but is probably part of the spondylitic process. . Atlanto-axial subluxation. Ku Ankylosing Spondylitis Prognosis m The characteristic bamboo spine results from syndesmophyte or paraspinal ligament calcification around the normal disc space. At the other end. The romanus sign. Spondylodiscitis may develop in the lower thoracic and upper lumbar segments. and ankylosis occurs in this position producing variable degrees of a fixed 'C' shaped deformity. Maintain maximum skeletal mobility. Symptoms may be persistant or intermittent over the years or we can say that the disease is present throughout the life but does not shorten the life of the patient. The course of AS varies.2. To control pain. Surgical Management. causing marked and permanent spinal rigidity. the disease may progress or may be uncontrolled. Physiotherapy Management. is the erosion surrounded by sclerosis at the vertebral body margin. Since patients with spinal pain tend to flex the back and neck. there is little permanent limitation of the spine. Syndesmophyte formation usually first seen at the thoraco-lumbar level. Arthritic changes and later apophysial joint fusion occurs which is best seen in cervical spine.
By this. Surgery may be performed if pain or joint damage is severe. Gaenslen sign. In cases where chronic therapy is needed. potential drug side effects must be taken into consideration. This will successfully restore mobility and eliminate pain of the damaged joint.The patient is in supine lying and then. A) PHYSICAL EXAMINATION: i) Sacroiliac Joint: There are certain simple tests. Ku Surgery as a Ankylosing Spondylitis Treatment m ar . or methotrexate (Rheumatrex). In rare cases surgery is used to restore a straighter posture of the spine and neck to people who have become severely stooped. the pain is felt on affected side. Ask the patient to drop the unsupported leg off the table. Lateral compression of the pelvis with the examiner's hand will elicit pain. treatment with corticosteroids is usually limited to a short amount of time with a gradual weaning from the drug. this procedure will elicit pain in the contralateral SI joint by stretching it. By this procedure. but are usually reserved for severe cases that do not improve when NSAIDs are used. SLR test (straight leg raising test). do the flexion of the hip and knee and then give some extra pressure as to touch the knee to the opposite side of the shoulder. In severe cases. is recommended. Corticosteroid drugs are effective in relieving symptoms.The patient is in supine lying position and then asked to lift the leg upwards with his knee extended. pain is felt on the affected side at the SI joint. Pump Handle Test. Some health care professionals use cytotoxic drugs (drugs that block cell growth) in people who do not respond well to corticosteroids or who are dependent on high doses of corticosteroids. About 6% of people with AS need to have a hip replaced. Vi na y SI joint tenderness and paraspinal muscle spasm. sulfasalazine (Azulfidine). another drug to reduce inflammation. Drugs called TNF-inhibitors have been shown to improve the symptoms of ankylosing spondylitis. Surgery plays a very small part in the management of this condition. an immune-suppressing drug. Physiotherapy Management in Ankylosing Spondylitis Treatment The physiotherapy management consists of the physical examination or assessment of the patient and the physiotherapy methods used for Ankylosing Spondylitis Treatment. Corticosteroid therapy or medications to suppress the immune system may be prescribed to control various symptoms. which may be positive if the SI joint is affected. To avoid potential side effects.58 Nonsteroidal anti-inflammatory drugs (NSAIDs). like naproxen (Naprosyn) or indomethacin (Indocin) are used to relieve pain and stiffness.Instruct the patient to lie supine on the edge of the examining table with knee flexed and with one buttock over the edge.
hip. done with the help of goniometer. Prevent and correct deformity. So the patients spine become rounded. B) PHYSIOTHERAPY TREATMENT: Regular physiotherapy is very essential in the management of a patient of AS and only physiotherapist is the person who can help the patient to fight with the disease. Lateral spinal flexion. na y Relieve pain. Attention to posture.This test detects an early involvement of the cervical spine. If the patient can't do this. shoulder etc. Thoraco-lumbar flexion extension. Increase chest expansion and vital capacity. The measurement is done by goniometry. Advice to patient. m The cervical spine also become stiff and flexion deformity develops. To maintain and improve physical endurance. shows the involvement of the cervical spine. thorax. In physiotherapy department using spondylometer helps in measurement of postural deformity. Try to do a complete set of exercises at least twice daily at a time convenient to you. knee and shoulder. Less than 5cm of chest expansion during inspiration in an adult is considered to be reduced. cervical spine iv) Lung Function Test: Early involvement of the costo-vertebral joints in the disease process makes careful spirometry and measurement of chest cage movement essential. AIMS OF PHYSIOTHERAPY MANAGEMENT IN ANKYLOSING SPONDYLITIS TREATMENT: Vi General instruction to patients:Make the exercise part of your daily routine. loss of secondary spinal curve occurs. It is advisable to make objective measurement of these. Fleche Test. As mentioned before early diagnosis is important in order to start on the Ankylosing Spondylitis treatment program. ar . first the lumbar lordosis is lost and then the cervical lordosis and increase of thoracic curve develops. Commonly involved joints are temporomandibular . Ask the patient to stand on the heel and back touched on the wall and then ask the patient to touch his back of the head to the wall and at the same time the chin is not moved upward. Lumbar or spinal forward flexion (Schobere test). hip. v) Measurement of Postural Deformity: In this. measurement can be made from the wall behind and the tragus of the ear. Ku iii) Examination of peripheral joint movements: All the joints are measured for active and passive range of motion. Combined hip and spinal flexion.For the flexion deformity. Tragus to wall test.59 ii) Spine: Loss of spinal motion can be detected quite early in most cases. Maintain the mobility of joints affected like spine.
Low arm chair should be avoided. thoracic cage are essential in Ankylosing Spondylitis Treatment. by giving mobility exercises to particular joints. Perform exercises on a firm surface. The therapeutic effects of water in relation to Ankylosing Spondylitis TreatmentThe relief of pain and muscle spasm. the spine remain in extended position and not in flexion. which are affected like. hip. do not rush. in real sense refers to the therapeutic use of water. Hydrotherapy:- Prevent and correct deformity by giving attention to posture: Vi na y Hydrotherapy. Adjust the height of the working table and ensure that the patient does not stoop on that. Hot packs. Cryotherapy. ar . Hydrotherapy. Ku Exercises for mobilization of joints:- m Infra red. Modify the exercise regime during an acute attack and contact your physical therapist if you have any complaints or problems with the exercises. The encouragement of functional activities. This helps to prevent and correct deformity and thus help in Ankylosing Spondylitis Treatment. Sleeping should occur in prone position or supine on a firm mattress with a thin or no pillow by this. The design of chairs is important particularly for those who spend most of their working hours sitting at desk. The strengthening of weak muscles and an increase in their tolerances to exercise. Pain Relief:- Pain and muscle spasm are treated by the following modalities and the relaxation is advised- Maintaining the mobility of joints. shoulder. Avoid holding your breath while exercising.60 Heat and cold application amy precede exercises to enhance relaxation and decrease pain. The spondylitic patient should always be conscious of his posture while sitting. Steam bath. an upright chair with some cushioning to support the lower lumber spine is better. standing and walking patient should maintain the erect posture during these activities. spine. Maintenance of the mobility is very important and the basic aim is that all the joints are moved to their maximum limit and by this. we can delay the process of ankylosis. co-ordination and posture. Perform only those exercises given to you by your physiotherapist. The importance of circulation. The maintenance or increase in range of motion of joints. Exercise slowly with a smooth motion. The maintenance and improvement of balance.
ar . Improvement in physical fitness. Development of competitiveness and motivational aspects. The advantages of group therapy classes in Ankylosing Spondylitis Treatment: Vi na y The patient can give support to the other member of the class that is another patient. Ku m Deep breathing exercises are encouraged. Group Therapy Classes:- The group therapy classes means that number of patients of the same disease are collected under one roof and physiotherapist can give treatment simultaneously to all the patients. Improvement of physical endurance in Ankylosing Spondylitis Treatment:- Endurance is a quality which develops in response to repetitive contraction. Shared problems providing a good medium for patient's education and latest information about the disease process. Endurance is improved by working muscles against light resistance and high repetition i. Increase chest expansion and vital capacity:To increase the chest expansion and vital capacity. the spinal extensors become weak and by this the extended position of the spine is not retained. Breathing exercises that are used in Ankylosing Spondylitis Treatment: Apical breathing exercises.e for longer time.61 Avoidance of prolonged immobilisation or bed rest. Lateral costal breathing exercises. They increase the vital capacity of the lung. Ballooning exercise is also very useful in Ankylosing Spondylitis Treatment. because of this. the breathing exercises are required. Diaphragmatic breathing exercises. Thoracic mobility exercises.
stiffness. developmental. is a group of mechanical abnormalities involving degradation of joints. The typical changes seen on X-ray include: joint space narrowing subchondral cyst formation subchondral sclerosis (increased bony formation around the joint) osteophytes Plain films may not correlate with the findings on physical examination or with the degree of pain Ku m Osteoarthritis is a common cause of pain and disability in the aging population. OA is the most common form of arthritis. and ligaments may become more lax. ar . As a result of decreased movement secondary to pain. Diagnosis Usually other imaging techniques are not necessary to clinically diagnose osteoarthritis. Symptoms may include joint pain. how can exercise help me? Won‘t exercise make my arthritis knee pain worse? Studies for instance. bone may be exposed and damaged. X-rays may confirm the diagnosis. A variety of causes—hereditary. One study shows that a relatively small increase in strength (20-25 percent) can lead to a 20-30 percent decrease in the chance of developing knee osteoarthritis. and sometimes an effusion. and mechanical— may initiate processes leading to loss of cartilage. metabolic. Acetaminophen / paracetamol is used first line and NSAIDS are only recommended as add on therapy if pain relief is not sufficient. regional muscles may atrophy. If pain becomes debilitating joint replacement surgery may be used to improve the quality of life. locking. lifestyle modification and analgesics. Osteoarthritis (OA) also known as degenerative arthritis or degenerative joint disease. tenderness. physical therapyand analgesics are the mainstay of treatment. have shown that strengthening the quadriceps muscles can reduce arthritis knee pain and disability.62 osteoarthritis what is osteoarthritis ? Patients with osteoarthritis often ask. Osteoarthritis Treatment Lifestyle modification (such as weight loss and exercise). including articular cartilage and subchondral bone. Treatment generally involves a combination of exercise. When bone surfaces become less well protected by cartilage. Vi na y Diagnosis is made with reasonable certainty based on history and clinical examination.
In people with osteoarthritis. Strengthening exercises: Every alternate day. Ku Range-of-motion: To maintain normal joint movement and relieve stiffness. ease off exercise programme and talk to your health care provider if your joints get painful. Increase the difficulty of your exercise routine slowly. Strengthening exercises: To increase the strength of muscles that support the joints affected by arthritis.63 Goal of Osteoarthritis Exercises Main aim of Osteoarthritis Exercises are to reduce pain. na y Discuss the osteoarthritis exercises plan with your health care provider. Osteoarthritis Exercises There are mainly three kinds: Osteoarthritis Exercises Plan How Often Should You Exercise? Vi Range-of-motion Osteoarthritis Exercises There are several types of knee therapy exercises to help increase the range of motion of the knee joint and begin to re-strengthen the muscles that support the knee. and prevent disability. These make the joints flexible. all with the ultimate goal of improving quality of life. Start under supervision of a physical therapist or a qualified athletic trainer. Begin exercising with stretching. improving flexibility has an even greater benefit than simply providing a warm up before exercise. The facilitated heel slides range of motion exercises are the movements described here. Strengthening exercises Strengthening exercises can be classified into three categories: isometric. and isotonic exercises. control weight and improve overall body function. Endurance exercises: For 20 to 30 minutes three times a week. Aerobic or endurance exercises: They improve cardiovascular fitness. Apply heat to sore joints before you begin exercising. flexibility and range of motion exercises. inflammed or red. static. ballistic and something calledproprioceptive neuromuscular facilitation (PNF). start strengthening exercises slowly with small light weights or resistance band. isokinetic. m ar Muscle Strengthening Improving Flexibility and Joint Motion Improve Aerobic Functioning Weight Loss . There are many ways that these goals can be achieved through exercise programs. There are a few different types of stretching exercises. improve function. apply cold packs to sore joints and muscles after osteoarthritis exercises. as discussed below. Range-of-motion: Either daily or every alternate day.
bend your knees so that your feet are flat on the floor. ar . Isokinetic exercises are infrequently used. Hold this position for 10 seconds. When beginning resistance training. Vi Quad sets: while in a seated position. it is best to start with isometric exercises. Wall slide: place your back up against the wall with your hips and knees bent to a 90 degree angle as if you were sitting in a chair. Relax and bring back to the floor. Hold for 10 seconds then relax. hamstrings. Press down using the backs of your thighs and hold contraction for 10 seconds. Lastly. it is better to use lighter and easier weights with additional repetitions. Isotonic Hamstrings lying on your belly with a pillow under your abdomen to support your back. make a muscle with your thighs trying to push the back of your knee down towards the floor. Repeat. and gluteal muscles. Isometric Hamstrings while lying on the floor place heels on surface such as a couch or an exercise ball. then come up and relax. It should incorporate exercises that target major muscle groups such as quadriceps. For people who have restrictions in their ability to execute full range of motion. Calf muscles Strenthening Using a wall or chair for balance. without moving your joints. relax and then repeat. Bring back down to the floor repeat on the other side. Isotonic Quad exercise: sitting in a chair with your feet planted flat on the floor. A word of caution in patients with a history of heart problems. it is good to start with just a single set of up to 15 repetitions. particularly in patients who can not tolerate repetitive joint motion. therefore. Hold for 10 seconds. raise your right leg straight out in front of you. Contract for 10 seconds. na y Ku m Isometric exercises are those in which you are strengthening your muscles by contracting them and not moving them through their normal range which might be painful if you have arthritis. again using constant weight or resistance. Relax and then repeat. isokinetic exercises involve constant speed of motion throughout the joint range during muscle contraction. with legs fully extended in front of you. Isometric Glutes Lying down on a flat surface back flat on the floor. Isotonic exercises are those in which you contract your muscle throughout the full range of motion. A problem with isometric exercises is that they tend to raise the blood pressure more than others. An example of this is simply contracting your leg muscles. relax and repeat. Isometric exercises are often the best type of exercise to begin with in a strengthening program.64 Some examples of exercises specifically for the legs good for those with osteoarthritis of the knee and or hips. Raise your buttocks up off the ground contracting your butt muscles together. go up on your toes using your calf muscles hold yourself. done 2 days a week. As you are able to you can add ankle weights to increase resistance. Repeat on the left. bend your knee and bring your foot back towards your buttock. For patients in which putting the joint through repetitive range of motion aggravates their pain. due to equipment requirements and uncertain correlation to functional activities. while the amount of resistance may vary throughout the range. isometric exercises may not be the best type of strengthening for you and. such as performing a biceps curl while holding a dumbbell. One possible goal is to complete 2 sets of 10 repetitions before resistance is increased. it is best to discuss this with your doctor before implementing such an osteoarthritis exercises plan.
the first goal should be to minimize time spent sitting throughout the day. like swimming or water aerobics. As the lumbar discs and associated ligaments undergo aging. adequate hydration and nutrition. symptoms including pain may accompany activity. thoracic. Spondylosis Definition Vi SPONDYLO is a Greek word meaning vertebra. more than one vertebrae). Disc degeneration. Pain and morning stiffness are common complaints. it is recommended that for benefits of aerobic exercise to be achieved. Usually multiple levels are involved (eg. Within that 30 minute time interval. one must remember to consider proper breathing techniques. increase with age but are often asymptomatic. biking. Repetitive movements such as lifting and bending (eg. that you should aim to have 30 minutes of moderate activity most days of the week. also known as spinal osteoarthritis. Lumbar spondylosis encompasses lumbar disk bulges. and vertebral bony overgrowths (osteophytes). Exercise in water. ar . Movement stimulates pain fibers in the annulus fibrosus and facet joints. Compromise of the spinal canal or of the openings through which the spinal nerves leave the spinal canal can occur. a workout and a cool down. On the whole. relieves weight on stiff or sore joints. when these are done for an appropriate amount of time. The ability to move freely in water can also be a liberating experience. Sitting for prolonged periods of time may cause pain and other symptoms due to pressure on the lumbar vertebrae. swimming and rowing. jogging. the disc spaces frequently narrow.65 Spondylosis often affects the lumbar spine in people over the age of 40. this can be achieved via activities such as walking. intensity can all be tailored to your personal needs and abilities. Traditionally. improving your psychological outlook. Degenerative changes. Ku Lumbar Spondylosis m Endurance and flexibility exercises: Aerobic exercise strives to improvecardiovascular function through activities that will increase your heart rate. Although aging is the primary cause. Factors such as frequency of activity. including osteophyte formation. there should be a warm up. Thickening of the ligaments that surround the disc and those that surround the facet joints develops. Spondylosis generally mean changes in the vertebral joint characterized by increasing degeneration of the intervertebral disc with subsequent changes in the bones and soft tissues. when degenerative forces compromise its structural integrity. and/or the cervical regions of the spine. facet joint degeneration. the less stress there is to your joints. the location and rate of degeneration is individual. Walking or using a stationary bike or elliptical trainer helps promote weight loss. spinal canal stenosis. The less weight you carry. manual labor) may increase pain. Spondylosis. These ligamentous thickening may eventually become calcified. can affect the lumbar. In people who are sedentary. spondylolisthesis are the resultant pathological changes. and prior cardiovascular status. With any aerobic activity. duration of exercise. Therefore. The lumbar spine carries most of the body's weight. herniations. Disk herniation is symptomatic when it na y Lumbar Spondylosis is a condition associated with degenerative changes in the intervertebral discs and facet joints.
