Articles on physiotherapy

Physiotherapy Can Do Miracles

Dr. Rajiv Mehta, Physiotherapist
Managing pain through alternative medication is in demand. The wear and tear in human bodies require specialized treatment.  However, how the cure has been devised will matter a lot. How would the procedure provide all-inclusive benefit? How time will be managed within the prescribed plan in treating through physiotherapy. These details are only effective reflected by a professional therapist having the expertise to make systematic cure plan for the individual.Professional therapists offer privilege to people looking for alternative medication.  The specialty service is especially designed in the treatment of a range of different problems that can negatively impact the human body. Physiotherapy utilizes a range of different therapeutic exercises for different physical dysfunctions. The expert will develop a practical cure mechanism for different conditions that can restore the body function. The imminent aspiration is to improve the quality of life. In addition the scope of treating different types of injuries offers a renewed hope in restoring the function. Sports injuries will be treated through a dedicated cure mechanism; similarly managing pain will be defined within a dedicated framework that can force the healing process.The rehabilitation needs of older people along with the specific needs of special children are also entertained by the service provider in its entirety. Assessment is the initial effort that identifies the problem. Then only a dedicated cure can be established. A particular remedy may undertake different situations that can offer customized benefit to the individual. Physiotherapy undertakes every variable that can influence the extent of the cure. This facilitation will be provided by the expert therapists having considerable knowledge of treating every condition with intent and rationality. The therapist would closely screen out all the aspects before proposing the most suitable procedure that can generate maximum benefit.

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.

Role of Physiotherapy in Women’s Health

Dr. Richa Patil, Physiotherapist
​Women today are more competent and independent as compared to those of the previous era. They have redefined gender roles, claimed more authority and freedom for themselves and proved their potential to the fullest. However, in the process of fighting for equality and carving a niche for themselves, it’s usually their health that gets neglected. Here are a few benefits of physiotherapy for some of the top health issues faced by women. Women by nature are caregivers and there are numerous occasions when they tend to neglect their health in order to help a loved one. This neglect can cause a number of health complications as they grow older. Preventive healthcare is much better than taking medications after being diagnosed with a health condition. There are a number of therapy options available like Allopathy, Ayurveda and others. Physiotherapy is one such branch of medicine that can help you prevent a number of health issues when followed diligently.A simple assessment and structured exercise program by a physiotherapist is often sufficient to prevent these health issues in women across the life span, from the young athlete to the child bearing woman to the menopausal to the elderly.Women’s Health Physiotherapy refers to the non-surgical therapeutic treatment specific to various health problems affecting women. During the course of therapy, specially designed exercises and equipment are used to help patients restore their normal physical activities.Here are a few benefits of physiotherapy for some of the top health issues faced by women.Premenstrual syndrome: A physiotherapist assesses the physical effect PMS has on your body as well as the risk factors that can influence and worsen them, before offering a range of management options and advice. Treatment may include manual therapy to relieve tension as well as related discomfort such as headaches and constipation, relaxation point stimulation, kinesiotaping or electrotherapy. An important part of the treatment is teaching relaxation techniques and advice on self-management and self-care.Endometriosis: Physical therapy modalities may prove to be a fundamental treatment option for the patient with endometriosis, pre and post laparoscopic surgery, especially if they experience musculoskeletal impairments. Effective physical therapy treatment options include: myofascial manual therapy, pelvic floor muscle lengthening, trigger point release, stretching and flexibility exercises, spinal mobilizations, nerve glides, relaxation exercises and behavioral modifications.Polycystic ovary syndrome: Physiotherapists can provide a customized exercise program which would help in losing the weight gained due to the storage of estrogen in adipose tissue, lower insulin levels, and dietary changes to reduce consumption of carbohydrates.Heart diseases: Physical therapy can help to prevent the onset of heart disease, and reduce the negative consequences of heart disease by implementing a treatment program that addresses all the contributing factors of this disease. This may include advice on smoking cessation, an exercise program for weight management and improving cholesterol levels. There are cardiac rehabilitation programs for patients who have had a heart attack or severe heart disease.Osteoporosis: Post-menopausal women are at greater risk of developing osteoporosis. Physical therapy can help to prevent further bone loss and reduce the risk of bone fractures. Strengthening exercises for your bones is of high importance in maintaining the health of osteoporotic bones. Exercise programs also include weight bearing exercises, flexibility exercises, postural and balance exercises.Obesity: Physiotherapy has a role to play in the prevention and management of obesity.Obesity leads to restrictions in movement, affecting engagement in physical activity. Exercise and movement is the keystone of the scope of physiotherapy practice. A treatment plan for an obese patient may comprise of a provision of personalized lifestyle advice, prescription, supervision, and progression of appropriate physical activity to increase muscle strength, flexibility, and endurance, to sustain energy output to enhance and maintain weight loss under safe and controlled conditions.Depression: Exercise has been known to benefit patients with mild to moderate mood disorders, especially anxiety and depression. When performing aerobic exercises your body releases endorphins which are responsible for relieving pain and improving mood. These endorphins can also lower cortisol levels known to be elevated in patients with depression. Additionally, exercise increases the sensitivity of serotonin in the same way antidepressants work, allowing for more serotonin to remain in the nerve synapse. Exercise can be aerobic or resistive in nature, as both are known to be beneficial in a variety of patient types.Urinary Incontinence - Urinary incontinence, also referred to as overactive bladder, is the inability to control the flow of urine. Leakage of urine occurs due to weakness of the pelvic floor muscles as a result of injury, pregnancy, surgery or lack of exercise. Physiotherapy session includes: Diet modifications to avoid bladder irritation, Pelvic floor exercises to strengthen your pelvic floor, Methods to reduce the urinary urgency and frequency.Pregnancy related conditions - Pain in the lower back, pelvic region, rib and thoracic region, headache, neck pain and stiffness, muscle weakness of the pelvic floor, leg cramps, weakened abdominal muscles and bladder, pain or numbness in the wrist and hand, all can also be treated with physical therapy.At times, the only thing you need is the right assessment to prevent the onset of any kind of health issues.Your assessment and treatment often depend on your present condition. Whilst these sensitive issues are often difficult to discuss, understanding the onset of your symptoms and how your daily life is affected is vital in directing your treatment.

