Articles on therapy

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

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.

5 Priceless Benefits of Salt Therapy for All Your Respiratory Troubles!

Mrs. Anju Chandna, Yoga and Naturopathy
Salt therapy is fast catching everyone’s attention. A therapy that was born within the confines of natural salt caves in the Eastern European countries like Poland and Romania around 150 years ago is now on its way to become one of the most revolutionary treatments of all time for all respiratory allergies like Asthma, Bronchitis,Sinusitis, Allergic cough, Dry cough, COPD and many others. A lot can be attributed to the fact that the treatment is natural.So let me give you a 5 point count as to what makes this therapy different from the conventional methods of treatment that we’ve known all these years. Salt therapy is a 100% natural treatment. The main ingredient that does all the trick is salt. The salt room has around 3-4 tons of salt on the walls, the ceiling, the floor and the aerosol that you inhale while sitting inside this artificial salt cave is also pharma-grade salt. Old age wisdom says that consuming too much salt is not good for our body but what needs to be understood is that this salt does not enter your digestive tract. So any side effect could arise of consuming salt directly is absent here. This salt aerosol enters only the respiratory tract through the nasal passage and goes directly into your lungs. It cleanses the mucous along its way and reaches the smallest bronchioles of the lungs. All naturally with no medicines.Salt therapy is absolutely safe for infants, the elderly and pregnant women. Since there is no medicine involved in the treatment, everyone from a 6 month old baby to an 80 year old adult can take the therapy without bothering about any negative fallout. Even pregnant women who are otherwise not advised medication can take this therapy and get relief from any allergy arising during their pregnancy. Salt therapy has no side effects. There is nothing entering your digestive tract that can possibly cause any side effect. Salt enters the lungs, reacts with the mucous present there and comes out of the body along with that mucous.  Presence of tons of salt in the salt room makes the environment absolutely clean and no allergens can find their way into it. People with respiratory disorders need such a clean atmosphere so that a one hour salt room session helps to cleanse their system and not irritate it. That is the reason why people with very chronic allergic cough can also endure the salt spray and benefit from it.Salt therapy offers long term relief. The basic function of salt therapy is to cleanse your lungs. So once your treatment is complete and your lungs get cleansed, the chances that they will remain that way are very high. But here we cannot ignore the fact that we are living in one of the most polluted regions of the world and you are constant being exposed to allergens. One might need maintenance sessions once every 3 months to keep your lungs clean and healthy.  Salt therapy de-stresses and calms the mind. Salt is inherently negatively ionized. Nature has made it this way.Negative ions are considered to be ‘cleansers of the air’ and salt has the property of negative ionization. Negative ionization of the air relieves stress, so spending an hour inside the salt room not just cleanses your lungs but also relieves your mind of stress. De-stressing the mind is considered to be an important step towards treating any kind of respiratory problem.So what are you waiting for? Come to the salt room and soak in the benefits of this miracle mineral!

Occupational Therapy a Solution for Osteoarthritis

Dr. Chaitanya Ulhas Mantri, Occupational Therapist
First, let us understand what is Osteoarthritis ...    OA is a degenerative disease of joints that affects all of the weight-bearing components of the joint:Articular CartilageMenisciBoneAbout OSTEOARTHRITIS [OA]:Most common joint disease Most common form of arthritis Most OA patients > age 45  Women> menMost often appears at the ends of the fingers, thumbs, neck, lower back, knees, and hips.Joints affected by Osteoarthritis[OA]OA-RiskFactors:Age:Strongest risk factorOA can start in young adulthood but risk increases with ageGender:Affects more in women than menMore common in men before age 45, women after age 45OA of the hand particularly common in womenJoint injury/Overuse from physical labor or sports:Trauma to any joint increases risk of OA Ligament or meniscus tearsRepeated movements in certain jobs increase risk Obesity:Joint overload is among strongest risks for knee OAObesity a risk to Knee OAOA–Symptoms:Gradual onset PainStiffnessSwelling or tenderness in one or more joints Crunching feeling or sound of bone rubbing on bone (called crepitus) when the joint is usedRadiographic Diagnosis:Asymmetrical joint space narrowing from loss of articular cartilageHow to Manage OA ???Goals in Managing OA :Decreasing painIncrease range of motionIncrease Muscle strengthOccupational therapy for Osteoarthritis: It would involvePain management through use of Physical Agent Modalities, Exercises to improve and maintain Range of Motion of the jointExercises to Strengthen Muscles of the jointUse of Energy Conservative and Work Simplification Techniques to help in doing the activity with easeUse of Joint Protection Technique while using the jointErgonomic Modification in Work & Home environment