making a person prone to lumbar spondylosis. ar Spondylosis is mainly caused by aging. although surgery is indicated for spinal cord compression or intractable pain. An increased risk of disc herniation also results. causing wear and tear. na y • Age: As a person ages the healing ability of the body decreases and developing arthritis at that time can make the disease progress much faster. results in strain on all the surrounding joints and tissues. What Causes Lumbar Spondylosis? Pathology Vi The degenerative effects of aging can cause the fibers of the discs to weaken. The job of the facet joins is to allow the spinal column to flex. As people age. Common symptoms include low back pain. Persons over 40 years of age are more prone to developing lumbar spondylosis. The job of the end plates is to attach the disks to the vertebrae and to supply nutrients to the disc. • Heredity or Family history Ku Risk factors for developing lumbar spondylosis m One of the structures that form the disks is known as the annulus fibrosus. and decreased in size. the size of the end plates can decrease and stiffen. extend. With less water in the center of the discs. Constant wear and tear and injury to the joints of the vertebrae causes inflammation in the joints. in turn. gel-like center part of each disk. the intervertebral disks are cushion like structures that act as shock absorbers between the vertebral bones. the vertebrae (spinal bones) and intervertebral disks degenerate with aging. The bones of the facet joints are covered with cartilage (a type of flexible tissue) known as end plates. Degeneration of the discs leads to the formation of mineral deposits within the discs. These hinges are known as facet joints or zygapophyseal joints. along with water and proteoglycans (types of large molecules made of a protein and at least one carbohydrate chain) help to form the soft. Relapse is common. stiff. causing the sensation of stiffness. This. which is when the disc abnormally protrudes from its normal position. and restriction in back movement. Each vertebral body contains four joints that act as hinges. • Obesity: Overweight puts excess load on the joints as the lumbar region carries most of the body‘s weight. and rotate. The annulus fibrosus is made up of the 60 or more tough circular bands of collagen fiber (called lamellae). • Sitting for prolonged periods: Sitting in one position for prolonged time which puts pressure on the lumbar vertebrae. they have decreased shock absorbing qualities. Furthermore. the vertebral bone underneath the end plates can become thick and hard. In the spine. sciatica. When the facet joints degenerate. center part is known as the nucleus pulposus and is surrounded by the annulus fibrosus.66 causes nerve root compression and spinal stenosis. certain biological and chemical changes cause tissues throughout the body to degenerate. This soft. Treatment is usually conservative. Movement can stimulate pain fibers in the facet joints and annulus fibrosus. Collagen fibers. Collagen is a type of inelastic fiber. • Prior injury: Trauma makes a person more susceptible to developing lumbar spondylosis. The water content of the center of the disc decreases with age and as a result the discs become hard. with patients experiencing episodic back pain. .
and muscle spasm. making it weaken. weakness. Particular attention may be given to the extremities. ligaments connect spinal structures such as vertebrae and prevent them from moving too much. These changes can also cause osteoarthritis. In more severe cases. In the spine. ligament. or numbness in the perianal area. numbness. This is called referred pain. degenerative spondylolisthesis.67 Degenerative disease can cause ligaments to lose their strength. spinal stenosis. In degenerative spondylosis. Facet blocks work in a similar manner. These signs and symptoms could represent an important massive nerve compression needing surgical intervention (cauda equina syndrome). tingling). and thighs. Lower back arthritis may be felt as pain in the buttock. hips. A ligament is a tough band of tissue that attaches to joint bones. The physical exam may include: X-rays and Other Tests Vi Radiographs (X-rays) may indicate loss of vertebral disc height and the presence of osteophytes. Either a CT Scan or MRI study may be required if there is evidence of neurologic dysfunction. groin. lateral bending. Osteoarthritis is a disease of the joints that is made worse by stress. extension. Range of Motion measures the degree to which a patient can perform movement of flexion. one of the main ligaments (known as the ligamentum flavum) can thicken or buckle. The physical part of the exam includes a review of the patient's medical and family history. A neurologic evaluation assesses the patient's symptoms including pain. and degenerative scoliosis. as the pain is not felt at its site of origin. abnormal bone growths (known as bone spurs or osteophytes) can form in the vertebrae. and bowel/bladder changes. na y Palpation (exam by touch) determines spinal abnormalities. and nerve abnormalities. muscle spasm. Knobby. An MRI is a sensitive imaging tool capable of revealing disc. Often laboratory tests such as complete blood count and urinalysis are ordered. Areas of the body supplied by these nerves may become painful or develop loss of sensation and function. Symptoms of lumbar spondylosis Physical Examination A thorough physical examination reveals much about the patient's health and general fitness. A CT Scan may help reveal bony changes sometimes associated with spondylosis. m ar . Ku Symptoms of lumbar spondylosis follow those associated with each of the various aspects of the disorder: disc herniation. Pain associated with disc degeneration may be felt locally in the back or at a distance away. As with spinal stenosis or disc herniation in the lumbar region. Both are considered controversial. paresthesias (e.g. Discography seeks to reproduce the patient's symptoms to identify the anatomical source of pain. extremity sensation and motor function. and spinal rotation. sciatica. these bones spurs can compress nerves coming out of the spinal cord and/or decreased blood supply to the vertebrae. areas of tenderness. it is important to be aware of any bowel or bladder incontinence. but is not as useful as a CT Scan or MRI.
discontinue corset by gradually increasing the time without the corset. Ku • Modifying lifestyle including occupational changes if doing manual labor. m ar . esp. cervical collars may be used to alleviate pain by restricting movement. • Physical therapy which teaches the patient to strengthen the paravertebral and abdominal muscles which lend support to the spine. muscle relaxants andanalgesics. losing weight and quitting smoking. neck and shoulders should be supported by the back rest of chair with a small pillow in the lumbar spine.68 The physician compares the patient's symptoms to the findings to formulate a diagnosis and treatment plan. General exercises which help build flexibility. Education of posture. increase range of motion and strength. Physical Therapy Management in Lumbar Spondylosis Goals Vi Management of acute symptoms na y Relief of pain . • Hot or cold packs on the affected area. Uploaded by malton1. Education of posture. Treatment of lumbar spondylosis Each patient is treated differently for arthritis depending on their individual condition. • Rest combined with anti-inflammatory medications. if there are neurologic signs due to decrease in the foraminal space from joint swelling or osteophytes. Analysis of precipitating factors to reduce recurrence of the patient's problems. Restoration of movements. • More powerful anti-inflammatory drugs like corticosteroids can also be injected into the joints to help control pain. Some of the ways of Treating Lumbar Spondylosis are: In more severe cases surgical methods are advised to improve pain and increase motion. ultrasound and electric stimulation are some of the other treatments which are used.With acute joint symptoms. The results from the examination provide a baseline from which the physician can monitor and measure the patient's progress. In the early stages lifestyle modifications or medicines are used for treatment and surgery is needed only if these measures are ineffective. the feet supported and the arm resting on arm rests or on a pillow in the lap. Strengthening of muscles. Often the most comfortable position is flexion. • A corset or a brace could be used to provide support. When acute symptoms decrease.Head. Rest and Support. a lumbar corset may be helpful to provide rest to inflamed facet joints.
The following is a statement made years ago by Risser:"It was customary at the scoliosis clinic at . therefore . sitting and standing. Gentle ROM within the limits of pain-. one must avoid exercises that adversely affect one of the curves. For many years. Overemphasis on flexibility was wrong. Mobilization.. Strengthening exercises. quadriped. program of scoliosis exercises for patients continued to be looked upon with scepticism. Relaxation. Except in some isolated cases. When treating patients with S-curves. elaborate programs of exercise have been instituted in response to the treatment needs of the scoliosis patients. Adequate musculoskeletal evaluation has been lacking. this statement appears:"Physical Therapy cannot prevent a progressive deformity.it was therefore assumed that exercises and spinal motion made the curve increase". The idea is not new. that the usefulness of exercises in case of scoliosis has been questioned.. and as a result there has been little scientific basis upon which to justify the selection of Vi na y Throughout the years.. Invaribly the patients who were 12 to 13 years of age showed an increase of the scoliosis. ultrasound and electric stimulation are some of the other treatments which are used to decrease pain and reduce muscle spasm. Pelvic tilting forward.Restoration of intersegmental mobility by accessory pressure enables the patient to regain full functional painfree movement.Gentle intermittent joint distraction and gliding techniques may inhibit painful muscle responses and provide synovial fluid movement within the joint for healing. and there are those who believe specific spinal exercises programs work in a counterproductive fashion by making the spine more flexible than it ordinarily would be and by so doing making it more susceptible to progression".by soft tissue techniques.e. to send new patients with scoliosis to the gymnasium for exercises. backward in crook lying. . while attempting to correct the other. ar Modalities. Exercises that overemphasized flexibility created problems by making the spine more vulnerable to collapse. In the American Academy of Orthopedic Surgeons 1985 Lecture series. as late as 1920-1930.Orthopedic Hospital. Teach self relaxation techniques. Posture correction. Ku Scoliosis Exercises m Increase ROM.69 Management of subacute and chronic phase Scoliosis Exercises Program It is not surprising.. Traction.Hot or cold packs on the affected area. stretching exercises.Free active exercises of lumbar spine. the attitude has been that scoliosis exercises are of little or no value. The creeping scoliosis exercises advocated by Klapp were discarded when problems with children's knees forced the discontinuance of such a program.g like deep breathing exercises and physiological relaxation (Laura Mitchell method) and hydrotherapy.
left lumbar scoliosis. The object is to use asymmetrical exercises to bring about optical symmetry. Myofascial limitations which make three-plane corrective movements of scoliosis corrections difficult. Dysfunctions associated to scoliosis Scoliosis Exercise General Guideline Scoliosis exercises should be carefully selected on the basis of examination findings. and shortness of the upper anterior part of the left External oblique. In a right thoracic. the object of the exercise is to bring the two hands closer by contracting the abdominal muscles. and the pelvis shifts towards the right. All too often. without flexing the trunk. To restore symmetry requires the use of asymmetrical scoliosis exercises along with appropriate support. In the supine position. sitting tall with spine in as good anteroposterior alignment as possible. Limited mobility of 3-4 ribs on the side of the scoliosis concavity. plus the necessary shoe alteration to Vi na y Ku m ar Insufficient awareness of his/her own posture which makes children less involved in the treatment process. slightly forward from the coronal plane. Incorrect feet loading. Disturbed stabilization of lower trunk. Incorrect posture patterns caused by the long-lasting scoliogenic stimulation. Scoliosis is a problem of asymmetry. and contracting the posterior lateral fibers of the External oblique. . Perform vice-versa for left thoracic. The faulty position has become so customary that the straight position feels abnormal. Keeping the hands in position. but overall flexibility of the spine is not. early cases of lateral curvature are "treated" merely by observation and x-rays at specified specified intervals. there will be tendency toward some counter-clockwise rotation of the thorax in the direction of correcting the thoracic rotation that accompanies a right thoracic curve. It is better to have stiffness in the best attainable position than to have too much flexibility of the back. It is as if the upper part of the body shifts towards the left. there is often weakness of the posterolateral part of the right External oblique muscle. disturbed mechanism of thorax movements during breathing (breathing with convexities).70 therapeutic scoliosis exercises. the subject reaches in a diagonally upward direction. right lumbar scoliosis. Early tendencies toward a lateral curvature are potentially more serious than the anteroposterior deviations seen in the usual faulty postures. Stretching of tight muscles is desirable. By not allowing trunk flexion. Regarding the thoracic curve correction. the subject places the right hand on the right lateral chest wall. and the left hand on the left side of the pelvis. Increased myofascial tension between the thoracolumbar scoliosis apex and the iliac crest which limits the spine shift of the scoliosis correction. The aim is to practise holding the corrected position in order to develop a new kinesthetic sense of what is straight. The person who monitors this exercise should stand behind the subject as the exercise is being performed to be sure that both curves are being corrected at the same time . Instruction in good body mechanics and appropriate scoliosis exercises. There must be adequate instruction to ensure that scoliosis exercises will be performed with precision.
Along with the use of appropriate Scoliosis exercises. Scoliosis Exercises of the lower abdominals. The significance of muscle imbalance and overall faulty posture as etiological factors in idiopathic scoliosis should not be overlooked.71 mechanically assist in correction of allignment constitutes more rational treatment than mere observation. In an effort to obtain better extension in the upper back. emphasizing the action by the External oblique. treatment may involve stretching of the tight Tensor fasciae latae and Iliotibial band and use of a lift on the low side. Braces can be custom-made or can be made from a prefabricated mold. provided that strength is also increased in order to maintain the corrections. as in more advanced cases. As such. Scoliosis is a complex postural problem. But no amount of lift can help if the subject continue to stand with weight predominantly on the leg with the higher hip and with knee flexed on the side of the lift. The exercises will be counter productive because curling the trunk is rounding the upper back. would however. Correction of lateral pelvic tilt associated with a lateral curvature can be helped by proper heel lifts. such an exercise would increase the kyphotic curve. in the form of pelvic tilt. The habit of standing with weight mainly on one leg and the pelvis swayed sideways weakens the abductors. scoliosis exercises that increase flexibility can have a desirable end result. It may be that only a corset type of support is needed or. If tightness develops in the Tensor fasciae latae and Iliotibial band on one side. Gains in flexibility in the direction of correcting the curves are indicated. If tightness of the Tensor fasciae latae on one side and weakness of the Gluteus medius on the other is mild. A subject who is developing a kyphoscoliosis along with a lordosis should not do back extension exercises from a prone position. it is important to avoid those exercises that would have an adverse effect. In the same instance. the low back problem increases. Cooperation by the subject is of utmost importance. it calls for thorough evaluation procedures to determine the existence of weakness or tightness of muscles that results in distortion of alignment. There are two main types of braces. Extension of the upper back may be done sitting on a stool with the back against a wall. There is an inherent danger in increasing overall flexibility of the spine. be strongly indicated. or pelvic tilt and leg sliding. The lifts can be used in all shoes and bedroom slippers. treatment may be as simple as breaking the habit and standing evenly on both legs. If there is Gluteus medius weakness on one side. the pelvis will ride higher on the side of the weakness. If the imbalance is more marked. many early scoliosis patients need some support. a more rigid support. "upper" abdominal exercises by the trunk curl or sit-up should be avoided even if upper abdominals are weak. and is dedicated to a strict program of strengthening exercises and the wearing of a support. If the subject has the potential for gaining in strength. The lift will help stretch the tight Tensor and relive strain on the opposite Gluteus medius. If there is a developing kyphoscoliosis. Support Vi In addition to scoliosis exercises and proper shoe corrections. but the low back must not arch in an effort to make it appear that the upper back is straight. the pelvis will be tilted down on that side. All must be selected for the specific curve problem and fitted to each na y Ku m ar . especially the Gluteus medius on that side.
back extension. allow for expansion in the area of concavity. The TLSO is an underarm brace.72 patient. Thoracolumbosacral orthosis (TLSO) – Patients can wear this brace to correct curves whose apex is at or below the eighth thoracic vertebra.Lie down on your back with knees bent. rather. Scoliosis exercises patterns of adults and children vary widely. braces must be worn every day for the full number of hours prescribed by the doctor until the child stops growing. upright row and one-arm row. m ar . in many instances. which means that it fits under the arm and around the rib cage. A series of safe and effective abdominal exercises that strengthen the back and improve posture are leg and arm extensions. Ku Doing something in the very early stages of treating a lateral curve does not mean getting involved in a vigerous. Force the lumbar spine towards the bars by tightening and pushing backward with the abdominal muscles. prescribing a few carefully selected scoliosis exercises that help to establish a kinesthetic sense of good alignment. and hips. but. there are newer materials that provide greater versatility and ease of handling. It also means providing incentives that help keep the person intrested and cooperative because achieving correction is an ongoing project. Today. Keep the shoulders flat on the floor and breathe regularly. Tighten the buttocks. standing raise. To have their intended effect (to keep a curve from getting worse). but the basic principles for use of supports remain with little change: Obtain the best possible allignment. This brace has a neck ring. triceps raise. lower back. active program of exercises. bent-over raise. Exercises 6 and 8 are to be done many times a day. SCOLIOSIS EXERCISES FOR PATIENTS WEARING THE MILWAUKEE BRACE Scoliosis Exercises 1 through 5 are held to the count of five and done ten times once daily. Milwaukee brace – Patients can wear this brace to correct any curve in the spine. it is necessary and advisable. why not treat the problem to help prevent the curve getting worse? Vi na y It may mean taking a picture of the child's back in the usual sitting or standing position and taking another in a corrected position so the child can see the effect that the scoliosis exercise has on the posture. When a scoliosis curve is progressive and severe. Importance of Early Intervention Instead of waiting to see if a curve gets worse before deciding to do something about it. apply pressure in the area of convexity to the extent tolerated without adverse effects or discomfort. 1. For those in whom the curve has become more advanced. Pelvic tilt backlying with the knees bent. therapeutic scoliosis exercises are not a substitute for surgery. It means providing goodinstruction to the patient and the parents in how to avoid habitual positions or activities that clearly are conducive to increasing the curvature. to provide some kind of a support in order to help maintain the improvement in alignment that has been gained through an scoliosis exercise program.
