Author: Arunalaya

Physiotherapy In DelhiArticles by: Arunalaya
Anatomy of the Nervous system
By Arunalaya Physio

Anatomy of the Nervous system

A nervous system can be defined as an organized group of cells called neurons which is
specialized for the conduction of an impulse – an excited state from a sensory receptor through
a nerve network to an effector, the site at which the response occur.
Functions of the nervous system
1) Sensory function – gathers information from both inside and outside of the body.
2) Transmit information to the processing areas of the brain and spine .
3) Process the information in the brain and the spine – integration function
4) Motor function – sends information to the muscles, glands, and organs so they can respond
appropriately.
The Nervous system is divided in to two divisions
1) Central nervous system
2) peripheral nervous system .
Peripheral nervous system is divided in to #somatic nervous system and autonomic nervous system.

A nervous system can be defined as an organized group of cells called neurons which is
specialized for the conduction of an impulse – an excited state from a sensory receptor through
a nerve network to an effector, the site at which the response occur.
Functions of the nervous system
1) Sensory function – gathers information from both inside and outside of the body.
2) Transmit information to the processing areas of the brain and spine .
3) Process the information in the brain and the spine – integration function
4) Motor function – sends information to the muscles, glands, and organs so they can respond
appropriately.
The Nervous system is divided in to two divisions
1) Central nervous system
2) peripheral nervous system .
Peripheral nervous system is divided in to #somatic nervous system and autonomic nervous system.

Autonomic nervous system has further sub divisions in to sympathetic nervous system and =parasympathetic nervous system.


FUNCTIONAL UNIT OF THE NERVOUS SYSTEM.
Neuron – unit of nervous system
Transmit impulses up to 250 mph.
PARTS OF A NEURON
1) Dendrite – receive stimulus and carry impulse toward the cell body.
2) Cell body – with nucleus and most of the cytoplasm.
3) Axon – fibres which carry impulses away from the cell body.
4) schwann cells- cells which produce myelin or fat layer in the peripheral nervous system
5) myelin sheath- dense lipid layer which insulates the axon.
6) Nodes of Ranvier – These are gaps in myelin sheath.
THREE TYPES OF NEURONS ARE THERE
1) Sensory neurons – beings information to CNS
2) Motor neurons – carry messages from CNS
3) Interneuron – between sensory and motor neurons in the CNS
IMPULSES
1) a stimulus is a change in the environment with sufficient strength to initiate a response.
2) Excitability is the ability of a neuron to respond to the stimulus and convert it into a nerve
impulse .
3) All of nothing rule – the stimulus is either strong enough to start and impulse or nothing
happens
4) Impulses are always the same length along a given neuron and they are self propagation .
Once it starts it continues to the end of the neuron in only one direction from Dendrite to cell
body to axon.
5) The nerve impulse causes a movement of ions across the cell membrane of the nerve cell.


● SYNAPSE – small gap or space between the axon of one neuron and the dendrite of another .
It is junction between neurons which uses neurotransmitter to start the impulse in the second
neuron or an effector. The synapse insures one way transmission of IMPULSES.
●Neurotransmitters – Chemicals in the junction which allow IMPULSES to be started in the
second neuron.
Components of REFLEX ARC
A) Receptor – reacts to stimulus
B) Afferent pathway – conducts impulses to CNS
C) Interneuron – consist of one or more synapses in the CNS
D) Efferent pathway – Conducts impulses from CNS to effector .
E) Effector – muscles fibers or glands responds by contracting or secreting a product.
Spinal reflexes – initiated and completed at the spinal cord level. Occur without the involvement
of higher brain centers.
●CENTRAL NERVOUS ZONE
1)Brain
Brain stem –
•medulla ,
•pons, midbrain
•Diencephalon – thalamus and hypothalamus
•Cerebellum , cerebrum
2) spine
•Spinal cord


MENINGES
Meninges are the three coverings around the brain and spine and help cushion, protect and
nourish the brain and spinal cord.
1) Duramater is the most outer layer
2) Archanoid mater is the middle layer and adheres to the duramater and has web like
attachments to the innermost layer, the pia mater.
3) pia mater is very thin , transparent but tough and covers the entire brain .
4) Cerebrospinal fluid which buffers, nourishes and detoxifies the brain and spinal cord , flows
through the subarachnoid space , between the arschanoid mater and the pia mater.


• Regions of the brain
1) Cerebellum – coordination of movement and aspects of motor learning
2) Cerebrum – conscious activity including perception, emotions,thought and planning
3) Thalamus – filters and then relay information to various brain regions
4) Medulla – vital reflexes as heartbeat and respiration
5) Brainstem – medulla, pons, midbrain and relays information from spine to upper brain.
6) Hypothalamus – involved in regulating activities of internal organs,monitoring information
from the autonomic nervous system, controlling the pituitary gland and its hormone , regulate
sleep and appetite.


• CEREBRUM – Its the largest portion of the brain encompasses about two third of the brain
mass. It consist of two hemispheres divided by a fissure called corpus callosum.
It includes
• the cerebral cortex ,
• the medullary body,and
• basal ganglia.
• cerebral cortex – it’s the layer of the brain called gray matter as it has cell bodies and
synapses but no myelin.
• Medullary body – is the white matter of the cerebrum and consist of mayelinated axons
• Basal ganglia- they are the gray matter in each hemisphere which are involved in the control of
voluntary muscle movement.