Shirodhara- Best Therapy for Mental Stress

Dr. Pritam Raj, Ayurveda
Shirodhara a snehan treatment in Ayurveda is basically one of the most relaxing, healing and rejuvenating therapy in today's world. The roots of this treatment stems out from the 6000 year old Indian science of Ayurveda.Its a gentle pouring of a stream of warm medicated oil on your forehead specifically on the third eye or the Ajna chakra located between the brows.Shirodhara has an ability to cure multiple neurological disorders like Alzheimer, Parkinson, multiple sclerosis, dementia, paralysis,etc. It's the only complete therapy for brain, some of benefits are:It nourishes the brain cells called neurons by increasing the blood circulation. Strengthens the nerves originating from the brain. Increases the secretions of neurotransmitters like dopamine,Influences the master glands improves its secretionsIncreases the production of serotonin and endorphin's, which eventually improves the quality of sleep, and creates a condition of heightened consciousness which is attributed to the fact that the treatments unblocks the chakra and creates an increased flow of prana the vital energy towards the brain.Hence, we can say that it's an energizing treatment.It's an excellent form of therapy for people suffering from insomnia, migraine, Trigeminal neuralgia, etc. Even if you are not suffering from any disorders it is always advisable to take Shirodhara once in a month, to nourish the scalp, improve the thought process, gain mental clarity, de-stress, as a preventive treatment for hair loss, baldness, neurological disorders, keeping our concentration and memory in better condition,It's a therapy recommended highly for the stressed out people, and you need to undergo this treatment to experience the benefits. I am talking about one of the most amazing the therapeutic experiences.It wont be wrong to say that its one of the gift to the mankind from Ayurveda.Avail Shirodhara in its authentic form only at nirvana spa' n' wellness center running at GK-1,GK-2 & GREEN PARK

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.

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

Microneedling (Collagen Induction Therapy)

Dr. Dhwani Shah (Vakta), Dermatologist
Derma Roller  (Micro needling)[For Treatment of Acne scars, Wrinkles, Fine Lines, Hair Loss and Facial Rejuvenation]1. What is Derma Roller (Microneedling)?Dermaroller therapy or collagen induction therapy (CIT) is a relatively new concept that helps to significantly stimulate collagen to reduce the appearance of acne scarring and wrinkles.The principle of skin needling is to stimulate the body’s own production of collagen. It involves using a sterile roller comprised of a series of fine, sharp needles to puncture the skin. Performed under local anaesthetic, the device is "rolled" over the surface of the face to create many microscopic channels deep into the dermis of the skin, which stimulate your own body to produce new collagen.2. What does procedure involve?The skin is thoroughly  cleaned and numbing cream may be applied to lessen discomfort. For better results we use a collagen-stimulating product like Hyaluronic Acid, Vitamin-C serum or skin lightener for pigmentation during the procedure. A small handheld pen like device with a sterile, tiny micro needles is rolled over to pierce skin, which opens micro channels and stimulate collagen induction.  After the treatment, soothing Vitamin-C serum or Hyaluronic acid are used to hydrate, heal and protect the skin.3. What effects does the Medical Micro-Needling have on the skin?Improves skin texture and reduces the appearance of WrinklesStimulates tissue regenerationDisfiguring Scars, especially acne scars can be improved as new collagen fibres elevate the depressed scar tissue with the periphery skinPore size reductionImproves the appearance of Stretch marksIt releases growth factors, which helps in follicular regeneration in scalp in patients with Hair loss problems4. Is this procedure is painful?Prior to the treatment, numbing cream can be applied to minimize pain that is felt during the procedure.5. Risk of any post op infections?Since the tiny pricking channels close within one hour, and provided the procedure is done under clinical conditions, post-op infections are extremely unlikely.6. What should I avoid on my skin after treatment?To ensure the right healing environment, for 2-3 days do not use AHA’s (glycolic Acid), retinol, acidic or “active” ingredients. Exposure to sun should also be avoided or zinc based sunblock should be used.7. What are the side effects of Medical Microneedling/Derma Roller procedure?There are virtually no negative side effects, and none have ever been reported in over 150,000 procedures performed worldwide.8. How many treatments do I need and how often can Medical Micro Micro-Needling procedures be repeated?Micro-needling can be safely repeated every 4-6 weeks until you achieve the desired results.For scar reduction an average of 3 to 6 treatments are recommended. The number of treatments required will depend on how each individual responds to the treatments.Most people will begin to see results after the very first appointment.For Hair Loss problems, once a week treatment for 12 weeks is recommended, followed by maintenance session once in a month.9. Advantages of this procedure:Minimal riskCost effectiveShort healing period within daysNo permanent injuryNo sun- sensitivity after treatmentOut patient treatment with topical anaesthesia (cream) [total duration 2 hours, Numbing time is usually 45 mins and procedure takes 30-45 mins]

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