‖ Lie on your side with a small pillow under the thoracic pad. Try to ―Crush‖ the Therapist‘s hand under the back. SCOLIOSIS EXERCISES TO BE DONE OUT OF THE MILWAUKEE BRACE Exercises are to be held for the count of 5 and done 10 times once or twice daily. arms and shoulders about 6 inches against resistance between the shoulder blades. Same with the Lumbar Pad. 1. Active correction of the Thoracic Lordosis and Rib Hump. when you can do this well. 4. 3. spread the ribs and press the chest wall backward toward theposterior uprights. with arms on the side. As you progress.Sitting with legs out in front of you. Make this posture a habit.Keep the shoulders flat on floor. Pelvic tilt with the knees straight. touch head to floor in front of you. 3. Filling out the ―Thoracic Valley. Tilt the pelvis. 2. but breathe regularly. 7. abdomen. pull away from the front of the girdle. Sitting Indian style. Sit up with pelvic tilt. 5. Active correction of the curves. Spine extension in the facelying position.73 2. Inhale deeply and then exhale completely in each part. roll up to touch the knees with fingers. Tighten the buttocks. Pelvic tilt backlying with the knees bent. Walk. ar 4. Vi na y Ku m 6. Lie down on your back with knees straight.Divide the chest into three parts. Pelvic tilt supine with the knees straight. lower arm and leg bent. Pushup with the pelvis tilted. Repeat the same procedure mentioned above. Pelvic tilt standing. then release the tilt. 8. holding the tilt.In standing position relax the knees. touch your toes. tilt the pelvis and hold the tilt.Tilt the pelvis. Force the small fo the back into the floor by tightening and pushing backward the abdominal muscles. lower ribcage and upper ribcage. Back stretch. Tilt the pelvis in the standing position.Lie flat on the stomach. Keep the pelvis tilted and shift away from the Thoracic Pad. Inhale deeply. combine all three into one deep breath.Lie down flat on the back with knees straight repeat the same procedure. Roll back down slowly. 5. try to touch your head to your knees. Hamstring stretch. Later. tilt pelvis shift away from both pads and stretch up tall out of the brace. . tilt the pelvis by pulling in the abdomen and tucking the hips under. Now. 6. Tilt the pelvis. With the elbows straight. Raise the head. Deep breathing exercises. Breathe in while pushing chest back toward the posterior uprights.With the knees bent. The top arm and leg should be straight.
Hold a ball overhead and raise straight up. Back strengthening. Side stretch standing. 12. Pelvic tilt in the standing position. The most effective yoga exercises include passive back arch. Relax the knees. with the legs off the floor. 9. 7. make a ―Tunnel‖ under your abdomen.Lie down flat on the floor. 10. back flat to table. They restore the normal shape.Sitting on your heels. tiltthe pelvis.Be sure you are a straight line from knees to shoulders. 6. another option is hitch exercise. bend to the side opposite the raised arm. hands behind your back. Arms at your sides. Abdominal strengthening. and the curve is corrected. Lift head and shoulders.With the head. stand tall. arms outstretched. Bicycle. In the hitch position. Make this posture a habit.Standing with one arm overhead and one arm at side. Vi na y 3. Pushup with pelvis tilted. and to hold the hitched position for 10 seconds. Back strengthening. Spine extension in the prone (facelying) position. Stretch out your arms and slowly bend your trunk to one side. Walk away holding the tilt. Patients are instructed to lift their heel on the convex side of their curve while keeping their hip and knee straight. rotate as far as possible from side to side trying to touch your elbow to the opposite knee. keep tummy on your thighs. raise trunk and arms in straight line to table.With waist at edge of table. palm down.Sit on heels. lean forward with tummy on your knees. shoulders and back against the wall and the heels 3 inches from the wall. Now try mimic pedaling a bicycle. forehead near floor. function and mobility of the spine. crocodile twist. Rotational stretch.With knees bent.74 8. ADDITIONAL TRUNK STRENGTHENING SCOLIOSIS EXERCISES 1. 5. Repeat to other side. and other trunk and pelvic Ku m 11. Raise head and shoulders only. ar . Pinch shoulder blades together and raise head and shoulders and arms about 6 inches from the floor against resistance. Yoga exercises are very useful in providing relief from scoliosis.Sitting in a chair. Back strengthening. 13. Learn to do this correction without the wall.Sitting Indian style with hands behind head. lateral tilt at the inferior end vertebra is reduced or reversed. Tilt the pelvis. hands behind your head. pull in tummy and tuck hips under. pelvis on the convex side is lifted. Be sure to keep your elbows to the wall.Sit Indian style with back as flat as possible to the wall. rotate knees side to side. supine knee chest twist. Back strengthening. 4. 2. Side stretch sitting on heels.Hitch ExerciseFor lumbar curve or thoracolumbar curve.
the shoulders start drooping which causes the cervical rib to get depressed na y Appropriate techniques for rolling. ankle and upper arm movements within the limit of pain must be initiated as early as possible. The cause is that by middle age. For first two days o o o o For third and fourth day After fifth day o o Vi Cervical Rib refers to an abnormal protrussion in the cervical region which can either be due to abnormal enlargement of the transverse process of C7vertebra or a small rib or fibrous band running from the 7th cervical vertebra to the first true rib or to the sternum but usually it is present posteriorly upto a short distance. Hence first balancing is taught to the patient. ar Scoliosis Physical therapy (Post Operative) . VIbration with assisted coughing.75 exercises. The patient is encouraged to do all the above activities without giving much pressure over the spine. Early toe. sitting and standing are taught to the patient. Change the position of the patient every 2 hours. m Deep breathing exercises are given to the patient to increase the vital capacity. CERVICAL RIB SYNDROMES Ku Full range passive movements are given to hip and knee joint in addition to activities of first two days. he is given gait training with the help of parallel bars. The patient is to be made ambulatory as soon as possible. As soon as the patient is able to balance himself. Active movement must also be initiated within the limit of pain. It is usually diagnosed in middle age group persons though is present since birth. These exercises are quite helpful in raising one's lowered shoulder and decreasing back pain. crutch or cane.
(b) Skin colour changes to blue associated with trophic changes.76 and hence compressing the nerve root of the concerned region. A cervical rib is present in only about 1 in 200 (0. It is a congenital abnormality located above the normal first rib. Clinical Features Local Symptoms There is often a tender supraclavicular lump which is bony hard and is fixed when palpated. particularly the fingers. an individual may have not one but two cervical ribs. Compression of the subclavian artery is often diagnosed by finding a positive Adson's sign on examination. (b) Tendency of dropping things from the hand. Sensory Symptoms (a) Tingling in hands or fingers. Motor Symptoms (a) Loss of gripping power of the hand. The presence of a cervical rib can cause a form of thoracic outlet syndromedue to compression of the brachial plexus or subclavian artery. This rib is usually asymptomatic but it may give rise to neurological symptoms if it exerts pressure on the subclavian artery or the brachial plexus like paraesthesia of hand hypothenar wasting atonia in the muscles of the shoulder girdle. near the base of the thumb. where the radial pulse in the arm is lost during abduction and external rotation of the shoulder. Compression of the brachial plexus may be identified by weakness of the muscles around the muscles in the hand. confined either to radial side or ulnar side or sometimes involve even whole hand.<br. Vi na y Ku m A cervical rib is a supernumerary (extra) rib which arises from the seventh cervical vertebra. ar . either thenar or hypothenar or interossei muscles.<> Vascular Symptoms (a) Cold and clumpsy extremities.< p=""></br. (b) Pain may sometimes radiate downwards from the arm. (c) Wasting of palmar muscles. in even rarer cases.5%) of people.
and peripheral neuropathies.Mainly by X-ray to detect presence of Cervical ribs .Patient breathes deeply. Interpretation. and notes whether the radial pulse disappears. and esophageal disorders. Ku m Indications. Technique. A positive test will involve a decrease in radiculopathy or pain.The examiner lifts the arm away to the side to 90 degrees and performs external rotation of the shoulder. Repeat test with chin to opposite side. cervical spondylosis. pulmonary. It should not be used in instances in which vertebral instability is suspected. 2-Adson's Test Foraminal Compression Test/Spurling's Test Spurling's test is an orthopedic test used to diagnose nerve root compression primarily at the cervical level.77 (c) There is rare risk of gengrene. motor neuron disease. 2) Peripheral vascular disease like Raynaud's disease. muscular dystrophy. na y Shoulder Abduction Test is an orthopedic test used to help diagnose a cervical nerve root injury or cervical disc herniation. vascular. (d) Radial pulse becomes feeble or may even be absent. Medical treatment Vi Surgical treatment Anti-inflammatory drugs and analgesics are provided as a conservative means of treatment.Evaluation of Cervical Ribs/Thoracic Outlet Syndrome. It is performed by having the patient abduct their shoulder and place their hand on top of their head. ar . 1)Some of the more common conditions include herniated cervical disk. 3) Neurological conditions-like syringomyelia. which could be easily palpated. Diagnosis 1. cardiac. Shoulder Abduction Test Differential Diagnosis The differential diagnosis for Cervical Ribs is quite broad and includes neurologic. polio.Positive test finding ( Decreased Radial Pulse and/or Distal extremity pain reproduced ) suggests interscalene compression. as the radial pulse may disappear in normal people as the head of the humerus (upper arm bone) compresses the brachial vessels when the arm is taken beyond 90 degrees.Chin turned toward affected side.Neck extended. However there are many false positives.
To improve distal circulation. The continued growth of the medial condyle results in unilateral knock knees. It includes: (a) Removal of extra segment. progressive vascular and neurological signs and symptoms which are unbearable for the patients.Strengthening exercises of whole arm perticularly small muscles of the arm. the regime of physiotherapy is planned. These symptoms reflect the pathologic strain on the knee and its patellofemoral extensor mechanism. (b) Dividing the scalene group of muscles.The typical gait pattern is circumduction. Progressive resistance exercises for shoulder girdle muscles with weight.Exercises of hand and finger should be started. with significant angular deformity. Not only are the mechanics of gait compromised but also. and raising the arm overhead as these movements brings spontaneous relief. results in arrested growth of the lateral condyle of the femur. m ar On the basis of symptoms of the patient. Self resisted scapular adduction. The important exercises areSelf resisted scapular elevation. the knees are tilted toward the midline i.78 surgery is essential in conditions of severe. Physiotherapy treatment Genu Valgum is also known as knock knee. power and endurance. anterior and medial knee pain are common.Heat modalities are used like short wave diathermy but it should not be applied in case of sensory impairments. looking forward.In this. TO improve tone. It may be due to Vi na y Rickets Osteomalacia Rheumatoid Arthritis Muscular paralysis of semimembranosus or semitendinosus Fracture Ku Genu Valgum For pain relief. Endurance training exercise for the shoulder girdle muscles. It can result from injury or septic destruction of the lateral half of the lower femoral epiphyseal plate. patient is taught to use postural mirror to see that his shoulders are in level.e Legs curve inwardly so that the knees are closer together than normal. . retraction. Planning specific exercises. In the valgum deformity. requiring that the individual swing each leg outward while walking in order to take a step without striking the planted limb with the moving limb. Deep Tissue Massage for TOS ( thoracic Outlet Syndrome). Bilateral Valgum deformity can result from condition which softens bone tissue.To develop particular muscles groups for specific movements of shoulder girdle like elevation. Correction of posture by postural guidance. head is straight.
and treatment should be made available when needs are identified. bed rest during the acute stage and avoidance of injections. the Q angle should be less than 22 degrees with the knee in extension and less than 9 degrees with the knee in 90 degrees of flexion. Types of polio: Spinal Paralytic poliomyelitis: In this the motor neurons in the anterior horns of spinal cord are affected. Patients with prior polio or post polio syndrome should have access to regular physiotherapy assessment. In men. corrective surgery and physiotherapy along with rehabilitation helps the patient. Strengthening exercises for quadriceps. There is an increasing evidence base for the effectiveness of physiotherapy in alleviating PPS (post polio syndrome) associated physical problems. Diagnostic Test Treatment of Genu Valgum Degree of deformity. predominantly involves proximal na y Gradual knee mobilization is the main part of the treatment. Physiotherapy is a cornerstone of management of polio and post polio syndrome. hamstrings and gluteus muscles are given. should be measured next. weight transferring and walking. muscle chart and ROM are measured. the child requires a supracondyles closed wedge osteotomy. osteoarthritis The degree of knock knee is measured by the distance between the medial malleoli at the ankle when the child lies down with the knees touching each other. the Q angle should be less than 18 degrees with the knee in extension and less than 8 degrees with the knee in 90 degrees of flexion. balancing. Ku Polio Treatment m ar The Q angle which is formed by a line drawn from the anterosuperior iliac spine through the center of the patella and a line drawn from the center of the patella to the center of the tibial tubercle. In more complicated cases. wearing of boots with the inner side of heel raised by 3/8" inch and elongated forward heel (Robert Jones heels) corrects the deformity. Some heat modalities may be given for relief of pain. . In mild cases of Genu Valgum in young children. Post operative Physiotherapy Vi Polio is non curable and there is no polio treatment available . Paralysis is usually asymmetrical. In women. he is given correct training for standing. When the patient is able to walk.79 May be secondary to flat foot.
motor cortex and the spinal cord. general discomfort or a slight fever for up to three days. Most commonly it affects the leg. followed by neck stiffness and meningitis. It leads to the stiffness of back and neck. Bulbospinal paralytic poliomyelitis: It is also known as respiratory poliomyelitis. nausea. m ar . Stage 3: Residual paralysis: : Some cases do not progress beyond the early stage of meningeal irritation. and difficulty swallowing.80 muscle with pain and tenderness. distress of respiratory control. Vi Polio treatment in the acute stage of muscle paralysis: It involves meticulous attention to intensive care during the acute paralytic phase. na y Ku There are many symptoms of polio and not everyone will experience all of the symptoms. dysphagia. stiff neck and back. It can lead to respiratory muscle failure. with the addition of moderate fever. muscle pain and spasms. Cardiovascular. constipation. fatigue and muscle pain. Dysphagia and respiratory failure follow. pain and pyrexia subsides after 7-10 days and the patient enters the convalescent stage. Paralysis soon follows and reaches its maximum in 2-3 days. Bulbar Paralytic poliomyelitis: It occurs due to damage to the medulla. Extent of weakness can vary from a single muscle group to complete tetraparesis. In mild polio. muscle weakness. headaches and paraesthesias. muscle cramps. but there may be continuing improvement for up to 2 years. The symptoms for polio and paralytic polio different. sweating and gut mobility disturbances may occur. The return of muscle power is most noticeable during the first 6 months. dysphonia and dysarthria. pons and midbrain with dysfunction of the cranial nerve nuclei and respiratory and vasomotor regulating centres in the medulla. They symptoms vary according to the type of polio the individual has. Muscles are painful and tender. vomiting. Limbs are weak and there may be difficulty with breathing and swallowing. Polio Symptoms Polio treatment The disease may be staged as:- Stage 1: Acute stage of paralysis: : it begins with fever and headache. It has symptoms both of spinal cord and bulbar poliomyelitis. some of the symptoms are: headache. Stage 2: Recovery/convalescent stage: : This stage is prolonged. Individuals with paralytic polio experience tremor. stiffness. In others. fever. Polio encephalitis: There is inflammation of motor neurons within the brain stem. In nonparalytic polio (aseptic meningitis): the symptoms are similar to mild cases. Paralysis occurs within 10 days after symptoms develop progress in 2 to 3 days and complete by the time fever subsides. If the patient does not succumb to respiratory failure. however recovery is incomplete and the patient is left with some degree of asymmetric flaccid paralysis or muscle weakness. It affects the part of spinal cord C3 to C5 segments and causes paralysis of the diaphragm.
