Articles on physical therapy

Aerobic Exercise: 10 Reasons to Get Physical

Ms. Raisa Luther, Psychotherapist
Whatever your age, weight or physical condition, aerobic exercise is good for you. Find out why, get the motivation and get moving! How your body responds to aerobic exerciseWhen you indulge in aerobic activity, you’ll breathe faster and deeper. That means more oxygen gets into your blood stream, which in turn increases blood flow to your muscles and lungs.Moreover, your brain will release endorphins, a chemical that enhances your sense of well-being.Whatever you age or condition, physical activity will make you healthier and happier.Check out these 10 ways that aerobic activity can help you feel better and enjoy life more:Keep excess kilos away Combined with a healthy diet, aerobic exercise helps you lose weight and keep fit.Increase your stamina Regular exercise will increase your staying power, reduce fatigue and enable you to do more.Protect yourself from viral illnesses Aerobic exercise strengthens your immune system. This may leave you less vulnerable to minor viral illnesses, such as colds and flu.Reduce your health risks Aerobic exercise reduces the risk of many health risks, such as obesity, heart disease, high blood pressure and type 2 diabetes.Manage chronic conditions Aerobic exercise is known to help in lowering blood pressure and control blood sugar. If you have a heart condition, aerobic exercise will also help you.Lower cholesterol Aerobic exercise boosts your high-density lipoprotein (HDL), the "good," cholesterol, and lowers your low-density lipoprotein (LDL), the "bad," cholesterol. This may result in less build-up of plaque in your arteries.Boost your mood Aerobic exercise elevates your mood, helps in fighting depression, reduces stress and promotes relaxation.Stay 'young' as you age Aerobic exercise strengthens your muscles, which helps you stay physically stable and mobile as you get older.Aerobic exercise also keeps your mind sharp Research indicates that at least 30 minutes of aerobic exercise three days a week reduces cognitive decline in older adults.Live longer Studies also indicate that people who indulge in regular aerobic exercise live longer than those who don't exercise regularly.Don’t rushConvinced? But remember to start with small steps. Especially if you’ve been inactive for some time, or have a chronic health condition, get your physician’s consent.And when you start, start slowly. You might walk for 5 minutes in the beginning and gradually build on that. Do not overstrain.What are the options? Walking, swimming, bicycling are some.Start today. And stay healthy tomorrow.

The Many Benefits of Hydrotherapy!