LOBES OF THE CEREBRUM –
1) frontal – motor area involved in movement and in coordinating behaviour.
2)parietal- sensory processing , attention, and language
3) temporal – Auditory perception, speech and complex visual perception .
4) Occipital – visual center – plays a role in processing visual information.
Special regions
1) BROCA’S Area – located in the frontal lobe, aids in speech
2) WERNICKE’S area – Comprehension of language
3) LIMBIC system – help regulates the expression of emotions and emotional memory.
BRAIN WAVES – are rhythmic fluctuation of electric potential between parts of the brain as seen
on EEG .
Electrodes are placed on to the scalp using the EEG .
There are 4 types of brain WAVES
• Beta
• Alpha
• Theta
• Delta
PERIPHERAL NERVOUS SYSTEM
• Cranial 12
• Spinal 31
• Somatic nervous system ( voluntary)
1) relays information from skin, sense organs and muscles to CNS
2) Brings responses back to skeletal muscles for responses.


• Autonomic nervous system ( involuntary)
1) regulates bodies involuntary responses
2) relays information to internal organs.
3) Two divisions
A) sympathetic nervous system in times of
Emergency response , fight or flight.
B) Parasympathetic nervous system – when body is at rest or with normal functions. Normal
everyday conditions.
Major sense organs.
Sensation and perception.
Vision – eye
Hearing – ear
Taste – taste receptors
Smell – olfactory system
Skin – hot, cold, pressure, pain
Sense organs
Eye- the organ used to sense light


Three layers –
Outer layer consists of sclera and cornea
Middle layer consist of choroid, ciliary body and iris
Inner layer consist of retina
Sclera – A tough protective layer of connective tissue that helps maintain the shape of the eye
and provides an attachment for the muscles that move the eye.
Cornea – the clear, dome shaped part of the sclera covering the front of the eye through which
light enters the eyes.
Anterior chamber – is a small chamber between the cornea and the pupil.
Choroid layer – middle layer of the eye containing many blood vessels
Optic nerve – the nerve that transmits electrical impulses from the retina to the brain.
Retina – sensory tissue that lines the back of the eye. It contains millions of photoreceptors that
convert light rays in to electrical impulses that are relayed to the brain via optic nerve.
Lens – a crystalline structure located just behind the iris . It focuses light on to the retina.
OUTER EAR & EAR CANAL – brings sounds into eardrum.
Eardrum – vibrates to amplify sound and separates inner and middle ear
Middle ear has 3 small bones anvil, stirrup, stapes ( amplify sounds ) which vibrates sound.
Eustachian tube – connects middle ear to throat and equalizes pressure on eardrum
Cochlea – has receptors for sound and send signal to brain via auditory nerve.


Taste and smell
Taste buds – the mouth contains around 10,000 taste buds, most of which are located on and
around the tiny bumps on your tongue . Every taste buds detect five primary tastes.
1) sour
2) sweet
3) bitter
4) Salty
5) umami – salts of certain acids
Each of your tastebud contain 50 -100 specialized receptors cells.
Sticking out of every single one of these receptors cells is a tiny taste hair that checks out the
food chemicals in your saliva. Each taste hair responds best to one of the basic tastes.


Smell receptors or olfactory receptors
1) humans are able to detect thousands of different smells
2) olfactory receptors occupy a stamp sized area in the roof of the nasal cavity, the hollow space
inside the nose.
3) tiny hairs are covered with mucus
4) olfactory hairs easily fatigued so you do not notice smell.
5) if a smell , formed by chemicals in the air , dissolves in the mucus , the hair absorbs it and
excite your olfactory receptors .
6) smell leave long lasting impressions and our strongly linked to your memories.


Skin receptors
Most of your touch receptors sit close to your skin’s surface.
Light touch – Meissner s corrupslces are enclosed in a capsule of connective tissue.
They react to light touch and are located in the skin of your palms, soles, lips, eyelids ,external
genitals and nipples. These areas are particularly sensitive.
Heavy pressure – paccinian corrupslces sense pressure and vibration changes deep in your skin .
Pain – skin receptors register pain, pain receptor are the most numerous
Temperature – skin receptors registers warmth and cold. Each square centimetre of your skin
contains 6 receptors for cold and one receptor for warmth. Thermoreceptors are found all over
the body , but cold receptors are found in greater density than heat receptors – most of the
the time of our environment is colder than our body temperatures. The highest concentration
of thermoreceptors can be found in the face and ears so your nose and ears always gets cold
faster than the rest of your body on a chilly winter day