active assisted to active resisted/ strengthening exercises.81 Polio treatment in the recovery or convalescent stage: Sitting up can be encouraged if the paralysis is not severe. Crutches. Passive range of motion for the joints to avoid contracture formation. Emotional and psychological support. Moist hot packs to the affected muscles produce considerable relief from the pain. Whenever possible make exercises fun. Making the patient as independent as possible. standing balance training in parallel bars. exercises should be started to prevent contractures and return strength. Avoid massage. As soon as the fever drops. Preventing contractures and deformities. Hip and knees should be positioned as straight as possible and arms in abduction with mild support. Feet to be supported by rigid boards at 90˚ angle. Analgesics can also be used to relief pain. Ku m Feeding by nasogastric tube in those with bulbar dysfunction. Endotracheal intubation and ventilation should be instituted in case of respiratory muscle failure or bulbar and laryngeal muscle paralysis. sitting balance training. Goals of polio treatment in the stage of residual paralysis: Strengthening of all the innervated muscles. ar . Positon the patient with face down and hip extended every 2 hourly to prevent pressure sores and deformities. Pulmonary atelactasis and infection are treated with antibiotics and regular physiotherapy intervention. neurological musculoskeletal cardiorespiratory neurological musculoskeletal cardiorespiratory na y Rehabilitation (stage 3) in poliomyelitis once all the recovery has taken place. swimming and other activities to keep limb moving as much as they can are important throughout the child‘s rehabilitation. Avoid forceful exercise as this may increase paralysis. leg braces(calipers) and other aids may help the child to move better and may prevent contractures or deformities. An assessment will usually have three components. gait training should be started. Active games. Polio Examination of the patient Vi A comprehensive and detailed assessment is necessary at the first consultation to establish a baseline from which future changes can be evaluated and a polio treatment plan developed. Early spinal bracing for the back if it is weak. Passive. Rest on a firm mattress with back supported on a lumbar board.
e. difference in leg length. especially of muscles that are weak. Thoracic cage deformity. Elsewhere. kyphoscoliosis Breathing problems Measurement of peak flow. isolated weakness may be treated by tendon transfer. For some children. if necessary by arthrodesis. Ku Reduced pulmonary function results from the virus affecting the medullary respiratory centres. Also test muscles that need to be strong to make up for the weak ones (shoulder strength for crutch use) Check for deformities. Shortening: Lack of muscle activity undermines normal bone growth. Leg length inequality of upto 3 cm can be compensated for by shoe modification. reflexes and muscle atrophy Musculoskeletal Examination in polio treatment include Cardiorespiratory Examination in polio treatment include During the stage of residual paralysis following problems may require polio treatment. the muscles of respiration and the cranial nerves. it is best managed with a splint which holds the knee straight. Deformity: Unbalanced paralysis may lead to deformity. Flail joint: If the joint is unstable or flail it must be stabilized either by permanent splintage or by arthrodesis. Vi Common biomechanical deficits in post polio Genu Recurvatum na y Each child will have a different combination and severity of paralyzed muscles and will have his own special needs. Anything more may require operative lengthening of the limb. spinal curve etc ar . contractures. oxygen saturation.g. At first it is passively correctable and can be counteracted by a splint. Those who are severely paralyzed may require wheelchair.82 Neurological Examination in polio treatment include New weakness in previously affected or unaffected muscles Decreased muscular endurance Gait changes History of falls Decreased function Other lower motor neuron signs – decreased tone. dislocations. and interpretation of theresults of pulmonary function tests Forced expiratory techniques such as coughing and huffing to assess apatient‘s ability to expectorate secretions effectively should be assessed m Range of motion testing especially for the joints affected Muscle testing. Isolated muscle weakness without deformity: Quadriceps paralysis may make walking impossible. normal exercises and play may be all that are needed. Others may require braces or other aids to help them move about better. Fixed deformity require tendon transfer and joint stabilization.
m Strength of hip abductors and hip extensors Knee extensor Hip.83 Knee flexion contracture Inadequate dorsiflexion in swing Dorsiflexion collapse in stance Genu valgum Mediolateral ankle instability Orthotic prescription Before prescribing orthosis it is necessary to assess: ADL‘s training and occupational therapy role in polio treatment Prevention Individual children should be protected by immunization with polio vaccine. About 5-10% of the patients may develop bulbar or respiratory paralysis. bath or shower seats and adjustments to the height of washing bowl. Motorized wheelchairs and cars with special control are also available Ku A child with foot drop can be given an ankle foot orthosis of plastic or metal. Two types of polio vaccines are available. Child with weak trunk may require long leg braces attached to a body brace or body jacket. Prognosis is generally worse for the older children and in those who had a sudden onset of illness with high fever. many patients succumb to it. Prognosis Vi During early phase of the illness. knee and ankle stability Strength of upper limb Limb length measurement and gait pattern Contractures and derformities ar . domestic aids and furnitures may be modified for the severely disabled Transport: wheelchairs must be strong enough for rough roads and be patient propelled whenever possible. an inactivated (killed) injectable polio vaccine (IPV) and a live attenuated (weakened) oral polio vaccine (OPV). A child with weak knee may need a long-leg brace of plastic or metal. Paralyzed muscles generally recover power to a variable degree. basin or bath may be provided Dressing: clothes with zip fasteners and Velcro may be provided Housing. na y Washing and toilet: supporting rails. Both vaccines are highly effective. It may be with or without a knee joint that locks straight for walking and bends for sitting. it is difficult to evaluate the extent of paralysis because of pain and spasm of the muscles. Though bulbar paralysis is not invariably fatal.
or a direct bang. and na y Ku The tendinous origin of extensor carpi radialis brevis (ECRB) is the area of most pathologic changes.Raking leaves. overuse. poor racket dampening. that places excess force across the extensor wad. that is. almost a type oftendinous 'nonunion'. Etiology of Lateral Epicondylitis Vi The most common cause of Lateral Epicondylitis in tennis players is a 'late' mechanically poor backhand..10-50% of regular tennis players experience tennis elbow symptoms of varying degree sometimes in their tennis lives. The resulting inflammation produces exudate in which fibrin forms to heal the torn tissue. Frequency of Lateral Epicondylitis Most patients with Lateral Epicondylitis are between the age of 30 to 55 years. gardening. and so healing fails to take place. the elbow leads the arm. hence the pain of the condition. leading to small tears of the tendons (Tendonitis). Often a history of repetitive flexion-extension or pronation-supination activity and overuse is obtained (eg. A tear occurs at the teno-muscular junction. The condition that is commonly associated with playing tennis and other racket sports.string tension. The granulation tissue formed appears to contain large number of free nerve endings.84 Lateral Epicondylitis What is Lateral Epicondylitis (tennis elbow) ateral Epicondylitis is a common clinical entity characterized by pain and tenderness at the common origin of the extensor group muscles of the forearm. with subsequent granulation tissue formation on the underside of the tendon unit and at the teno-periosteal junction. and underlying weak muscles of the shoulder. Nirschl referred to the micro tears and the vascular in growth of the involved tissues as angiofibroblastic hyperplasia.Repeated activity causes microtrauma. golfing. The major problem is that the granulation tissue does not progress quickly to a mature form.elbow and arm. in the tendon. Overuse and repetitive trauma in this area causes fibrosis and micro tears in the involved tissues.Tennis grips that are too small often exacerbate or cause tennis elbow. though the injury can happen to almost anybody. 95% of tennis elbow occurs in non-tennis players. lifting heavy luggage with the palm down). baseball. and many have poorly conditioned muscles. m Pathophysiology of Lateral Epicondylitis ar . Changes can also be found at musculotendinous structures of the extensor carpi radialis longus.twisting a screw driver. Tightly gripping a heavy briefcase is a very common cause.usually as a result of a specific strain. extensor carpi ulnaris and extensor digitorum communis. or at the teno-periosteal junction.It is considered a cumulative trauma injury that occurs over time from repeated use of the muscles of the arm and forearm. Other contributing factors include incorrect grip size.
wringing wet clothes or even holding a cup of tea.85 bowling can also cause Lateral Epicondylitis. Clinical Presentation At first. there is likely to be considerable atrophy and weakness of extensor muscles and limitation of passive wrist flexion. -Tenderness over muscles of dorsal forearm. Differential Diagnosis Vi na y Ku m ar . Special tests for Lateral Epicondylitis 1)Cozen's test. and flexes the wrist fully and extends the elbow. -Pain with passive stretching of wrist extensors. such as carrying a briefcase. 3)Maudsley's test.The patient's elbow is stabilized by the examiner's thumb. Less commonly. 2)Mill's test-While palpating the lateral epicondyle. A positive test is indicated by pain over the lateral epicondyle of humerus.The examiner resists extension of the 3rd digit of the hand. stressing the extensor digitorum muscle and tendon. the examiner pronates the patient's forearm. Grip becomes weak. The patient is then asked to make a fist. Accessory movements of the elbow and superior radio-ulnar joint may be reduced in along term problem. A positive test is indicated by pain over the lateral epicondyle of the humerus. finger extension and resisted radial deviation. A positive sign is indicated by sudden severe pain in the area of lateral epicondyle of the humerus. which rests on the patient's lateral epicondyle. Eventually the pain may become so constant and severe so as to stop the athlete from further playing and to interfere with activities of daily living. -Pain with resisted wrist extension.tendonitis is simply a result of single acute injury. Physical Examination -Point tenderness over or just distal to the lateral humeral epicondyle (the bony attachment of the common extensor tendon) which gives rise to burning sensation when pressure is applied.Morning stiffness may be felt. -With long standing symptoms. the athlete may be aware of only fatigue and spasm of dorsal forearm muscles related to unaccustomed activity. pronate the forearm and radially deviate and extend the wrist while the examiner resists the motion. Then they may note the onset of aching lateral elbow pain after playing.
Correction of mechanics -If a late poor backhand causes pain. ar . repetitive valve opening).Avoidance of ball impact that lacks a forward body weight transference is stressed. Nonsteroidal Anti-inflammatory Drugs Vi na y -Often repetitive pronation-supination motions and lifting heavy weights at work can be modified or eliminated. The word "tear" implies injury and the need for repair--both of which are probably inaccurate and inappropriate for this degenerative enthesopathy. supination and wrist extension.It is the most common cause of refractory lateral pain and coexists with Lateral Epicondylitis in 10% of the patients.. Rarely. -The cervical nerve roots should be examined to rule out cervical radiculopathy. There may also be a defect in this tissue. radial neck fracture. Investigations Activity Modification -In non-athletes. magnetic resonance imaging (MRI) scans may be used to show changes in the tendon at the site of attachment onto the bone. Ku Conservative treatment of Lateral Epicondylitis m X-rays are not necessary. -Lifting should be done with the palm up whenever possible. placing the elbows on stalked towels for support will help. elimination of activities that are painful is key to improvement (eg.86 -Evaluation should note possible sensory paresthesias in the superficial radial nerve distribution to rule out Radial tunnel syndrome. little league elbow and osteochondritis dissecans of the elbow. chronic irritation of the radiohumeral joint or capsule. and both upper extremities should be used in a manner that reduces forcible elbow extension. -Other conditions that should be considered include bursitis of the bursa below the conjoined tendon.The figure obtained represents the circumference of the racket handle. The use of the word "tear" to refer to this defect can be misleading. but continued repetition of the aggravating motion will prolong any recovery. MRI typically shows fluid in the ECRB origin. -Calculation of grip-The distance from the proximal palmar crease to the tip of the middle finger determine the proper grip size. correction of mechanics of the game is warranted. radiocapitellar chondromalacia or arthritis. panner's disease. Activity modifications such as avoidance of grasping in pronation and substituting controlled supination lifting instead may relieve symptoms. -Treatment such as ice and NSAIDs may lessen the inflammation. -If typing with unsupported arms exacerbates the pain.
The tension is adjusted to comfort while the muscles are relaxed so that maximal contraction of the finger and wrist extensors is inhibited by the band. we use Cox-2 inhibitors (rofecoxib. Forearm extensor stretch may be performed with the athlete facing the wall. Your doctor may suggest an injection of a small dose of steroid to the affected area. Some authors recommend 6-8 weeks use of a wrist splint positioned at 45 degree of dorsiflexion. and the elbow remains locked. Icing 10-15 minutes of icing. The band is placed 2 finger breadths distal to the painful area of the lateral epicondyle. na y Counterforce Bracing Ku m Stretching ar Cortisone Injection . and although it may need to be repeated you seldom need more than two or possibly three injections.Cross fibre friction massage is done with and perpendicular to the tissue involved. By leaning forward the wrist is forced into 90 degree of flexion. -Soft tissue mobilization.Keeping the elbow locked. Wrist flexion may be combined with a pronation stretch. ROM of exercises emphasizing end-range and passive stretching (elbow in full extension and wrist in flexion with slight ulnar deviation).Overpressure is applied by other hand and static stretch is performed. four to six times a day.87 -If not contraindicated. the forearm is maximally pronated and wrist flexed. The scar tissue is more pliable when warm.The dorsum of the hand is placed on the wall. If used it can last for up to three months. celecoxib) for their improved safety profile. So stretching exercises can be given after some superficial heating modality. Range of Motion Exercises Vi Electrotherapy Exercises emphasize end-range and passive stretching (elbow in full extension and wrist in flexion with slight ulnar deviation). This is not the sort of steroid banned for athletes.stretching the posterior forearm tissues. Brace is used only during actual play or aggravating activity.
-Squeeze a sponge ball repetitively for forearm and hand strength. -Elbow flexion and extension exercises. and endurance in a graduated fashion with slow-velocity exercises involving application of gradually increasing resistance.One end of the band is placed under the foot and the other end is gripped. The mobilization is applied at the same time the patient performs a painful action with the affected joint (extension of wrist). -Wrist curls-Sit with the hand over the knee. Later on upper limb plyometrics. Extensor tenotomy-Release of ECRB with debridement of chronic inflammatory tissues is the treatment of the choice.In this a sustained mobilization is applied to a joint. bend the wrist 10 times holding a 1-2 pound weight.With palm up. and holds it tight for 10 seconds. Repeat this with palm down. -Forearm strengthening-Hold the arm out in front of the body. m However. bends the wrist up. and rotator cuff strengthening. The exercise program includes-Active motion and submaximal isometrics. Hold for 10 seconds. the patient attempts to push the hand down.Increase to two sets of 10 daily. Next with the other hand. wrist extensors. -Theraband extension is performed with athlete sitting. Surgical treatment of Lateral Epicondylitis Operative treatment is required in less than 2% cases. 5 repetitions.Development of symptoms (pain) modifies the exercise progression. then increase the weight by 1 pound upto 5-6 pounds.88 -TENS for pain relief -LASER -Phonophoresis or iontophoresis may be helpful. biceps. wrist flexors. triceps. -Mobilization with movement (MWM). Strengthening exercises for Lateral Epicondylitis A gentle strengthening program should be used for grip strength. with a lower level of intensity and more icing if pain recurs. -Progress strength. with two weeks of no pain before initiation of graduated strengthening exercises. flexibility. ar . The patient clenches the fingers. palm down. but progress to only 4 pounds.the acute inflammatory phase must have resolved first. closed chain activities and sport specific activities are done. slowly increasing to 20 repetitions 2-3 times a day. Vi na y Ku -Isotonic eccentric hand exercises with graduated weights not to exceed 5 pounds.
The condition require detailed examination because of the proximity of other medial structures that may mimic Medial Epicondylitis. Clinical Features Vi Golfer's elbow is characterized byPain on the inner side of your elbow. racquetball. Exclusion of other etiologies of medial elbow pain is important for appropriate treatment. The serve and forearm strokes are the most likely to bring on pain. Occupation that require repetitive and strenuous forearm and wrist movement like carpentry. abnormal changes in the flexor carpi ulnaris and palmaris longus origins at the elbow may also be present. Throwing athletes who have repetitive valgus stress on the elbow and repetitive flexor forearm musculature pull develop an overuse syndrome that affects the medial common flexor origin. the elbow flexors are the prime movers.89 Guidelines of Surgery-Persistent pain (more than 1 year). In doing curls. However. squash. is an inflammatory condition and is far less frequent than tennis elbow ar Medial Epicondylitis . and it may hurt to make a fist.Flexor-pronator tendinitis is a weight training ailment. and throwing often produce this condition. high activity level. Weakness in hands and wrists. Flexor/Pronator tendinitis Curler's elbow Reverse tennis elbow Medial Epicondylitis Incidence Medial Epicondylitis is less common than tennis elbow. occurring at a ratio of 1:15. pain at rest. Numbness or tingling Many people with Golfer's elbow experience numbness or a tingling sensation that radiates into one or more fingers — usually the ring and little fingers. Causes Repetitive trauma resulting in microtears is a causative factor. failure of quality rehab program. but the wrist flexors must also resist the force of gravity throughout the lift. Tennis. Golfer's elbow. Pain may extends along the inner side of your forearm. Stiffness Elbow may feel stiff.often also called Medial Epicondylitis is defined as a pathologic condition that involves the pronator teres and flexor carpi radialisorigins at the medial epicondyle. na y Ku Other names for Golfers elbow m Golfer's elbow.