Managing Neck and Back Pain Through Physiotherapy

Dr. Biju Nirmal Jacob, Physiotherapist
One of the commonest cause of people consulting a physician is neck or back pain. Many of them try to live with the pain until it stops them from working. The common cause of neck and back pain is poor posture, muscle imbalance, repeated tasks involving the area or localized degenerative changes in the vertebrae. This causes reduced range of motion of the part, reduced strength and increased pain. POOR POSTURE: Forward headed posture or exaggerated lumbar lordosis can cause increased pressure on the surrounding structures of the vertebra this ultimately lead to segmental instability of the spine. In order to keep the part intact the muscles and other structures will adjust themselves, this will happen in a course of time. Whenever the person uses the part for a prolonged period or activity his pain and other symptoms will increase. MUSCLE IMBALANCE : If you closely examine yourself your posture you may observe that your shoulders are round, your head is forward protruding, abdomen is week, if you stand with both the leg together and eyes closed you may feel like you are swinging and loosing the balance. These features are pointing towards your muscle weakness. Major muscle that may get weakened are neck flexor muscles, inter scapular muscles, abdomen and buttock muscles. Major muscles that may get tightened are neck extensors, chest muscles, lower back muscles and hip flexors. Proper training of these muscles will help in reduction of neck and back discomfort. PHYSIOTHERAPY MANAGEMENT EVALUATION: A thorough evaluation of the patient is required before stating the physiotherapy treatment, which include a detailed history of the patient, explanations regarding the site of pain, onset, previous history, lifestyle of the patient, sleep, nature of pain, assessment of strength, range of motion, swelling, warmth, functional performances, clinical investigations like X-ray, MRI, Lab report to wipeout red flags. EXPLANATION TO THE PATIENT: Once the assessment is over the therapist will explain the treatment method to the patient, about the condition, the procedures, precautions, duration of session, total number of sessions etc. Once the patient is convinced the therapist will start the treatment after signing an informed consent. TREATMENT: After marking the location of pain initial the treatment is given to the soft tissues around that area using techniques like deep pressure soft tissue massage to reduce muscle tightness, trigger point release therapy followed by myofascial release. Once the pain is reduced we may follow muscle energy techniques to release muscle tightness and to take the muscle to a new length. Once the muscle pain is reduced we will mobilize the corresponding joints to correct the joint dysfuntions this will help in proper working of the joint in correct muscle length. We teach patients self stretching exercises and progressive strengthening exercises so that they can maintain the length and strength of the structures. We may tape the part using either dynamic stretch taping (kinesiology) or static non-stretch taping (zinc oxide), which will help in holding the structure in good length and position. We also use pain releasing modalities ultrasound therapy, interferential therapy, TENS & moist heat etc. to reduce the pain and increase the localized circulation. We also advise patients to do heat fermentation to reduce the tenderness. Once the pain and discomforts are reduced we put patients on further stretching and strength training program like self myofascial release techniques, stretch band and weight cuff exercises with increasing the resistance. Upon secondary evaluations we may also perform nerve mobilizations and other articular mobilizations to relieve other discomforts. We also start postural awareness training programs and core stabilization exercises to strengthen the weak muscles. Aerobic training programs like treadmill walking, static cycling, virtual reality based games are also included in the final stage to improve the overall fitness of the patients. This helps in prevention of recurrence of pain and other discomforts. We suggests our patients to visit us once a month for the next 3 months to make sure that they are following the exercises and also to modify the exercises if required. Thus a tailor-made treatment physiotherapy program will help in the management of neck & back pain than a conventional treatment methods. This includes a team work of many people including the patient itself. 