Ms. Anu Priya, Alternative Medicine
Undoubtedly, the first human beings to come across a sparkling, warm-water spring entered the soothing waters after a long day of hunting and gathering, and said, “Ahhhhhh.” From ancient times to modern day, people have intuitively been drawn to the restorative powers of hydrotherapy. Can something that feels so good actually be good for you? Happily, the answer is a resounding “Yes.”Today there is a body of research to support the use of warm-water immersion and hydro acupressure bubbles, to promote healing and increase both a physical and mental sense of well-being. Alleviation of StressFor most of us, stress is now an unavoidable part of everyday life. Over the long term, without the use of appropriate stress management techniques, your health will begin to suffer. Hydrotherapy is one of the easiest ways to reduce the effects of stress on both your body and your mind. This, in turn, encourages release of endorphins, a naturally occurring substance in the body which induces a sense of well-being. For stress relief, we recommend using our hydrotherapy at least three times a week at a temperature that allows 20 minutes of immersion. Additionally, aromatherapies can be combined with hydrotherapy by adding essential oils that are available especially for use in your therapy.Natural Aid to Sound SleepA good night’s sleep is vital to your health and safety. The National Sleep Foundation , among other experts on sleep, recognizes a regular soak in a hot tub as an excellent way to prepare for a night of sound sleep. To obtain more restful sleep and to overcome insomnia take up a hydrotherapy session in the evening, this will raise your body temperature. The therapy helps clear your mind of stresses that can disturb sleep. The essential oils were chosen particularly to aid natural sleep. Once you leave the hot tub, your body temperature will fall, providing a natural inducement to falling into a deep, sound sleep. Muscle and Joint HealthAfter just 12 minutes in a hot tub, deep muscle temperature increases to reach the temperature of the water. This has been shown to provide relief to sore or injured muscles and joints and promote healing of injured tissue. While hydrotherapy will benefit almost anyone with common muscle fatigue or joint pain.Fitness BenefitsThe hydrotherapy is well-suited for a water-based exercise program. To quote directly from a 2009 study: Aquatic activity impacts the cardiovascular, musculoskeletal, autonomic nervous system and endocrine systems in ways that have positive public health implications for issues, including obesity, diabetes, and arthritis. When using your hot tub to increase your overall physical fitness, you may adopt an exercise program or simply enjoy the heart-healthy effects of a daily soak.Thus 20 minutes of our Hydrotherapy session burns minimum 250 calories without any exercise movements inside the tub. In a water workout, the buoyancy provided by water reduces the impact on your joints which occurs on dry land. Many people with a physical limitation that restricts them from using traditional gym equipment or engaging in vigorous exercise are able to accomplish a water-workout that can improve and restore strength and flexibility. But we’ll let you in on a secret: simply sitting and soaking can provide many of the benefits of a more strenuous aerobic workout. In a study cited in the New England Journal of Medicine, a group of sedentary people added a 30 minute daily hot tub immersion to their routines, reducing their weight by an average of 3.75 pounds over the course of the three week study.Immersion in hot water increases blood flow to central organs, including the heart. As blood flow to the heart increases, the heart “exercises” by speeding up to accommodate the added volume. Of course, it is most appropriate to consult your doctor before starting a new program of treatment or strenuous exercise, especially if you have any pre-existing health or heart conditions.Resources:Popke, Michael. “Calming Influence.” Athletic Business, March 2010. Magazine online. Retrieved from http://www.athleticbusiness.com/articles/article.aspx?articleid=2894&zoneid=43 on 11 June 2010.“Healthy Sleep Tips.” National Sleep Foundation website. Retrieved fromhttp://www.sleepfoundation.org/ article/sleep-topics/healthy-sleep-tips on 15 June 2010.PT Staff. “Hydrotherapy: The Soothing Power of Soaking.” Psychology Today, March 2001. Magazine online. Retrieved fromhttp://www.psychologytoday.com/articles/200103/hydrotherapy-the-soothing-power-soaking on 15 June 2010.  Becker, Bruce E., et al. “Biophysiologic Effects of Warm Water Immersion.” International Journal of Aquatic Research and Education, 2009. Retrieved fromhttp://education.wsu.edu/research/nasmi/publications/BiophysiologicEffectsofWarmWaterImmersion.pdf on 14 June 2010.

7 Signs That Say You May Need Physiotherapy

Dr. Rajiv Mehta, Physiotherapist
Often when people think about physiotherapy, they have images of someone struggling out of a wheelchair to learn to walk again, or learning how to move after a severe accident, injury or illness. However, you don’t have to be severely debilitated to benefit from physiotherapy. If you have physical pain or discomfort, then these could be good indicators that some therapy could benefit you enormously.Sometimes people play down their physical ailments or even learn to live with chronic pain and discomfort. The body is miraculous at compensating for weaknesses, and before you know it, you have either adapted or got used to a physical setback. While there’s no reason to seek out the services of a physiotherapist for every ache and pain, you don’t have to be unable to move at all to reap the benefits of some of the right type of muscle manipulation and focus that physiotherapy brings.Here are ‘7 signs you may need physiotherapy’, and if you relate to even just one, you might want to consider how you can help your body heal in the right way and become strong:Balance and coordination – Physiotherapy can retrain your body to move without falling over. Disequilibrium can be caused by a multitude of underlying issues, and whilst you may want to work out what the root of the problem is, you might want to challenge the effects and symptoms too. Unless you tackle this issue, you may be more vulnerable to falls and mishaps in the future.Pain won’t go away – If you are suffering from back or neck pain, and perhaps have strains and sprains, or muscle imbalances caused by core muscle weakness, then there’s no reason to suffer in silence. Often pain can come and go, and it is because of this intermittent nature that people often keep quiet and just put up with it. Physiotherapy specifically targets pain and this, along with increasing mobility, is the cornerstone of what this type of therapy aims to accomplish.Flare up problems – Do you have an old injury that just won’t seem to heal or completely go away? Do you find that you are okay for a while but then certain activities or even environments can really cause symptoms to rear up again? If you didn’t deal with an injury when it was fresh, then it can take much longer to heal, and sometimes that part of you will never be the same again. However, physiotherapy is designed to address not only recent physical problems, but ones that have built up over time and nag at the body.Mobility issues – It can be amazing just how much one simple injury can affect your whole body. If you’ve ever had a fracture then you’ll know exactly what it feels like to have a part of your body that you really rely on not function in the way that it should. While it is all too easy to accept that you now have a funny knee and hobble a bit when walking, perhaps because of an old sport injury, for example, there’s no reason to accept restrictive or even painful movement for years to come.Pain in other areas – Sometimes the point of injury is not the point of pain. You might have initially impacted or had some weakness in one part of your body, only to find that a different part of you suffers, or becomes susceptible to pain and lack of mobility. If you have pain in your body but can’t attribute it to a specific incident or accident, could it be related to another part of you that was injured?Neurological problems – People who have suffered a stroke quite often need extensive physiotherapy, to learn mobility skills – sometimes all over again. Become aware of your body and how each bit of you is interconnected. If problems of a neurological nature have played a part in your life, then it may be time to reassess if and how this has impacted you and what you can do about it.Disturbed sleep – If you have chronic lower back pain then you’ll know that insomnia can be a result of that discomfort. Sleep patterns are a good indicator of what is going on inside your body. If you have problems getting to sleep, suffer from fitful nights, or simply don’t feel fully rested when you wake up, one cause could be pain and mobility problems. Sleep is a good indicator of your physical state.