90 The pain of Golfer's elbow may appear suddenly or gradually. ar .The area of the ulnar nerve in the groove between the olecranon process and medial epicondyle is tapped.An Xray can help the doctor rule out other possible causes of elbow pain. resisted wrist flexion and pronation is done. Other causes of medial elbow pain to be considered are osteochondritis dissecans of the elbow and osteoarthritis. -Pain with resisted wrist flexion. such as a fracture or arthritis. -Medial soft tissue swelling. A positive sign is indicated by a tingling sensation in the ulnar distribution of the forearm and hand distal to the point of compression of the nerve. A positive sign is indicated by pain over the medial epicondyle of humerus. The pain may get worse when: Swing a golf club or racket Squeeze or pitch a ball Shake hands Turn a doorknob Pick up something with your palm down Flex your wrist toward your forearm Physical Examination Diagnosis Golfer's elbow is usually diagnosed based on your medical history and a physical exam. more comprehensive imaging studies — such as magnetic resonance imagining (MRI) — are done. Ku m -Point tenderness over or just distal to the medial humeral epicondyle. In the later valgus stress testreveals UCL pain and opening (instability) of the elbow joint. More localized tenderness compared to lateral epicondylitis.While the examiner palpates the patient's medial epicondyle. 2)Tinel's sign at elbow. Vi Physiotherapy treatment of Medial Epicondylitis na y It is extremely important to differentiate Medial Epicondylitis from UCL (ulnar collateral ligament) rupture and instability. Differential Diagnosis Special Tests 1)Medial Epicondylitis test. Concomitantulnar neuropathy at the elbow may be present with either of these conditons. Tinel sign is positive at the elbow (cubital tunnel) with chronic neuropathy. -Pain with passive stretching of wrist flexors. -Tenderness over the muscles of volar forearm. Rarely.
Increase functional activities and return to function. Phonophoresis Friction massage Iontophoresis-With an anti-inflammatory.91 Non-operative treatment of Golfer's elbow is similar to that of tennis elbow and begins with modifying and stopping activities that produce tension overload. Use counterforce brace Continue use of cryotherapy after exercise or function. elbow flexor-extensors.Retard muscle atrophy. the underlying etiology of Golfer's elbow. Chronic stage management Vi na y Ku m Whirlpool ar Goals . Avoid painful activity-Such as gripping. Initiate shoulder strengthening (Rotator cuff). Continue flexibility exercises.Increase muscle strength and endurance.Icing and NSAIDs are used for control of edema and inflammation. Emphasize concentric-eccetric strengthening. Forearm pronator-supinators.Promote tissue healing. Acute stage management Decrease inflammation/pain. Initiate gradual return to stressful activities and previously painful movements. Cryotherapy. and correction of training errors (overuse) and throwing mechanics causing the tension overload. Concentrate on involved muscle group-Wrist flexor-extensors. Sub-acute stage management Goals- Improve flexibility. wrist extension-flexion elbow extension-flexion forearm supination-pronation. Stretching to increase flexibility.
Chronic Achilles tendonitis. playing surface). and make it susceptible to rupture. but should be given no more than 3 injections per year and no more frequently than every 3 months. The tendon has no true synovial sheath but is encased in a paratenon of varying thickness. m ar Continue to emphasize deficiencies in shoulder and elbow strength. it can lead to small tears within the tendon. Gradual return to sport (high level activities). Achilles Tendon Dysfunction Vi The Achilles tendon is the largest and strongest tendon in the body. Continue strengthening exercises (concentric-eccentric). Equipment modifications (grip size. also sometimes called Achilles tendinitis . string tension. Continue flexibility exercises. The overuse causes inflammation that can lead to pain and swelling. It is a common overuse injury that tends to occur in middle-age recreational athletes. Furthermore. is a painful and often debilitating inflammation of the large tendon in the back of the ankle (achilles tendon).92 GoalsImprove muscular strength and endurance. . The vascular supply to the tendon comes distally from intraosseous vessels from the calcaneus and proximally from intramuscular branches. Maintain/enhance flexibility. For persistent symptoms Surgical intervention for golfers elbow may be indicated for symptoms that persist longer than 1 year. Achilles tendon injuries are commonly associated with repetitive impact loading due to running and jumping. The primary factors resulting in damage of the Achilles tendon are training errors such as sudden increase in na y Ku Achilles Tendonitis Cortisone injection ( 0. There is relative area of avascularity 2-6 cm from the calcaneal insertion that is more vulnerable to degeneration and injury. Gradually diminish use of counterforce brace.5 ml of betamethasone) into the area of maximal tenderness may be useful.
It may cause swelling over the Achilles tendon. Causes of Chronic Achilles Tendonitis There are three stages of tendon inflammation: Peritenonitis Tendinosis Peritenonitis with tendinosis Peritenonitis is characterized by localized pain during or following activity. poor footwear (generally poor hindfoot support). pain often develops earlier on during activity. Chronic Achilles tendinitis pain associated with exercise is most significant when pushing off or jumping. such as when running or jumping. Peritenonitis with tendinosis results in pain and swelling with activity. Achilles dysfunction can also be related to postural problem (e. As this condition progresses.93 activity. pronation). Therefore patients tend to experience pain after first walking in the morning and when getting up after sitting for long periods of time. the tendon might tear when you jump or start sprinting. and running on uneven or loose terrain . is asymptomatic). or while at rest.. a sudden increase in training intensity (distance. Patients with Chronic Achilles tendonitis usually experience the most significant pain after periods of inactivity. ar There may be several factors leading to Chronic Achilles Tendonitis. Tendinosis is a degenerative condition that usually does not produce symptoms (i.. Patients will also experience pain while participating in activities. na y Ku m Overuse of the Achilles tendon Tight calf muscles Lots of uphill running Increasing the amount or intensity of sports training. For example. The range of motion of ankle may be limited. sometimes along with switching to racing flats. Patient complains of pain when rising up on toes and pain when stretching the tendon. It may cause swelling or a hard knot of tissue (nodule) on the back of the leg. resuming training after a long period of inactivity. and a tight gastrosoleus complex. Symptoms of Chronic Achilles Tendonitis Vi Diagnosis The main complaint is pain over the back of the heel. These are: . This is 2-6 cm above the point where the tendon inserts on the heel bone. As this condition progresses. partial or complete tendon rupture may occur.g. frequency). with decreased activity. a problem where your feet roll inward and flatten out more than normal when you walk or run Wearing high heels at work and then switching to lower-heeled shoes for exercise An Achilles tendon may tear when you move swiftly and forcefully.e. which are racing shoes with less heel lift Over-pronation.
when there is sudden (acute) inflammation. duration. Differential Diagnosis of Chronic Achilles Tendonitis Achilles Tendonitis Treatment Treatment approaches for Achilles tendonitis or tendonosis are selected on the basis of how long the injury has been present and the degree of damage to the tendon. schedule. -Begin a runner's stretching program before and after exercises.94 In diagnosing Chronic Achilles Tendonitis. hard surface. Stop rapid increase in mileage Stop hill running Correct functional overpronation and resultant vascular wringing of the tendon with a custom orthotic that usually incorporates a medial rear foot post. poor shoewear Ku m Partial rupture of Achilles tendon Retrocalcaneal bursitis (of retrocalcaneal bursa) Haglund's deformity (pump bump) Calcaneal apophysitis Calcaneal exostosis Calcaneal stress fracture (positive squeeze test) Calcaneal fracture PTT tendinitis (medial pain) Plantar fasciitis (inferior heel pain) ar . The extent of the condition can be further assessed with x-rays. one or more of the following options may be recommended: General guidelines for chronic Achilles tendonitis -Correct underlying training and biomechanical problems Vi -Soften a hard heel counter or use shoe counter heel cushions to minimize posterior "rubbing" symptoms. examine the patient‘s f oot and ankle and evaluate the range of motion and condition of the tendon. In the early stage. Nonsteroidal anti-inflammatory drugs (NSAIDs). ultrasound or MRI. na y Immobilization Ice Oral medications. -Oral anti-inflammatories (COX-2 inhibitors). Stop interval training Correct improper intensity of training. such as ibuprofen Physical therapy.
if not improved. however these exercises are not used until the patient is assymptomatic and painless for 2-3 weeks. -Shock wave Therapy -If symptoms persist after 4-6 weeks of conservative measures.95 -Avoid cortisone injections . this will cause weakening or rupture of the tendon. -Eccentric strengthening of Achilles tendon should condition the tendon and make it less susceptible to overuse injuries. surgery may be needed to remove inflamed tissue and abnormal areas of the tendon. go to 1/2 inch insert. If these treatments fail to improve symptoms. Prevention The best treatment of Chronic Achilles tendonitis is prevention. will help to maintain flexibility in the ankle joint. even at the start of the day. painless progression to preinjury activities ar . Overcorrection (too rapid an orthotic correction) may worsen symptoms. -Cryotherapy (ice massage)after exercise for anti-inflammatory effect. Problems with foot mechanics can also be treated with devices inserted into the shoes. -Correct leg length discrepancy if present. immobilization in a removable cam boot or cast may be required for 3-6 weeks. First try 1/4 inch heel insert for a half inch leg length discrepancy. Vi na y Ku swimming deep water running bicycling walking eccentric exercises for Achilles strengthening light jogging m -Slow. toe raises in pool plantar flexion against progressively harder therabands multiple sets of very light (20 pound) total gym or slider board exercises. Stretching the Achilles tendon before exercise.
. swelling and bruising. The athlete may notice swelling. over-stretch or an over contraction of the muscle. Patient feels tightness in the thigh. partial ruptures or strains are usually caused by a sudden twist. Strains are seen in all the quadriceps muscles but are most common in rectus femoris. Laser if superficial and pulsed ultrasound. The most common site of strain is the distal musculotendinous junction of the rectus femoris. which is more vulnerable to strain as it passes over two joints: the hip and the knee. Straightening the knee against resistance causes pain. Probably cannot walk properly. There is local muscle pain and tenderness and. An area of local spasm is palpable at the site of pain. moderate (grade 2) or severe. Ku m ar Like all muscles strains.strain of the rectus femoris occurs with sudden onset of pain and disability during intense activity.96 Quadricep Strain Quadricep Strain usually occur during sprinting. Bad swelling appearing immediately. Crutchs in a touch-down or partial weight bearing (painless) fashion. RICE NSAIDs if not contraindicated. Grade 2. There is usually a moderate area of inflammation surrounding a tender palpable lesion. Healing time-6 to 10 weeks. Unable to walk properly without the aid of crutches.Unable to walk properly. Electrical stimulation. jumping or kicking.strain is a minor injury with pain on resisted active contraction and on passive stretching. The athlete feels the injury as a sudden pain in the anterior thigh during an activity requiring explosive muscle contraction. Avoid SLR in early rehabilitation because of increased stress on torn rectus femoris. Grades of quadricep strain Treatment of Quadricep Strain (or Tears) Acute Stage Vi na y Grade 1. if the strain is severe. Grade 3. Healing time-2 to 10 days. Healing time-10 days to 6 weeks.Trying to straighten the knee against resistance probably won't produce much pain (unlike a grade 2 or 3). including ruptures. they resolve with conservative management. quadricep strain may be graded into mild (grade 1).strain cause significant pain on passive stretching as well as on unopposed active contraction. In the long term. such as while playing football or sprinting. A muscle fibre defect is usually palpable when the muscle is contracted. The athlete with a grade 2 strain is generally unable to continue the activity. Hold all lower extremity athletic participation. complete tears ( grade 3). often with surprisingly little disability. An athlete with such a strain may not cease activity at the time of the pain but will usually notice injury after cool down or the following day. A static contraction will be painful and might produce a bulge in the muscle. What are the causes of Quadricep Strain? A Quadricep Strain.Probably not much swelling.
ar . require surgery or cause loss of function. SLR. Elliptical trainer. Criteria for Return to Play Vi Quadricep Strain Prevention na y Terminal knee extension exercises. Quadricep strength 85-90% (via isokinetic testing) of contralateral quadricep. Employ preactivity quad stretching program and appropriate warm-up regimen with return to sports. but rarely. Usually intermediate stage begins 3-10 days postinjury. Ku m Initiate a gentle quadriceps and hamstring stretching program. PNF pattrens. abduction. Aquatic rehabilitation program in deep water with floatation belt. Myofascial tension in knee flexion. if ever. Progress bicycle resistance and intensity of workout. Initiate sports specific drills and agility training. Regain normal knee and hip motion. extension. Exercises and Modalities Return to Function Stage Note: Even quadriceps tears with palpable defects typically respond to this conservative regimen. Walking progression on jogging (painless). Increase aquatic program (deep water running). 30-degrees mini squats (painless). Cycling with no resistance Moist heat before stretching exercises Begin higher dosage ultrasound (for thermal effects) and or electrical stimulation. Isokinetic equipment (at higher speeds) with patient supine. Quadriceps flexibility equal bilaterally. Persistant defects are common.97 Intermediate Stage (usually 3-10 days postinjury) Goals Regain normal gait. quads sets progressing to PRE (progressive resistance exercises) with 1-5 pound weight on the ankle. adduction. Increase low impact exercises to progress endurance and strength. Asymptomatic with functional drills at full effort. Thera-bands for hip flexion. depending on severity of injury. Begin knee extension with light weights. when swelling has been controlled.
Make sure you spend time strengthening the groin and thigh muscles to improve your performance and reduce the risk of injury.It involves compression of the sciatic nerve at the hip by the piriformis muscle.the gluteal surface of ileum and the sacro-tuberous ligament. 3-Pain and discomfort(burning. Try to keep your body weight within normal limits for your height. 4-Heaviness or fatigue of the leg. 3-Poor physical conditioning(strength and flexibility).It then travels through the greater sciatic notch to attach to the upper medial side of the greater trochanter.98 Always warm up and cool down and stretch thoroughly before and after taking part in any physical or sporting activity in order to reduce the risk of injury. Its position is such that sciatic nerve rests directly on the muscle and in 15% of the population the muscle is divided into two with sciatic nerve passing between two bellies.numbness or burning in the back of the thigh to the knee and occasionally the bottom of the foot. Piriformis Muscle Syndrome Piriformis Muscle Syndrome is a nerve condition in the hip causing pain and loss of feeling in the back of the thigh often to the bottom of the foot. 2-Being born with nerve traveling through the piriformis muscle. SIGNS AND SYMPTOMS 1-Tingling.jumping or prolonged walking. CAUSES 1-Pressure on the sciatic nerve at the hip by anything that may cause the piriformis muscle to spasm and constrict the nerve and can cause Piriformis Muscle Syndrome. 2-This include strain from a sudden increase in the amount of intensity of activity or overuse of lower extremity. or back of thigh and sometimes to the knee. mid buttock area. Vi na y Ku ANATOMY m ar .dull ache) in the hip or groin. as excessive body weight can aggravate hip pain caused by conditions like arthritis. 2-Occasionally tenderness in the back. The piriformis muscle attaches from the front of 2nd and 4th sacral segments. RISK INCREASES WITH 1-Sports involving running.
99 5-Pain that is worse with sports activities such as running, jumping,long walk, walking uphill and is increased by prolonged sitting. 6-Pain that is lessened by lying flat on the back. 7-Examination of lumber spine and SI joint is unrevealing. 8-Resisted lateral rotation of the affected hip joint gives pain. 9-Passive stretch into internal rotation is painful and limited.
SPECIAL TEST piriformis stretch test in side lying position with the test leg uppermost. DIAGNOSIS
PHYSIOTHERAPY TREATMENT 1-REST-The patient should temporarily stop running, bicycling, or doing any activity that elicits pain. A patient whose pain is aggravated by sitting should stand up immediately or, if unable to do so, change positions to raise the painful area from the seat.
3-PIRIFORMIS STRETCHING-Specific stretching exercises for the posterior hip and piriformis can be beneficial. Treatment usually begins with stretching exercises and massage, and avoidance of contributory activities. 4-STRENGTHENING EXERCISES-strengthening of the core muscles (abs, back, etc.) to reduce strain on the piriformis. Stretching exercises will target the piriformis, but may also include the hamstrings and hip muscles, in order to adequately reduce pain and increase range of motion. 5-PAIN RELIEVING MODALITIESultrasound therapy LASER interferential therapy TENS shortwave diathermy 6-ORTHOTICS-Custom foot orthotics also help with both treatment and prevention.
2-ICE-Patients with Piriformis Muscle Syndrome may also find relief from ice and heat. Ice can be helpful when the pain starts, or immediately after an activity that causes pain. This may be simply an ice pack, or ice massage. Alternating heat and ice is often helpful.