Physiotherapy Plus Ergonomics - for Total Wellness!

Dr. Aditi Kulkarni(P.T), Physiotherapist
Do you need an advice on injury prevention or other aspects of musculoskeletal or neurological conditions? Do you wish to improve your physical performance for sports? Are you planning to return to routine exercises following prolong period of inactivity or injury? Or planning to go out on adventure trip? The answer to improve your functional capacity or quality of life is physiotherapy under supervision of qualified physiotherapist.Physiotherapist & Ergonomist of “Be Active” clinic, Dr Aditi Kulkarni says “Physiotherapy has both curative and preventive disciplinary aspects”. As it is a drugless therapy it has become an integral part of healthcare industry and is becoming more & more popular among all age groups.In Be Active clinic physiotherapy, relaxation technique, tapping, electrotherapeutic modalities such as SWD, IFT, TENS, Wax Bath, EMS, Ultrasound and Traction machine along with lifestyle modification tips with the help of ergonomics are available under one roof.With the combination of above mentioned therapies one can hasten body’s natural healing processes by maximizing recovery & ensure optimal outcome on long-term basis, even in post operative rehabilitation and in chronic neurological conditions like Parkinson’s, Multiple Sclerosis, Paralysis, etc.Dr. Aditi also mentioned “ age or work related joint aches or dysfunctions, chest complications or sport injuries like pulled hamstrings, stress fractures, Osgood shatter disease/ runners knee, carpel tunnel syndrome, heel pain, ankle injuries or sprain” are some of the problems which can be cured completely with the help of physiotherapy and ergonomics.With the experience of practising in this field Dr. Aditi feels the real success of any treatment lies in healthy and happy atmosphere and cooperation between the therapist, patient and his family.

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.

Frozen Shoulder & Physiotherapy

Dr. Biju Nirmal Jacob, Physiotherapist
Frozen shoulder or adhesive capsulitis, a condition due to which it is difficult to comb your hair, difficult to put your dress on and pain if lying to the affected side. Usually it affects people between 40 - 60 years of age, ladies are more affected and it start with pain while doing activity or lifting heavy objects or a heaviness to shoulder.  This is commonly seen in patients with diabetes, after heart surgery or a history of previous shoulder injury.It is always better to take pain medication or muscle relaxants to reduce to severe pain.  you can apply heat fermentation at night to reduce discomforts.  Positioning of the hand is very important to reduce worsening of condition. Unique Physiotherapy Exercise for Frozen ShoulderPlease do this exercises twice daily, make sure to do a heat fermentation before and after the exercises. Manual Therapy for Frozen ShoulderMyofascial release to the rotator cuff muscles and trigger point release to subacapularis, infraspinatus and teres minor muscles helps to reduce pain and improve functions of shoulder. Shoulder joint mobilization with mulligan belt, maitland internal rotation mobilization helps to improve range of motion.To Reduce Pain due to Frozen ShoulderUltrasound therapy to the shoulder capsule helps in reducing adhesive tissues.TENS (Transcutaneous Electrical Nerve Stimulation) & IFT helps in reducing and and improving muscle strengthPositioning of hands to reduce worsening of the conditionsRange of Motion Exercises for Frozen ShoulderWand exercises, active assisted exercises, pully exercises are useful in improving ROM. Myofascial stretches of rotator cuff muscles and other muscles of shoulder girdle helps in improving the ROMStrengthening Exercises for Frozen Shoulder Exercise using exercise band, weight cuffs etc. helps in improving shoulder girdle strength. Home exercise program are also important to reduce pain and improve functionIt takes 3 weeks of physiotherapy sessions for proper improvement of frozen shoulder conditions.

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