Sex Therapy

Dr. Ramesh Maheshwari, Sexologist
Sex therapy is based on behavior therapy. It is a type of re-educative therapy. The fundamental of behavior therapy is that all the behaviors are learned, even the maladaptive behaviors. The behavior therapist helps the client to unlearn the unadaptive behavior and replaces it with newly learned adaptive behavior. The aims of behavior therapy are primarily educational and techniques facilitate improved self control.From amongst several techniques that are used in behavior therapy, ‘systematic desensitization technique’ is used in sex therapy. Prior to 1970, sexual dysfunctions were managed by psychiatrists. After  1970, the masters and Johnson model of sex therapy made it possible to treat sexual dysfunction by psychologists, social workers, nurses, counsellors, and medical doctors.Their approach included :Instead of treating the affected individual, the couple is treated. It is the relationship that is affected. This strategy provides an opportunity to gain  the co-operation and understanding of both the partners in overcoming the problem.Two therapist-a man and a woman work together as a team. This gives each partner a same sex therapist to whom he or she can relate more easily.Masters and Jonson recognized that it was important to identify organic conditions that might require medical or surgical treatment instead of sex therapy.They also found that explanining the anatomy and physiology of sexual response to the clients often had important therapeutic benefits.To individualize the therapy so as to meet the specific needs of each couple.The therapist must avoid imposing his own values on the client.The fear of performance and ‘spectatoring’ are often central to the cases of sexual dysfunction. The pressure of performance is removed initially by banning sexual contact. Couples are then helped to rediscover the sensual pleasures of touching and being touched without the goal of particular sexual response (Sensate Focus Exercise).Blaming each other for the sexual problem is discouraged.When a couple’s relationship improves outside the bedroom, it is apt to have positive results in the bedroom too.Basis : Sexual response is the function of Autonomic nervous system and is a physiological change when effective sexual stimuli are present , and a person is psychologically prepared to respond to them. All the sense organs are to be used to create a situation conducive to sexual response . (touch is most important).Systematic Desensitization : A mode of psychotherapy where all the anxiety provoking stimuli are arranged in an ascending level, and the client is exposed to, one by one, both the partners are to be involvedRelaxation: Deep breathing, deep muscle relaxation and plesant imagery are incorporated.Reassurance.Stages :Sensate focusWoman superior positionLateral positionMen superior positionFormat: No rigid format Variations in time, frequency and structure depending upon the dysfunction, the patient and the therapist.Results: Not as definite as in pharmacotherapy.As you shall sow and water, so you shall reap: A skilled and knowledgeable therapist is like a good seed. Client’s receptive mind is like fertile soil. Compliance and co-operation by wife is like watering by gardner. When all the three factors combine, the results are good. When sex therapy works, it does wonders and results are unparalleled for that particular couple.Contraindications:Severe DepressionActive psychopathologySubstance abuseIIInessHostility in couple-interaction