Diagnosis of Piriformis Muscle Syndrome is by physical examination. Pain with forceful internal rotation of the flexed thigh (Freiberg's maneuver), abduction of the affected leg while sitting (Pace's maneuver), raising of the knee several centimeters off the table while lying on a table on the side of the unaffected leg (Beatty's maneuver), or pressure into the buttocks where the sciatic nerve crosses the piriformis muscle while the patient slowly bends to the floor (Mirkin test) is diagnostic. Imaging is not useful except to rule out other causes of sciatic compression. Differentiation from a lumbar disk disorder is sometimes difficult, and referral to a specialist may be needed.
100 7-GAIT TRAINING-Gait correction can reduce the use of the piriformis, allowing the muscle to relax and heal itself. 8-Anti-inflammatory drugs 9-Corticosteroid injections
Torticollis is a condition of the neck in which the child‘s head tilts toward one
shoulder and the chin rotates towards the opposite shoulder. It occurs when one of the
may be caused by any number of factors, including the baby‘s position in the uterus, or trauma to the SCM muscle during birth. A pediatrician, or a pediatric orthopedist usually
Babies with torticollis may exhibit other signs and symptoms including
plagiocephaly (flattening of the back of the head on one side), hip dysplasia (when the top of the thighbone or femur does not securely fit into the socket or the acetabulum), and abnormality of the bones in the neck ( the vertebrae ). You may notice plagiocephaly from continually keeping the head turned and weight bearing on the same area all of the time. In advanced cases of torticollis there may be flattening of the forehead on one side with increased forehead prominence on the opposite side. Plagiocephaly will usually resolve itself when new positions are introduced and as the child increases his/her range of motion. However, some cases may require use of a special helmet to assist in reshaping the head. About 8% of babies born with torticollis have congenital hip dysplasia. When this occurs as a parent you may notice, one thigh looking longer then the other, asymmetrical skin folds, or one hip moving differently then the other. It is important to have the babies hips tested and/or x-rayed to rule out this out. Neck x-rays are also sometimes advised to rule out any abnormality of the vertebrae. Physical Therapy for Torticollis
diagnoses torticollis in the first 2-3 months of life.
muscles in the child‘s neck, called the sternocleidomastoid (SCM) is tight. This condition
101 Torticollis limits the ability for a child to move their head freely to see, hear and interact with his/her environment. Because of this torticollis may lead to delayed body awareness, weakness and difficulties with balance, and asymmetrical use of their arms and legs through developmental stages. This asymmetry can lead to uneven weight
respond very well to physical therapy intervention. It is important that parents get their
child into physical therapy as soon as possible. The older the child is the tighter the SCM
At the physical therapy initial evaluation the parents will be given a home
ideas to discourage the child‘s favored position, and strengthening exercises to help decrease any asymmetry that may be occurring. Your therapist will help work with you and establish the best program and ideas for your child. The combination of physical therapy and a consistent home exercise program is the key to success! Most parents are surprised at how quickly you see changes and improvements with your child‘s posture, and interaction with their environment.
1) To encourage the child to turn his/her head lay the child on his/her back. Position yourself and the child‘s toys on the opposite side of which the child prefers. 2) If the child likes holding his/her ear closer to the right shoulder, lay the child on his/her right side with a pillow underneath their head. This will stretch the child‘s neck to the opposite side. (If the child holds their head tilted to the left lie the child on their left side.) 3) During tummy time turn the child‘s head to the opposite of the preferred side. If your child likes to look to the right, you would lay him/her on the stomach with their head turned to the left and their right ear on the floor.
exercise program including range of motion exercises, massage instructions, positioning
General Activities for a child with Torticollis
becomes and the harder it becomes to stretch the child due to their increased activity
bearing through the legs and favoring one side of the body. Most cases of torticollis
it will be beneficial to switch direction. put a towel roll on the side the head is tilting toward to help support the neck in a more neutral position Physical Therapy Assessment Basic Orthopedic Physical Therapy Assessment Vi na y Patient history Observation Examination of movement Special tests Reflexes and cutaneous distribution Joint play movements Palpation Diagnostic imaging Ku • Are all of the child‘s toys on one side of the crib encouraging him/her to m ar sides. This will encourage the child to look to their non-preferred . look in one direction? • How is the baby positioned in his/her car seat? If the child‘s head is consistently tilting to one direction. place the child‘s head on the opposite end of the crib. • How the baby is fed and the position of their head.102 4) Be observant and aware of: • What side the baby is held on and which way they tend to look. does the child consistently look towards one side to see them? If so. When the parent walks into the room to pick the child up. • How the child is positioned in his/her crib. If the parent consistently holds the bottle to one side.
the lumbar and sacral spine. not only to delineate the extent of gross abnormalities but also to look closely for subtle anomalies. Observe the patient's eyes while palpating the joints and the surrounding structures in Orthopedic Physical Therapy examination.. use the classic techniques of inspection. m ar . subcutaneous tissue. ecchymoses. Concentrating on one area at a time. which might be located in a tendon sheath. With practice the examiner will establish an order of approach. Start by dividing the musculoskeletal system into functional parts. palpation. beginning with the temporomandibular joint. wasting. bones. While noting these changes. but for the beginner it is perhaps better to begin distally with the upper extremity. A patient's expression of pain depends on many factors. it is important to do a thorough Orthopedic Physical Therapy examination. The most objective indicator of the magnitude of tenderness produced by presence on palpation is involuntary muscle movements about the eyes. it is adequate to inspect the extremities and trunk for observable abnormalities and to ask the patient to perform a complete active range of motion with each joint or set of joints. Finally. again begin distally with the foot and proceed proximally through the hip. tendons. Glean the maximum information from observation. or other structures about the joint. If there is any question. and if possible identify the anatomic structures over which the tenderness is localized. in the lower extremity. and joints. Note areas of tenderness to pressure. andmanipulation. and deformity (abnormal angulation. subluxation). pass on to the cervical spine. By noting carefully the consistency of the enlargement and its boundaries. With practice the examiner will become skilled in evaluating the magnitude of pain produced by the examination and will be able to do a skillful evaluation without producing excessive discomfort to the patient. use your own anatomy as a control. an effusion into the joint capsule. bony enlargement. Note any gross abnormalities of mechanical function beginning with the initial introduction to the patient.. On Orthopedic Physical Therapy examination One should also note areas of enlargement while palpating the joints and surrounding structures. or nodule formation. and the sacroiliac joints. Vi na y Ku To perform an Orthopedic Physical Therapy examination of the muscles. thickening of the synovial lining of the joint. working proximally through the shoulder. attempt to determine whether they are limited to the joint or whether they involve the surrounding structures (e. soft tissue swelling. Continue to observe for such problems throughout the interview and the examination. Then. inspect the area for discoloration (e. If the patient presents complaints in the musculoskeletal system or if any abnormality has been observed.103 In Orthopedic Physical Therapy examining of the musculoskeletal system it is important to keep the concept of function in mind. bursae).g. On Orthopedic Physical Therapy examination of a patient who has no musculoskeletal complaints and in whom no gross abnormalities have been noted in the interview and general physical examination. redness). the examiner should observe the patient's eyes while palpating the joints and surrounding structures. the thoracic spine. Use the opposite side for comparisons: it is easier to spot subtle differences as well as identify symmetrical problems.g. For this reason the verbalization of pain often does not correlate directly with the magnitude of the pain. muscles. soft tissue swelling of the structure surrounding the joint. one can decide whether this is due to bony widening. Therefore.
Assess lateral flexion to both sides by asking the patient to touch their shoulder with their ear. Have the patient perform active movements through an entire range of motion for each joint in Orthopedic Physical Therapy examination. Orthopedic Physical Therapy Examination of the Neck 1. Manipulate the joint through a passive range of motion only if the patient is unable actively to perform a full range of motion. 2. lightly pass this part of your hand over all portions of the patient's extremity several times. 9. 6. or if there is obvious pain on active motion. to the left and right. 3. A method for doing this that will help even the most inexperienced to perceive subtle increases in heat is to choose the most heat-sensitive portion of the hand (usually the dorsum of the fingers) and. This involves asking the patient to assume a certain position and not let you overcome it. In passively manipulating a joint. 5. this represents increased heat. 11. and whether crepitus is produced when the joint is moved. 8. whether there is a pain on motion. Wrist extension. Shoulder adduction. Assess extension by asking the patient to look up and as far back as possible. note whether there is a reduction in the range of motion. If you find an area becoming slightly warmer. 7. Assess rotation by asking the patient to look over their shoulder. Observe the patient as a whole. the skin temperature gradually cools. Defects in function can be most rapidly perceived by having the patient perform active functions with each region of the musculoskeletal system. Observe the neck and shoulders from in front and behind. As you proceed from proximal to distal. Elbow extension. beginning proximally. Vi 12. note areas of increased warmth (heat). Assess neck flexion by asking the patient to touch their chest with their chin. Note also whether the joint is stable or whether abnormal movements may be produced in Orthopedic Physical Therapy examination. Begin the neurological assessment of the upper limb by examining themotor system. This reduces Orthopedic Physical Therapy examination time and helps the examiner to identify areas in which there is poor function for more careful evaluation. na y Ku m ar . 13. Palpate the front and back of the neck with the patient seated and the examiner behind. Wrist flexion.104 While palpating the joints. Elbow flexion. 4. Begin with shoulder abduction. 10.
Observe shoulder abduction from in front and behind. 9. 16. Note the presence of difficulty in initiation or a painful arc. through the entire range of movement. Test biceps function by asking the patient to flex the elbow against resistance. 6. looking for winging of the scapula. Palpate for tenderness over the sterno-clavicular joint. clavicle. Brachioradialis jerk. (3 photos) 11. front and back. 8. acromion process. Assess internal rotation by asking the patient to place both hands behind the head. Elicit the reflexes of the upper limb beginning with the biceps jerk. 21. 5. acromioclavicular joint. Test serratus anterior function by asking the patient to push against a wall. 12. 19. 2. supraspinatus tendon and the tendon of the long head of biceps. 17. behind the neck and behind the back. Assess external rotation with elbows in to the sides and flexed to 90º . Vi na y Ku m ar . 15. Finger flexion. 3. Secure the scapula to assess gleno-humeral movement. Test sensation of the upper limb and determine the distribution of any loss. Finger abduction 18. Observe the whole patient. Assess co-ordination of the upper limb. 4. Triceps jerk. 10. Orthopedic Physical Therapy Examination of the Shoulder 1. Assess internal rotation by asking the patient to reach over their opposite shoulder. 20. 22. Assess flexion and extension. Thumb abduction. Observe the axilla. Observe the shoulder. 7. Finger extension.105 14.
Feel for tenderness. 6.106 13. The apprehension test standing. Tennis elbow: point tenderness. Examine supination. 16. Test for pain with palpation of subacromial Bursa . Tennis elbow: pain on resisted extension. looking especially for deformity.Posterior . front and back.Anterior . Pivot shift of elbow (instability). 13. 7. Palpate the ulnar nerve. 8. Tennis elbow: pain on passive stretch. 4. Orthopedic Physical Therapy Examination of the Elbow 2. 14. 12. Observe the hand positioned on a pillow or a table. externally rotate and extend the patient's shoulder while pushing on the head of the humerus with the opposite hand to test for anterior subluxation or dislocation. Observe the whole patient. Apprehension test lying down. Observe the dorsum of the hand. 10. 9. 5. Examine pronation. 11. Examine extension. Assess any marked instability in the shoulder. Ensure you have adequate exposure. Examine flexion. na y Ku m 1.instability (moves too far back). 3.indicates impingement of the rotator cuff. Vi Orthopedic Physical Therapy Examination of the Wrist and Hand 1. Observe the palm of the hand.instability (moves too far forward). 15. Provocative test for Cubital Tunnel Syndrome (puts tension on ulnar nerve at elbow). Abduct. 2. ar . Accentuate the pain of tennis elbow.
107 4. Review the anatomy of the hand noting the tip of the styloid process, theanatomical snuffbox bordered by extensor pollicis brevis and extensor pollicis longus tendons and the abductor pollicis longus. 5. Feel for tenderness. 6. Test active movements of the wrist. 7. A useful method for screening of flexion and extension of the wrists. 8. Test passive movements of the wrist beginning with extension. 9. Flexion. 10. Radial deviation. 11. Ulnar deviation. 12. Pronation. 13. Supination. 14. Test thumb extension. 15. Test thumb abduction. 16. Test thumb adduction. 17. Test opposition. 18. Observe movement of fingers from extension to flexion. 19. Test flexor digitorum profundus function by holding the proximal interphalangeal joint extended and asking the patient to flex the finger. Successful finger flexion indicates the tendon is intact. 20. Test flexor digitorum superficialis function by holding the other fingers extended while asking the patient to flex the finger being tested. Successful flexion indicates the tendon is intact. 21. Assess joint hyperextension. 22. Axial compression test. 23. Asses ulnar nerve function with Froment's test. 24. Asses ulnar nerve/interosseus muscle function by asking the patient to abduct their fingers while slowly pushing the hands together until the weaker one collapses.
108 24. Asses ulnar nerve/interosseus muscle function by asking the patient to abduct their fingers while slowly pushing the hands together until the weaker one collapses. 25. Assess median nerve function. 26. Assess the function of the hand with the fine pinch grip (paperclip).
28. Tripod grip (pen). 29. Wide grip (mug). 30. Power grip. Orthopedic Physical Therapy Examination of the Back 1. Observe the patient as a whole, front and back. 2. Ask the patient to walk on their toes.
3. Ask the patient to walk on their heels. 4. Back extension. 5. Back flexion.
6. Bony Excursion: measure the distance between two bony points when standing. 7 Ask the patient to flex forward, the bony points should move at least 5 cm. 8. Lateralflexion
9. Rotation (make sure to anchor pelvis)
10. FABER test in Orthopedic Physical Therapy Examination: Flexion Abduction External Rotation. Press firmly on the knee. Pain in the groin suggests a hip problem and pain in the back refers to the sacroiliac joint. 11 Straight leg ranging, dorsiflexion increases the sciatic stretch. Watch for pain and limitation. 12. Femoral stretch test: Hip extension and passive flexion of the knee. Watch for pain and limitation. A Neurological examination including: 13. Knee extension.
27. Flat pinch grip (key).
109 14. Kneeflexion 15. Knee jerk reflex 16. Ankle jerk reflex. 17. Sensation 18. Pain on compression of the head can often be attributed to non-organic pathology. Orthopedic Physical Therapy Examination of the Hip 1. Observe the whole patient. 2. Trendelenburg test (normal). 3. Positive Trendelenburg Test. 4. Ask the patient to walk and observe their gait.
5. Test iliopsoas function by asking the patient to lift their thigh off the seat against resistance 6. Ensure the Anterior Superior Iliac Spines are horizontal. 7. Check the position of the medial malleoli.
8. Measure from the ASIS to the medial malleoli.
9. Measure the distance from the xiphisternum to the medial malleoli. 10. Feel for the femoral head. It is deep to the femoral pulse. 11. Thomas Test in Orthopedic Physical Therapy Examination: Flex both hips to eliminate the lumbar lordosis. Extend the hip you are examining and if it is normal it should return to the bed. A fixed flexion deformity of the hip will not allow it to extend to the neutral position. 12. Check the patient is not compensating with a lumbar lordosis. 13. Check the ASIS are horizontal again. Anchor leg over the edge of the bed and abduct the other hip. 14. Assess adduction. 14. Assess adduction. 15. Internal rotation.
2. Measure the circumference of the of the knee and leg. 11. 17. Feel the superficial and posterior surface of the patella by pushing it medially. 16. Observe the knee joint front and back.110 Orthopedic Physical Therapy Examination of the Knee 1. Assess patellae tracking from extension to flexion. Observe the knee with the patient lying on the bed. 9. Note quadriceps action.Empty the suprapatellar pouch with pressure above the patella. 12. 15. Ask the patient to squat. 10. Effusion: Bulge Test. 18. Compress the lateral side and watch for a bulge medially. 7. Feel the temperature of the knee and leg. 13. 4. Patellar apprehension test. ar 3. Soloman's test. To test for patello-femoral tenderness press patella against the femur and ask the patient to tighten their thigh muscles. Observe the patient as a whole. Flexion. In synovial thickening it will be hard to grasp. Assess extension of the knee. m 6. 5. Observe facial expressions for fear of impending dislocation. 14. Palpate for tenderness with the knee flexed to 90°. Pick a bony landmark on the knee and measure a fixed distance from it to the approximate centre of the quadriceps. Note any genu valgum (a slight degree of which is normal) or genu varum. Push sharply on the patella and with an effusion it will strike the femur and bounce back. Wipe hand along the medial side to displace fluid laterally. Apply lateral pressure to patellar as the patient flexes the knee. Effusion: Tap Test. Note any genu recurvatum. the ligaments and the tibial tubercle. 19. . Lift the patella away from the femur. Feel along the joint line. Effusion: Feel for fluid fluctuance. Observe knee from side. Vi na y Ku 8.
Flex the leg. . flex the leg. Coin test. 22. Extension fore foot. Femur should not move forward significantly unless the anterior cruciate ligament is torn. na y Ku m ar 23. 7. 6. Posterior drawer test. 27. internally rotate and adduct for lateral meniscal "clicks". Flexion fore foot.111 20. Internal and external rotation of the knee is limited. Lachmans test. Tib. MC test . 5. 12. 26. 1. Anterior drawer test. Look for posterior sag of the femur signifying posterior cruciate dysfunction. & 3. MacMurrays test:Place the thumb and finger on the joint line. externally rotate the foot. anterior test. post dysfunction). 10. 21. Test collateral ligaments by applying medial and lateral pressure to the lower leg which is tucked away under the examiners arm. 4. Mid foot abduction/adduction. 11. Plantar flexion. 8. Windlass test. Vi 9. Watching the patients face for pain. Dorsi flexion.lift leg off the bed and if tibia drops there is cruciate dysfunction. Check for inversion (tibialis function) and eversion (peroneal function). abduct and extend leg to test for medial meniscal "clicks". From behind check hind-foot alignment and "too many toes" sign (tib. 28. Orthopedic Physical Therapy Examination of the Ankle and Foot Observe patient as a whole from front and back. Ask the patient to lie prone and examine the back of the knee. 2. 24. Single stance heel raise test. (Posterior cruciate) 25.
Tib. 19. 16. Check pulses. Ankle instability . 20. The cause of the inflammation may be unknown. Tenosynovitis is inflammation of this sheath.inversion test. Tenosynovitis is inflammation of the lining of the sheath that surrounds a tendon (the cord that joins muscle to bone). Peroneal tendons test. 15.Anterior draw test. posterior test. Ankle instability . Simmond's test for TA. 14.112 13. sensation. NEWS & FEATURES Epidemic at the Computer: Hand and Arm Injuries Hazards At the Keyboard: A special report: Automation: Pain Replaces the Old Drudgery Alternative Names Inflammation of the tendon sheath Causes Vi The synovium is a lining of the protective sheath that covers tendons. reflexes. or it may result from: Infection Injury Overuse na y Ku Tenosynovitis m ar .Posterior draw test. Examine the sole. 18. Ankle instability . 17.
However. the tendon may be damaged and recovery may be slow or incomplete. Exams and Tests Treatment The goal of treatment is to relieve pain and reduce inflammation. Difficulty moving a joint Joint swelling in the affected area Pain when moving a joint Pain and tenderness around a joint. foot. Rest or keeping the affected tendons still is essential for recovery. Applying heat or cold to the affected area should help reduce the pain and inflammation. The health care provider may touch or stretch the tendon. However. hands. Note: An infected cut to the hands or wrists that causes tenosynovitis may be an emergency requiring surgery. For tenosynovitis caused by infection. which could be serious. especially if a puncture or cut caused these symptoms. your health care provider will prescribe antibiotics. but this is not common. the condition may occur with any tendon sheath. swelling. or have you move the muscle where it is attached to see whether you experience pain. Outlook (Prognosis) Vi Most people fully recover with treatment. Local injections of corticosteroids may be useful as well.113 Strain The wrists. or ankle Fever. Possible Complications If tenosynovitis is not treated. if the condition is caused by overuse and the activity is not stopped. wrist. Infection in the tendon may spread to other places in the body. Some patients need surgery to remove the inflammation surrounding the tendon. tenosynovitis is likely to come back. especially the hand. surgery may be needed to release the pus around the tendon. the tendon may become permanently restricted or it may tear (rupture). After recovery. do strengthening exercises using the muscles around the affected tendon to help prevent the injury from coming back. Ku A physical examination shows swelling over the involved tendon. You may want to use a splint or a removable brace to help immobilize the tendons. and redness may indicate an infection. and feet are commonly affected. In chronic conditions. na y Nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen can relieve pain and reduce inflammation. In some severe cases. m ar Symptoms .
The cells release enzymes into the joint space which causes further pain and irritation. It may also be associated with rheumatic fever. The increased blood flow that is a feature of the inflammation makes the joint warm.114 When to Contact a Medical Professional Call for an appointment with your health care provider if you have pain or difficulty straightening a joint or extremity. due to effusion (fluid collection) in a synovial sac. the joint appears swollen and feels puffy or boggy to the touch. particularly on motion. the enzymes may gradually digest the cartilage and bone of the joint leading to chronic pain and degenerative change Ku SYNOVITIS m ar . tuberculosis. The cells in the membrane divide and grow and inflammatory cells come into the joint from other parts of the body. Prevention Avoiding repetitive movements and overuse of tendons may help prevent tenosynovitis. in lupus. and characterized by swelling. In rheumatoid arthritis. Rheumatoid arthritis involves synovitis. If the process continues for years. Symptoms of Synovitis Vi na y Because of the mass of inflammatory cells in rheumatoid arthritis. contact your health care provider immediately. trauma. Synovitis is the inflammation of a synovial (joint-lining) membrane. or gout. If you suspect infection. usually painful. and in psoriatic arthritis. the synovial membrane lining the joint becomes inflamed. in juvenile arthritis. Synovitis is a major problem in rheumatoid arthritis.
the physical therapist may use cold modalities (e. m There are several possible treatments to control inflammation resulting from synovitis. or soft foam pad to protect the involved area until the swelling decreases. and whether surgery was required. The therapist also will educate the individual on how to avoid pressure on the inflamed synovial tissues by applying an elastic bandage. acute flare-up or chronic pain). Modifications may be made by the physical therapist depending on the location of the affected joint.. Ku When pain and inflammation of the acute stage of synovitis have lessened. Iontophoresis.115 Rehabilitation The goal of rehabilitation for synovitis is to decrease inflammation and pain to the synovium and affected joint(s) and then to restore range of motion and strength to the joint(s). which uses a small electric current to drive anti-inflammatory medication into the inflamed tissues. It uses high frequency sound waves to produce heat that penetrates deep into the involved synovial membrane and surrounding joint. ice packs) to control swelling and pain for as long as the joint area is warm to the touch. However. Exercise will be progressed to active stretching and strengthening as appropriate to restore function without recurrence of pain. this condition rarely requires surgical intervention. heat modalities such as moist heat packs may be used to help relieve joint pain and stiffness and to increase blood flow to the synovium to promote healing.g. Ultrasound is another heat treatment used in physical therapy. may also be used. the physical therapist will perform passive stretching exercises to help restore full range motion to an affected joint.e. Early in the course of synovitis. Electrostimulation combined with a cold treatment may be used to relax muscles around the inflamed joint and help to decrease pain and inflammation. the physical therapist may instruct the individual to elevate the affected joint to help reduce swelling. ar .. the stage of the inflammation (i. sling. At the initial flare-up. Vi na y Once pain and swelling have been greatly reduced.
the location of the symptoms helps determine your diagnosis. m Discs can rupture suddenly because of too much pressure all at once. ar . Both the pressure on the nerve root and the chemical irritation can lead to problems with how the nerve root functions. As the annulus becomes weaker. If you bend and try to lift something that is too heavy. na y A herniated disc causes problems in two ways. Degenerative changes in the spine that occur with aging actually make it less likely to develop a true herniated disc. The combination of the two can cause pain. First. either a vertebra can break or a disc can rupture. Therefore.116 DISC PROLAPSE Causes A true herniated nucleus pulposus is most common in young and middle-aged adults. This is because the nucleus in the middle of the disc dries out. The weakened disc ruptures while doing something that five years earlier would not have caused a problem. But many people do have back pain because they have other problems in their back when the disc ruptures. and irritation of. the nerves. Knowing where the pain is perceived gives your doctor a better idea of which disc has probably ruptured. The symptoms of a herniated disc usually include Vi Where these symptoms occur depends on which nerve(s) has been affected in the lumbar spine. It rarely occurs in children. Symptoms The symptoms of a true herniated disc may not include back pain at all. making it less likely to squeeze out of the disc. usually due to weakening of the annulus from repeated injuries that add up over time. the force can cause a disc to rupture. weakness. pain that travels into one or both legs numbness or tingling in areas of one or both legs muscle weakness in certain muscles of one or both legs loss of the reflexes in one or both legs Ku Discs can also rupture from a small amount of force. the material that has ruptured into the spinal canal from the nucleus pulposus can cause pressure on the nerves in the spinal canal. If the force is strong enough. This is due to the effects of aging on the spine-the most common reason for a disc herniation in the lumbar spine. For example. and numbness in the area of the body to which the nerve supplies sensation. falling from a ladder and landing in a sitting position can cause a great amount of force through the spine. There is also some evidence that the nucleus pulposus material causes a chemical irritation of the nerve roots. The symptoms come from pressure on. at some point lifting or bending causes too much pressure across the disc. Bending places high forces on the discs between each vertebra.
Observation You may not need any treatment other than watching to make sure that the problem does not progress. These tests may be required before a decision is made to proceed with surgery. but are somewhat less Vi na y Treatment Options Ku CT Scan Sometimes the X-ray and MRI do not tell the whole story. Over-thecounter pain relievers. Make sure to follow the directions and not take too many. medications can be used to help control it. your doctor may prescribe stronger pain pills-narcotic or non-narcotic pain medications. your doctor may suggest watching and waiting to see if they go away. This test is painless and accurate. Your doctor will want to make sure that you are aware when you have to urinate or have a bowel movement. A myelogram. MRI has almost completely replaced other tests when a herniated disc is suspected. If these types of medications do not control the pain. may be necessary to give as much information as possible. and some of the newer anti-inflammatory medications. EMG and SSEP Electrical tests can confirm that the pain in your leg is actually coming from a damaged nerve. it could indicate that a herniated disc in the lumbar spine is pushing against the spinal cord. your doctor may be more likely to suggest surgery. who initially have problems due to a herniated disc. Other tests may be suggested. may be helpful. find their symptoms completely resolve over several weeks or months. There do not appear to be any side effects with the test. If the symptoms are getting better. Narcotic pain medications are very strong but also very addictive. usually combined with a CT scan.117 Diagnosis Diagnosing a herniated nucleus pulposus begins with a complete history of the problem and a physical exam. Many people. If there is a problem. Diagnostic Tests X-rays The doctor may suggest taking X-rays of your low back. Discogram When surgery for lumbar disc herniation is being considered. Conservative Treatment The treatment of a herniated disc depends on the symptoms. Pain medications Depending on the severity of your pain. If the pain is bearable and symptoms from nerve or spinal cord pressure are not getting worse. but they can give your doctor an idea of how much wear and tear is present in the spine. your doctor may just want to watch and wait. Non-narcotic pain medications are less addictive. Regular X-rays can't show a herniated disc. ar . If they are getting steadily worse. such as ibuprofen. m MRI The MRI scan is the most common test used to diagnose a herniated disc. doctors may order a discogram to locate which discs are causing pain. Tylenol(tm).
How should things be lifted? Do‘s: Vi Hold heavy objects close to your body rather than away from it. Start with a gentle walking program and increase the distance you walk each day. This will support the back in a good lifting position and will help prevent excessive force on the spine.118 effective than narcotics. Exercises focus on improving strength and coordination of the low back and abdominal muscles. The goals of physical therapy are to help you learn ways to manage your condition and control symptoms resume appropriate activity levels learn correct posture and body movements to reduce back strain maximize your flexibility and strength Surgical Treatment Surgical treatment for a herniated disc depends on several factors such as your specific problem and your surgeon's experience. enabling you to resume normal activities. Holding the feet too close together will be unstable. you should begin to get moving. Rest If the pain is more severe. It is not usually suggested unless surgery is fast becoming an option. Therapy sessions may be scheduled two to three times each week for up to six weeks. After two days. and helping you do your daily activities with greater ease and ability. Ku m ar . solid base of support is important. A well-rounded rehabilitation program assists in calming pain and inflammation. The stomach muscles must be pulled in. na y Laminotomy and Discectomy Microdiscectomy Endoscopic Discectomya Epidural Steroid Injection (ESI) The ESI is usually reserved for more severe pain from nerve root irritation due to a herniated disc. A wide. The emphasis of therapy is to help you learn to take care of your back through safe exercise and self-care when symptoms flare up. An ESI is only successful in reducing the pain from a herniated disc in about half the cases. Legs must be bent at the knees while lifting weights from floor level and the back must be kept straight. Therapy visits are designed to help control symptoms. Learn more about medications used to treat back pain. too far apart will make movement difficult. Most physicians do not like to prescribe narcotics for more than a few days or weeks. improving your mobility and strength. Physical Therapy Patients with a herniated disc are commonly prescribed physical therapy. Your doctor may also prescribe a back brace to help limit movement around the injured disc. The feet must be about shoulder-width apart. it may be necessary to take a few days off from work and decrease your activities.
return of patient to social environment. family.e. the period when the burn patient is still in hospital but in the plastic surgery ward. and working life Ku m ar Avoid sudden and awkward movements while holding something heavy. Aims: A. and no longer in the intensive care unit. The legs are much stronger than the back muscles. recovery of muscular tone trophism B. family. treatment of neurological sequelae D. such as kinesitherapy. Once the na y 1. articular limitations B. restoration of patient‘s autonomy in shortest time possible (depending on pathology) 3. Don'ts: THE REHABILITATIVE MANAGEMENT OF BURN PATIENTS IN THE POST-ACUTE PHASE Introduction The most important rehabilitative commitment after a serious burn trauma is to guarantee to the patient maximum autonomy and functionality in order to ensure the best possible quality of life in the social. scar prevention B. treatment of orthopaedic sequelae C. breathing complications D.119 Push up with the legs. Acute phase. physiotherapists use a wide range of techniques. oedema 2. i. Face in the direction you are walking. Aims: A. To achieve this aim. If an object is too heavy. Chronic phase (sequelae). . or awkward in shape get someone to help you lift. Prevention of: A. and working environments. Never bend your back to pick something up Don't twist or bend. Post-acute phase. return of patient to normal overall condition C. muscle or tendon contractures C. and a number of devices. It is possible to distinguish three phases: Vi In this paper we will consider the post-acute phase.
The patient will need to learn to do all this by himself in the shortest amount of time possible to reach autonomy in moving between bed and wheelchair and consequently in personal cleanliness. sitting with legs out of bed). Exercises for the passive connective and active muscular parts of the body. Exercises in cases of neurological injury in order to make movements that are as precise as possible. initiation of rehabilitation to be arranged with the plastic surgeon) 3. Exercises performed autonomously by the patient during the day in order to improve circulation and metabolic exchange. Presence of muscle or tendon injuries Procedures Various procedures are used: 1.2 Contraindications to kinesitherapy 1. 7. Care must be Vi na y Ku m ar . 2. helpful aids are elastic bandages on the lower limbs in order to prevent circulatory disorders. 4. Assisted active mobilization Active mobilization Mobilization against resistance Dynamic proprioceptive re-education Stretching Postural sequences Recommencement of standing (orthostatism) Re-education for the recommencement of walking Splinting Exercises Numerous exercises are available: 1. Poor general condition of the patient 2. Exercises performed against resistance by the therapist in order to counteract muscular hypotrophy and restore the memory of movements. 3. Kinesitherapy allowing the patient analytic recovery of movement. Postural sequences are the next step (variation of decubitus: lateral. 8. an activity that gradually becomes once again autonomous. sitting with legs straight. using the whole kinetic chain and not just single isolated movements (as recommended by Freeman. 9. 2. and Kabat. transfer from bed to wheelchair. 7. Perfetti. if possible. initially with devices and later weaning the patient from their use in order to achieve autonomous walking.1. Skin graft (at least 5-10 days of immobility are necessary. depending on the patient‘s clinical conditions: a. b. 6. 4. 8.120 acute phase is over. Exercises performed with the help of the physiotherapist in order to overcome loss of articular and muscular movement. 6. 5. 3. 5. The physiotherapist plays an important role here: he or she teaches the patient how to walk. treatment will be oriented towards early neuromotor recovery in order to reduce the negative effects of overlong immobilization in bed. A long stay in bed requires exercises aimed at transferring weight distribution and controlling the trunk. sitting up in bed. There are two possibilities. Various devices are used to assist walking in the early stages.