Physiotherapy

Mr. V Ravichandran, Physiotherapist
Variation of Treatments in PhysiotherapyManual TherapyIt is a clinical approach utilizing skilled, specific hands-on techniques which helps to reduce soft tissue inflammation and increases range of motion (ROM).Other Benefit:-Manipulation/mobilization to diagnose and treat soft tissues/joint structures for the purpose of modulating pain.Reducing or eliminating soft tissue inflammationInducing relaxationImproving contractile and non-contractile tissue repair, extensibility and/or stability.Facilitating movement and improvement functionUltrasoundIt is a method of stimulating the tissue beneath the skin’s surface using very high frequency sound waves.Primary Benefit:-Speeds up the healing process from the increase in blood flow in the treated area.Decrease in pain from the reduction of inflammation and oedema.Provides a gentle massage of muscles, tendons and/or ligaments in the treated area as there is no strainadded and any scar tissue is softened.Interferential (IFT)IFT is one of various types of physical therapy equipment. It uses a mid-frequency signal to treat muscular spasms and strains. The current produces a massaging effect over the affected area at periodic intervals and this therefore stimulates the secretion of endorphins, which is the body’s natural pain relievers. This will relax strained muscles and promotes soft tissue healing. IFT is used in 4 clinical applications to:Relieve painStimulate musclesIncrease local blood flowIce Stone Therapy (Cryotherapy)Cryotherapy is the local or general use of low temperatures in medical therapy. When cryotherapy is applied to the affected area, it will decrease the cells’ metabolism activity and decrease the permeability of tissues surrounding the wounded area so as to minimise any tissue debris that may enter the affected area. This therefore will then increase cell survivability, decrease pain and spasm and promote vasoconstriction. The result of it is a decrease in inflammation.Mechanical TractionIt is a term that describes the relief of pressure on one or many spinal discs and pinched nerves (neural impingement) of the spinal column. Spinal traction (cervical/lumbar) can be achieved non-surgically and is used to treat conditions that results in chronic back pain such as disc bulge, slipped disc, sciatica, degenerative spondylolisthesis and many more. Spinal traction is achieved through the use of a mechanical traction device, which reduces the body’s natural propensity to resist external force and/or generate muscle spasm. The results of spinal traction include pain relief, proper spinal alignment, and decompressed joints. Spinal traction stretches the muscles and bones in the back to combat the effects of gravity.Aqua JoggingAqua jogging is a good exercise method for elderly people and overweight people because of its low impact to the muscles and it helps to burn more calories due to the water resistance. This combination avoids muscle soreness, stress fractures and aching joints. To start aqua jogging, an individual need only swimming wear and an aqua jogging belt. The  aqua belt helps with maintaining the proper upright position and support the individual in the water. The purpose of aqua belt is to balance ourself in the water.TapingTaping is good, as it still allows for the range of motion, not much as it may inure the individual again. It provides a continuous amount of stabilization to the affected area and gives muscles/ligaments a chance to rebuild and restore by taking the pressure off those areas that have been worked manually. Taping can also be used to help with alignment. If an individual has an area of the body that is not properly aligned, taping can bring the body back into alignment. Having the correct alignment can decrease pain and help the joints recover efficiently.

Exercise to Stimulate

Dr. Neeraj Gupta, Homeopath
Physical activity is a natural part of human life. But as we grow up our inclination and capacity to do exercises becomes less. This is because of our jobs, readily available transport and home based leisure such as watching television. Thus, it becomes necessary for an individual to have planned exercises. If he does not do so the body deteriorates and the bad effects of sedentary life e.g. high blood pressure, increase in cholesterol, start piling up. A human being needs to exercise to feel better and feel fit. Being fit relieves you of your tension and stress, thus improves your mental health too.Fitness and exercises help our lungs, heart and muscle work more efficiently and does not make them bigger in size. A fit muscle is capable of more work. Physically fit people can transfer large amounts of oxygen from the blood to the muscles, allowing the muscles to work longer.The heart pumps blood all over the body. The amount of blood reaching, for e.g. to the legs depends on how frequently heart beats and also on how much blood it pumps out at each beat. Thus exercise makes the heart muscle more elastic, so that at each beat it contracts more efficiently forcing out more blood. Thus fewer beats are needed to supply the required oxygen-bearing blood to the legs.CHOOSING YOUR EXERCISE. The best is to find a form of exercise that you like to do and can do easily. When you are ready for exercise routines, start slowly and never push yourself to a point where you feel uncomfortable. You should be able to carry out a conversation with someone exercising with you or next to you.The different types of exercises that you can do are:WalkingFast walkingCyclingSwimmingJoggingBadmintonTennisAerobicsHOW TO START?Some body who has never exercised in his life show rather begin slowly. You should not exercise for longer. You should feel comfortable even if it is only for 5 minutes. Then when you start tolerating go on increasing the time steadily. Try to have atleast 2 to 3 sessions a week.Do not take violent exercise (like a game of squash) only occasionally. Getting into an exercise pattern with short, regular sessions is far more effective than trying to achieve instant fitness in short bursts. BENEFITS OF EXERCISES: Along with diet, exercises can reduce your weight. Thus this one of the main reasons for obese and over weight people to take on exercise. Running a kilometer burns off no more than the calories found in small piece of cake. But in the long-term, exercise increases the rate at which the body breaks down foods, so less of your intake is stored as fat reserves. Exercises helps to lower the levels of cholesterol in your body, which is responsible for major cardiac problems. Some smokers feel exercises help them to stop smoking. Exercises regularly help to maintain good mental health by relieved stress and tension. DO'S AND DON’TS Do consult your doctor if you suffer from high blood pressure, black outs, dizziness, heart disorders, diabetes, back pain or arthritis.Do not exercise for more that 20 minutes at a time at first.Gradually build up your session.Don't exercise when you are tired, or feverish or sick.Do stop and take rest if you become breathless or there is pain. Do warming up exercise like stretching before starting any strenuous exercises.Do not enter competitive sport if you suffer from stress or tension.At least wait for 2 to 3 hours before exercising after a meal.Wear loose comfortable clothes during exercises.Buy good shoes for exercising. 