Reduces oedema and itching 3. and adjustable manner.this requires careful hygiene and good patient compliance. and softening effects on the scar. continuous. the only disadvantage is a further reduction in range of motion. These garments require continuous checking of their continued effectiveness. Such exercises. the use of pads in the lower back and subscapular area can be considered . Adhesive bandaging can be applied by the physiotherapist (this is useful also during postural sequences in the acute phase for the reduction of circulation disorders) before the use of girdles. are high). artificial ageing that will determine an orientation parallel to the cutaneous surface of the collagen fibres. palm. in order to avoid any haemostatic effect). Bandaging is applied: Compression is applied as follows: pre-packaged elastic girdle elastic bandaging elastic garments silicon Vi Girdles are made of elastic tissue that counteracts scar hypertrophy. frees adhesions. hydrating. since the adhesive bandaging can be applied directly on the dressing. to prevent oedema after skin grafting in burns in the course of healing during the chronic phase m ar . Compression needs to be continuous over time to be effective. and makes the new skin stronger na y Ku in the acute phase.compression therapy In 1968 Fujimori demonstrated that a moderate and constant compression of burned skin prevents scar hypertrophy. however. Girdles are made to measure in order to adjust tension and compression (care must be taken to ensure they are be correctly worn. Massotherapy is another useful technique. Walking helps to orient the positioning of grafted skin (Benninghoff). Static-dynamic exercises counteract hypertrophy and scar contractures by using forces that release scar tension in a constant. and back. It can be placed in between elastic girdles (costs.3-6 Bandaging . Massotherapy: 1. in cases of neurological injuries.121 taken when there are skin grafts and orthopaedic or neurological injuries. decongesting. Makes the skin more elastic. When compression is applied early. compensate for the loss of movement. it prevents the formation of nodules and collagen spirals within the scar and creates hypoxaemia in its vascular network: this causes precocious. This is very important from the acute phase on. Silicon has flattening. Silicon may be interposed to increase compression at the level of the hand. Made-to-measure elastic-compressive garments are useful only in the post-acute phase when oedema has stabilized and the skin has healed. Reorganizes the capillary network and local circulatory flow 2. 9.
with particular reference to walking and management of personal care.8 na y 1. thus determining emptying of tissues. Helps the patient to regain sensitivity 5. surgery) articular. it enables the lymph to flow . Immunological effect. 1. Analgesic effect. This defence depends on resistance. 2. neuromotor. The sympathetic nervous system prevails over the parasympathetic. The daily use of rapidly absorbed hydrating lotions is recommended.122 4. thus reducing it (see the gate control theory). with consequent oedema. intensity 1. Transcutaneous electrical nerve stimulation (TENS): this is to decrease pain during the process of scar healing.and thus prevents the creation of fibrous tissue and consequent sclerosis. This technique is required when there is impairment of venous and lymphatic circulation. Relaxes neighbouring tissues Massaging must be gentle and superficial. Blood pressure diminishes. i. the set of possibilities for reaction activated by the organism before an immune response. 2. as this prevents avoid maceration under the girdles. Manual lymphatic drainage acts by toning the smooth musculature of blood vessels at capillary level.the vegetative nervous system is composed of two antagonistic systems: the sympathetic and the parasympathetic nervous systems. Vacuum therapy: this therapy uses different-size nozzles that go over all the scars lengthwise. as also on the musculature of blood and lymph vessels. through contraction of the pre-capillary sphincters. Ku m ar . This includes: cutaneous assessment (baths. 4.7 Manual lymphatic drainage Manual lymphatic drainage has analgesic and immunological effects on the vegetative nervous system.even by alternative routes .5 W/m2. 3. 3. manual lymphatic drainage acts on the latter. Effect on smooth musculature of blood and lymph vessels. Vegetative effect . Manual lymphatic drainage permits an increase of the body‘s defence mechanisms by activating lymph routes.8 Physical therapy Vi At the end of each treatment it is useful to make an overall evaluation. increasing its effect. and breathing assessment assessment of functional recovery (functional independence rating). Manual lymphatic drainage can excite the cells that inhibit pain. The association of various bandaging techniques cannot always be used since the scars may still be open. by increasing and reducing pressure. Connective tissue massage is important as it stimulates body areas by modifying their connective trophism through the reflected action of the skin‘s sympathetic terminal reticulum.e. Ultrasounds: these improve the detachment of adherences and reduce oedema (they reduce fibrosis): 3 Hz. The action is exerted on the circulation in the scar.
accounting for about 70-80% of cases. balance. and problems with posture. Le but le plus important dans la rééducation du grand brûlé est le rétablissement de son autonomie et de sa fonctionnalité maximale possible dans la vie sociale. learning disabilities. swallowing. and posture. usually in infancy or early childhood. Dyskinetic (extrapyramidal): This includes types that affect coordination of movements. or quadriplegia (the entire body). and many other functions. seizures. sitting. poor muscle tone. There are 2 subtypes. Infants with cerebral palsy are usually slow to reach developmental milestones such as rolling over. walking. Les Auteurs considèrent la phase post-aiguë et en particulier les contre-indications à la kinésithérapie. Types of cerebral palsy are as follows: Vi na y Mental retardation. and movements are jerky or awkward. les pansements et la thérapie de compression. breathing problems. dental problems. Ku Cerebral palsy (CP) is an umbrella term for a group of disorders affecting body movement. speech. This type is classified by which part of the body is affected: diplegia (both legs). The resulting impairments first appear early in life. The severity of these problems varies widely. digestive problems. bladderand bowel control problems. uncontrolled movements. le drainage lymphatique manuel et la thérapie physique Common to all individuals with cerebral palsy is difficulty controlling and coordinating muscles. cerebral palsy means ―brainparalysis. hemiplegia (one side of the body). balance. skeletal deformities. This makes even very simple movements difficult. Although the magnitude of the problems may wax and wane over time. crawling. and walking. the condition does not get worse over time.‖ Cerebral palsy is caused by abnormal development or damage in one or more parts of the brain that control muscle tone and motor activity (movement). Loosely translated. On peut distinguer trois phases: aiguë. m Cerebral Palsy ar . This is the most common type of CP. eating difficulties. and hearing and vision problems are often linked to cerebral palsy. from very mild and subtle to very profound. coordination. familiale et professionnelle.123 RESUME. Cerebral palsy may involve muscle stiffness (spasticity). The muscles are stiff (spastic). post-aiguë et chronique. Spastic (pyramidal): Increased muscle tone is the defining characteristic of this type.
usually inadequate oxygen. regardless of intelligence level. and/or other medical problems in the mother na y Some cases begin after birth (postnatal). and speech/swallowing therapy. the gait is probably unsteady. Despite advances in medical care. Mixed: This is a mixture of different types of cerebral palsy. perinatal. during the birth process as the child passes through the birth canal. At one time. In many cases. Vi Risk factors linked with cerebral palsy include the following: Infection. About 10-20% of cerebral palsy cases are of this type. All children with cerebral palsy.124 o Athetoid: The person has uncontrolled movements that are slow and writhing. We now know that fewer than 10% of cases of cerebral palsy begin during birth (perinatal). In fact. including physical. such as writing. In all likelihood. are able to improve their abilities substantially with appropriate interventions. A common combination is spastic and athetoid. thyroid disorder. The number of people affected by cerebral palsy has increased over time. The movements can affect any part of the body. This may be because more and more premature infants are surviving. about 2-3 children per 1000 have cerebral palsy.000 people of all ages are affected. Their ability to express their intelligence may be limited by difficulties in communicating. or after birth in the first few years of life. Most children with cerebral palsy require significant medical and physical care. As many as 1. o cerebral Palsy Causes Cerebral palsy results from damage to certain parts of the developing brain. Depth perception is usually affected.000. Cerebral palsy affects both sexes and all ethnic and socioeconomic groups. and tongue. Ku Many individuals with cerebral palsy have normal or above average intelligence. the exact cause of the brain damage is never known. problems during birth. Ataxic: This type affects balance and coordination. mouth. current thinking is that at least 70-80% of cases of cerebral palsy begin before birth (prenatal). He or she has difficulty with movements that are quick or require a great deal of control. This damage can occur early in pregnancywhen the brain is just starting to form. m ar . and postnatal factors. If the person can walk. cerebral palsy remains a significant health problem. About 5-10% of cases of cerebral palsy are of this type. occupational. In the United States. seizure disorder. many cases of cerebral palsy are a result of a combination of prenatal. were blamed for cerebral palsy. including the face.
They may be very subtle. They may appear uncontrolled or without purpose.‖ Limbs may be held in unusual or awkward positions. Ku m ar . which normally disappear 3-6 months after birth Developing handedness before age 18 months: This indicates weakness or abnormal muscle tone on one side. which may be an early sign of CP. or bleeding Cerebral Palsy Symptoms The signs of cerebral palsy are usually not noticeable in early infancy but become more obvious as the child‘s nervous system matures. or slow and writhing. during. or walking Persistence of ―infantile‖ or ―primitive‖ reflexes. Vi na y Delayed milestones such as controlling head. triplets) Lack of oxygen (hypoxia) reaching the brain before. Early signs include the following: Problems and disabilities related to CP range from very mild to very severe. lack of oxygen. noticeable only to medical professionals. especially those affecting the brain. or metabolism Rh factor incompatibility. reaching with one hand. spinal cord.) Certain hereditary and genetic conditions Complications during labor and delivery Premature birth Low birth weight (especially if less than 2 pounds at birth) Severe jaundice after birth Multiple births (twins. due to infection (such as meningitis). face. head injury. or after birth Brain damage early in life. Abnormal muscle tone: Muscles may be very stiff (spastic) or unusually relaxed and ―floppy. For example. sitting without support. or may be obvious to the parents and other caregivers. crawling. rolling over.125 Birth defects. a difference in the blood between mother and fetusthat can cause brain damage in the fetus (Fortunately. head.lungs. this is almost always detected and treated in women who receive proper prenatal medical care. Their severity is related to the severity of the brain damage. Abnormal movements: Movements may be unusually jerky or abrupt. spasticleg muscles may cause legs to cross in a scissor-like position.
and controlling their saliva. This can cause infection or even suffocation. This information includes a detailed medical interview concerning medical histories of both the mother‘s and father‘s families. the more severe the disability overall. Dental problems: People with cerebral palsy tend to have more cavities than usual. Generally. and a detailed account of the pregnancy. There is no medical test that confirms the diagnosis of cerebral palsy. If not corrected by surgery or a device. na y Vision problems: Three quarters of people with cerebral palsy havestrabismus. Swallowing problems: Swallowing is a very complex function that requires precise interaction of many groups of muscles. An even greater risk isaspiration. Bowel and/or bladder control problems: These are caused by lack of muscle control. The child may not respond to sounds or may have delayed speech. This results from both defects in tooth enamel and difficulties brushing the teeth. Seizures may appear early in life or years after the brain damage that causes cerebral palsy. Some individuals with cerebral palsy are unable to control these muscles and thus cannot speak normally. Seizures: About one third of people with cerebral palsy have seizures. Hearing loss: Partial hearing loss is not unusual in people with cerebral palsy. the more severe the retardation. and neonatal(newborn) period. strabismus can lead to more severe vision problems over time. These people are often nearsighted. eating. he or she will undergo a very thorough evaluation. Joint contractures: People with spastic cerebral palsy may develop severe stiffening of the joints because of unequal pressures on the joints exerted by muscles of differing tone or strength. the inhalation into the lungs of food or fluids from the mouth ornose. mouth. this can lead to tilting of the pelvic bones and scoliosis (curvature of the spine). The diagnosis is made on the basis of various types of information gathered by the child‘s health care provider and. and throat. The physical signs of a seizure may be partly masked by the abnormal movements of a person with cerebral palsy. They may drool. This is due to weakness of the muscles that control eye movement. delivery. People with cerebral palsy who are unable to control these muscles will have problems sucking. children with cerebral palsy are affected by mental retardation. the mother‘s medical problems before and during pregnancy. Ku m ar Mental retardation: Some. although not all. If not corrected. which is the turning in or out of one eye. drinking. . labor. in some cases. other consultants. Vi xams and Tests If your child has problems that suggest cerebral palsy. Speech problems: Speech is partly controlled by movements of muscles of the tongue.126 Skeletal deformities: People who have cerebral palsy on only one side may have shortened limbs on the affected side.
including karyotype analysis and specificDNA testing. Vi na y MRI of the spinal cord: This may be necessary in children with spasticity of the legs and worsening of bowel and bladder function. or metabolic problems. Electromyography (EMG) and nerve conduction studies (NCS) may be helpful in distinguishing CP from other muscle or nerve disorders. when used on the brain or spinal cord. which suggest an abnormality of the spinal cord. they may help identify the cause or extent of the cerebral palsy. as the answers may help your child. Such abnormalities may or may not be related to cerebral palsy. and certain other abnormalities in infants more clearly than ultrasound. it can show hemorrhage (bleeding) in the brain or damage caused by lack of oxygen to the brain. Imaging studies: These studies provide a picture of structures inside the body. can be begun immediately. hemorrhage. These tests are not always necessary. your child‘s health care provider may want to do other tests. Lab studies: Various blood and urine tests may be ordered if your child‘s health care provider suspects that the child‘s difficulties are due to chemical. It identifies malformations. They should be done as early as possible so that appropriate treatment. CT scan of the brain: This scan is similar to an x-ray but shows greater detail and gives a more 3-dimensional image. Such testing. For instance. Electroencephalography (EEG) is important in the diagnosis of seizure disorders. MRI of the brain: This is the preferred test. Children who are unable to remain still for at least 45 minutes may require a sedative to undergo this test.127 You will be asked to relate in detail the child‘s medical problems and mental and physical development. Other tests: Under certain circumstances. hormonal. since it defines brain structures and abnormalities more clearly than any other method. This is a potentially treatable cause of a CP-look-alike. Ku Ultrasound of the brain: Ultrasound uses harmless sound waves to detect certain types of structural and anatomic abnormalities. Ultrasound is often used on newborns who cannot tolerate more rigorous tests such as CT scans or MRI. Many individuals with mild cerebral palsy have no visible brain abnormalities. which is easier to treat when treated early. You may be asked other questions as well. A high index of suspicion is needed in order to detect non-convulsive or minimally convulsive seizures.Analysis of the child‘s chromosomes. but in many cases. m ar . is often called neuroimaging. may be needed to rule out a genetic syndrome. if indicated. It is very important to answer all questions as completely and honestly as possible.
toes. Physiotherapy is used to help cerebral palsy patients improve movement and motor skills. Cerebral palsy physiotherapy techniques are determined by the degree of physical limitations of the individual. Fine motor skills are used during daily living skills like eating.. and it is used for aiding in the development of fine motor skills. dressing. Different treatments will work for different patients. improving speech or sign language messages. Physiotherapy has the ability to develop self-sufficiency in cerebral palsy patients where it was previously absent. however each case of cerebral palsy is as unique as the individual it affects. Ku Physiotherapy can be great for increasing the success of learning to walk. Talk to your child's physician about setting up physiotherapy plan today. such as those in the face. Physiotherapy is an integral part in the majority of many cerebral palsy patients' daily lives. and what will be most beneficial to the cerebral palsy patient. and to varying degrees of success. Fine motor skills focus on the use of smaller muscles. Other types of physiotherapy like speech and language therapy may also be incorporated into a cerebral palsy patient's program. fingers. The physical therapists involved in physiotherapy reduce further development of musculoskeletal problems by preventing muscle weakening. special eating utensils and other adaptive equipment provide a patient with the freedom to accomplish some tasks on their own. and feet. and are fine tuned by occupational physiotherapy. Motor skills that utilize the large muscles in the body. standing without aid. and other movement skills. and introducing communication tools such as computers and other visual aids. Since cerebral palsy is a physical and movement disorder that impairs the brain's ability to properly control muscle movement. hands. such as those in the arms and legs. This kind of physiotherapy can help improve a cerebral palsy patient's balance and movement. etc.128 Physiotherapy There are many different treatments for cerebral palsy available today. and other external means of treatment. deterioration. Physiotherapy generally consists of a few types of therapy and helps a cerebral palsy patient to improve their gross motor skills. walkers. massage. Physiotherapy also involves choosing the right type of adaptive equipment that can enhance a cerebral palsy patient's motor abilities. Wheelchairs. Physiotherapy in the form of speech and language therapy that enables a cerebral palsy patient to communicate more easily with others by developing the facial and jaw muscles. using a wheelchair or other adaptive equipment. m ar . physiotherapy can do wonders in helping cerebral palsy patients gain mobility. A child with cerebral palsy can start physiotherapy at just about any age. Vi na y Occupational therapy is another element of physiotherapy used for cerebral palsy patients. A treatment calledphysiotherapy is classified as a non-medicinal treatment of cerebral palsy with the use of exercise. and contracture through the correct physiotherapy techniques. heat. writing. are known as gross motor skills.
some important causes of cerebral palsy can be prevented in many cases. and certified nurse-midwives. and nothing can be done to prevent it. and illicit drugs during pregnancy: these increase your risk of premature delivery. which protects both you and your baby from contracting this potentially devastating illness. Make sure your child is restrained in a properly installed car seat and wears a helmet when riding on a bicycle. nurse practitioners. Appropriate prenatal care includes testing for Rh factor.129 Prevention Often the cause of cerebral palsy is not known. and head injuries. Vi na y Ku Routine vaccinations of babies can prevent serious infections such as meningitis that can lead to cerebral palsy. m ar Seek appropriate prenatal care as early as possible in the pregnancy. low birth weight. Avoid using cigarettes. Many women schedule a prepregnancy visit so they can be properly prepared for a healthy pregnancy. Rh incompatibility is easily treated but can cause brain damage and other problems if untreated. physician assistants. Testing for rubella immunity before you become pregnant allows you to be immunized. including premature birth. infections. However. Rubella (measles) during pregnancy or early in life is a cause of cerebral palsy. alcohol. . Appropriate care is available from physicians.
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