Occupational Therapy Is Essential for Stroke rehabilitation

Dr. Chaitanya Ulhas Mantri, Occupational Therapist
“Paralysis is defined as complete loss of strength in an affected limb or muscle group.”The chain of nerve cells that runs from the brain through the spinal cord outdo the muscle is called the motor pathway. Normal muscle function requires intact connections all along this motor pathway. Damage at any point reduces the brain's ability to control the muscle's movements. This reduced efficiency causes weakness, also called paresis. Complete loss of communication prevents any willed movement at all. This lack of control is called paralysis. Certain inherited abnormalities in muscle cause periodic paralysis, in which the weakness comes and goes.The line between weakness and paralysis is not absolute. A condition causing weakness may progress to paralysis. On the other hand, strength may be restored to a paralysed limb. Nerve regeneration or regrowth is one way in which strength can return to a paralysed muscle. Paralysis almost always causes a change in muscle tone. Paralysed muscle may be flaccid, flabby, and without appreciable tone, or it may be spastic, tight, and with abnormally high tone that increases when the muscle is moved.Paralysis may affect an individual muscle, but it usually affects an entire body region. The distribution of weakness is an important clue to the location of the nerve damage that is causing the paralysis. The types of paralysis are classified by region:Monoplegia, affecting only one limbDiplegia, affecting the same body region on both sides of the body (both arms, for example, or both sides of the face)Hemiplegia, affecting one side of the bodyParaplegia, affecting both legs and the trunkQuadriplegia, affecting all four limbs and the trunk.The nerve damage that causes paralysis may be in the brain or spinal cord (the central nervous system) or it may be in the nerves outside the spinal cord (the peripheral nervous system). The most common causes of damage to the brain are:StrokeTumorTrauma (caused by a fall or a blow)Multiple sclerosis (a disease of that destroys the protective sheath that covers nerve cells)Cerebral palsy (a condition caused by a defect or injury to the brain that occurs at or shortly after birth)Metabolic disorder (a disorder that interferes with the body's ability to maintain itself).Damage to the spinal cord or peripheral nerves is most often caused by trauma, such as a fall or a car crash.INTRODUCTION TO STROKEImagine yourself in a marketing place and you suddenly collapse on the ground and are unconscious. It can be a STROKE!To be classified as stroke, focal neurological deficits should persist for at least 24 hours.Stroke is a disease that affects the blood vessels that supply blood to the brain. It occurs when a blood vessel that brings oxygen and nutrients to the brain either bursts or is clogged by a blood clot or some other mass. The former is called as the hemorrhagic stroke and the later an ischemic stroke.When the rupture or blockage of the blood vessel takes place, there is no enough blood supply and hence, no enough nutrients and oxygen to that part of brain. This damages the nerve cells and may lead to their (cells) death.As a result, that part of the brain is damaged which results in improper functioning of those body parts which are under the control of damaged brain area.The term cerebrovascular accident (CVA) is also used to refer to the cerebrovascular conditions that accompany either ischemic or hemorrhagic lesions.Stroke may be classified by the etiological categories, management categories and anatomical categoriesRisk of STROKE:Age (over age 65)Brain tumorCoagulopathy (blood clotting disorder)DiabetesHigh cholesterol levelHypertensionHeart diseaseInfection (e.g., meningitis, endocarditis)SmokingWarning signs of STROKE?Sudden severe headache with no known causeSudden difficulty seeing in one or both eyes (particularly in one eye)Sudden problems with walking, dizziness, loss of balance or coordinationSudden weakness or numbness of the face, arm, or leg on one side of the bodyDifficulty in swallowingCare and Rehabilitation Stroke rehabilitation is the process by which patients with disabling strokes undergo Occupational Therapy/ Physical Rehabilitation to help them return to normal life as much as possible by regaining and relearning the skills of everyday living. It also aims to help the survivor understand and adapt to difficulties, prevent secondary complications and educate family members to play a supporting role.Stroke rehabilitation should be started as immediately as possible and can last anywhere from a few days to over a year. Most return of function is seen in the first few days and weeks, patients have been known to continue to improve for years, regaining and strengthening abilities like writing, walking, running, and talking. Daily rehabilitation exercises should continue to be part of the stroke patient's routine.Hand TrainingGait Training

Shockwave Therapy – a New Therapy Approach for Physiotherapy

Dr. Rakesh Kumar, Physiotherapist
Musculoskeletal disorders originating from muscles and tendons affects majority of general population. It impairs mobility, causes pain and reduces overall well being. Efforts are made constantly to treat these disorders. But often shows limited success due to wide range of competing technology options available and lack of time from the patient’s part. Shock wave application represents a new therapy approach. Clinical experience has shown that a wide range of functional disorders can be treated effectively with shock wave therapy.Musculoskeletal disorders like epicondylitis, tendinopathies, sciatica, dorsalgia, tensorfascia lata syndrome etc are very detrimental and are caused due to mechanical over-strain, trauma, poor posture, emotional stress or due to some muscular disorder. These disorders leads to physiological changes deep down in the tissues. There is an increase calcium release leading to permanent contracture of actin/myosin filaments and an increase in energy consumption. There is further capillary compression and leads to local ischemia. This causes a local energy crisis. Local ischemia causes bradykinin release, sensitizing the muscle nocioceptors and increase tenderness. Ischemia also causes motor end plate dysfunction and a vicious cycle is produced. During Shockwave therapy, a high-intensity sound wave interacts with the tissues of the body. This leads to a flow of beneficial effects such as neovascularisation in growth, reversal of chronic inflammation, stimulation of collagen and dissolution of calcium build-up. Stimulation of these biological mechanisms creates an optimal healing environment. As the injured area is returned to normal, functionality is restored and pain is relieved. Conventional physiotherapy treatment of these Musculoskeletal disorder includes myofascial massage, electrical stimulation, ultrasound etc with some degree of success rate. Shockwave therapy on other hand is enormously effective, shortens the treatment period and brings better results in long time follow-up. PHYSIOLOGICAL EFFECTS Shock wave travels through a medium and comes to an interface, part of the wave is reflected and part transmitted. The dissipation of the energy at the interface results in generation of the physical, physiological and thus the therapeutic effects. The following are established treatment effects of shockwave therapy:Shock wave create microrupters in tendon which stimulate the growth and remodelling of new arterioles and an increased blood supply. This results better oxygenation leading to faster healing of tendon.Shock waves force collagen fibres in to a longitudinal structure.These newly formed tendon fibres are more dense and stiff.Due to micro trauma to a tendon there is calcification formation. Shock wave therapy starts the biochemical de-calcification.There is an increase in cellular activity. There is release of substance P, prostaglandin E2, NO, TGF β, VEGF, and other inflammatory cytokines.There is transient analgesic effect on afferent nerves. APPLICATIONS FOR SHOCKWAVE THERAPYShock wave applications in physiotherapy is mostly associated with the treatment of chronic muscular and tendon disorders. Most common indications include:Painful shoulder Epicondylitis Low back pain Achilles tendon pain Patellar tendonitis Trigger points treatmentPeriarthritis shoulder Calcar calcanei/heel spur Arthrotic changes - secondary symptoms Achillodynia Lateral & ulnar epicondylitis Muscular strainProlonged joint distortion treatment Groin pain Hip pain Low-back pain CONTRAINDICATIONS AND PRECAUTIONSThere are several areas or pathologies where concern has been expressed with regard to the use of shockwave. This list is compiled from current available evidence and clinical experience:Patients who are haemophiliac or who are on anticoagulant therapy are best not treated with shockwave.Malignancy remains on the contraindication list•Infection in the local area should be treated with strong caution.It is advisable to avoid epiphyseal regionsDuring shock wave therapy, it is crucial that pulmonary tissue is not within the target area of shock waves.Relative contraindications include pregnancy.CASE STUDYA 38-year-old female, right hand dominant, house wife suffered from right elbow pain since nine months. The pain, worsened in the previous two weeks and was characterized as stiff, achy, and sometimes throbbing. On VAS scale she rated 9/10 on the very first day of assessment. The patient was no longer able to do daily activities at home and was unable to sleep at night. Initially she was treated with anti inflammatory and analgesics for 2 weeks.Thereafter she was treated with corticosteroid injection 3 times with no clinical improvement in pain. She was then treated with advance PRP injections which availed no relief but only aggravated the symptoms. The pain was noted to be at its worst in the morning, and was aggravated by extending the wrist to brush her teeth, open doors, and while washing clothes No numbness, tingling or weakness was noted in the hand. The patient denied previous trauma to her right elbow, but did recall a similar pain in his left elbow a few years earlier that resolved on its own with rest. Upon inspection, lateral epicondyle and common extensor origin appear to be inflamed when compared to the opposite side. All active ranges of motion of the elbow joints were full, while flexion and extension in the right wrist were limited due to pain. Passive range of motion, was also limited by patient discomfort particularly at the end range of right wrist flexion, and was able to reproduce the patient’s chief complaint at the right elbow. Resisted wrist extension and grip strength were very painful and the patient declined to provide much effort as this reproduced a sharp pain at the lateral epicondyle. Orthopedically, Cozen’s test (resisted wrist flexion from a flexed elbow and pro-nated/extended wrist position) was positive. Mill’s test, (passive extension of the elbow from a flexed elbow, pro-nated forearm and flexed wrist/finger position) was in- conclusive in that it was uncomfortable but did not produce pain at the lateral epicondyle. The patient was diagnosed with lateral epicondylosis. she was treated six times over two weeks with shockwave. In addition to the soft tissue treatment, a rehabilitation program was performed, which was followed by 20 minutes of interferential current and 10 minutes of ice. After the first treatment the patient reported to feel 80% better, and at the time of discharge there was complete resolution of her symptoms (VAS 0/10 with no pain provocation on examination).Hence shockwave treatment is a good non-invasive and result oriented treatment modality. For details visit www.perfectophysios.com

Ayurvedic Leech Therapy

Dr. Phanindra V V, Ayurveda
Leeches are used in the medical practice since ancient times to treat many diseases. It is a method in which localized impure blood is let out to heal the tissue. Leech therapy is Para-surgical treatment modality according to Ayurveda. Due to its therapeutic effects, this is successful even today. The description of using leech for therapy can be found in Sushruta Samhita written by Acharya Sushruta. He has described the nature of leeches, their habitat, the method of application, diseases indicated like Visarpa (Herpes), Skin diseases etc., in detail. Though there are hundreds leech species, only 15 are used for therapy. In the medieval ages, this was very popular. According to Ayurveda, Leech only sucks impure blood. Leech is used to relieve venous congestion and to improve blood circulation.Indications: Skin diseases, Vascular Problems, Varicose Veins, Acne, Non-healing Ulcers, Diabetic wounds, Boils and abscess, Herpes, Thrombosis, Arthritis, Sciatica, Dermatitis, Psoriasis, Alopecia, etc..Steps for application of LeechSnehana and swedana to the patient.Leech activation.Patient’s skin is cleaned.The leeches are applied.Cover the leech with wet cotton.Remove the leech once it has finished sucking the blood.Remove the blood from leech by inducing vomiting to the leech and then put back in fresh water container.The area should be cleaned and bandaged.Mode of Action: Leech have many distinct enzymes in its saliva, through which they act. The enzymes enter the blood through the place the leech sucks the blood. The most important is the Hirudin, which acts as an anti-coagulant. This leech enzymes also has the ability to stay in the blood and do vasodilation and further facilitate the blood supply to the surrounding tissue and prevent necrosis and healing. Some anti allergic factors ensure reduction in the lesions.