Ankle Sprain Rehab
By Arunalaya blog

Ankle Sprain Rehab

A sprained ankle is an injury that occurs when you roll, twist or turn your ankle in an awkward
way. This stretches or tear the ligaments which surrounds our ankle joint. Ankle sprain are
usually of 2 types . Medial and lateral ankle sprain . When your ankle gets twisted in innversion
then lateral sprain occur which is more common. When your ankle gets twisted in everson then
medial sprain occurs.
Ligaments which gets torned or stretched in lateral ankle sprain are
A) the Anterior talofibular ligament
B) Calcaneofibular ligament
C) Posterior talofibular ligament
Ligaments which gets affected in medial sprain are
A) Deltoid
Sign and symptoms of a sprained ankle( depends upon the severity of the sprain )
1) pain and tenderness
2) warmth
3) swelling
4) Restricted ROM
5) instability in the ankle
6) limp during walking
7) inability to bear weight on affected side
MANAGEMENT
grade 1 and grade 2 ankle sprains are treated conservatively. Surgical intervention is required
for grade 3.
The first protocol for sprained ankle is PRICE which means prevention from further injury, Rest,
Icing, Compression, Elevation .
1) patient can perform ankle ROM active movements within painfree limits to improve local
circulation
2) Cold compress or cryotherapy is unbeatable .
3) Ultrasonic on sprained ankle to reduce tenderness and inflammation
Strengthening exercises of ankle joint are done ones pain subcides.
POST OP rehab of a sprained ankle.
1) ankle toe pumps
2) Ankle ROM
3) Calf muscle pumping and stretching
4) isometric of of quads and hams
5) Toe raise
6) heel raise
7) toe curls
8) strengthening exercises with thearaband (resistance should be mild at the initiation )
9) walking to discard any gait abnormality
10) Strengthening exercises of the healthy limb
11) Balancing exercises
Teaching to patient to prevent from further injury and reoccurence is also necessary.

Joint cracking
By Arunalaya blog

Joint cracking

Cracking a joint is manipulating one’s joints to produce a distinct cracking or popping sound. It
is sometimes performed by physical therapists, chiropractors, osteopaths
The cracking mechanism and the resulting sound is caused by nitrogen cavitation bubbles
suddenly partially collapsing inside the joints. To be able to crack the same knuckle again
requires waiting about 15 minutes before the bubbles will be able to form again.
NOTE- “Cracking of joints doesnot believe to cause arthritis”.
CAUSES
In 2015, research showed that bubbles remained in the fluid after cracking, suggesting that
the cracking sound was produced when the bubble within the joint was formed, not when it
collapsed. In 2018, a team in France created a mathematical simulation of what happens in a
joint just before it cracks. The team concluded that the sound is caused by bubbles’ collapse,
and bubbles observed in the fluid are the result of a partial collapse. Due to the theoretical basis
and lack of physical experimentation, the scientific community is still not fully convinced of this
conclusion.
The snapping of tendons or scar tissue over a prominence (as in snapping hip syndrome) can
also generate a loud snapping or popping sound.
For many decades, the physical mechanism that causes the cracking sound as a result of
bending, twisting, or compressing joints was uncertain. Suggested causes included:
1)Cavitation within the joint—small cavities of partial vacuum form in the synovial fluid and then
rapidly collapse, producing a sharp sound.
2)Rapid stretching of ligaments.
3)Intra-articular (within-joint) adhesions being broken.
4)Formation of bubbles of joint air as the joint is expanded.
Why do people do it?
Studies show that as many as 54 percent of people crack their knuckles. They do it for a lot of
reasons, including:
Sound. Some people like hearing the sound knuckle cracking makes.
The way it feels. Some people think cracking their knuckles makes more room in the joint, which
relieves tension and increases mobility. However, although it may feel like there’s more room,
there’s no evidence that there actually is.
Nervousness. Just like wringing your hands or twirling your hair, cracking your knuckles may be a
way to occupy your hands when you’re nervous.
Stress. Some people who are stressed need to take it out on something. Cracking knuckles may
allow for diversion and release without actually causing harm.
Habit. Once you start cracking your knuckles for any of these reasons, it’s easy to keep doing it
until it happens without even thinking about it. When you find yourself unconsciously cracking
your knuckles many times a day, it’s become a habit. People who do it five times a day or more
are called habitual knuckle crackers.
Tips to stop cracking
1)Although cracking your knuckles isn’t harming you, it may be distracting to people around you.
You might find it difficult to stop if it’s become a habit.
2) Some tips that might help you break the habit:
3)Think about why you crack your knuckles and address any underlying issues.
4)Find another way to relieve stress, such as deep breathing, exercise, or meditation.
5)Occupy your hands with other stress relievers, such as squeezing a stress ball or rubbing a
worry stone.
6)Become aware of each time you crack your knuckles and consciously stop yourself

HAGLUND DISEASE
By Arunalaya blog

Haglund Disease

It is a painful condition of the heel caused by mechanically induced inflammation of the
retrocalcaneal bursa, supracancaneal bursa and Achillies tendon.
The bump is usually due to an abnormality in foot function or bone position that creates shoe
friction around the natural bony prominence at the back of the heel.
The primary symptoms of Haglund deformity are
A) bump on the back of the heel
B) pain
C) swelling
D) callouses on and around the bump
Haglund deformity is believed to be caused by
A) high arches
B) tight achillies tendon
C) walking on outer edges of foot
D) Tight or poor fitting shoes
E) Abnormal biomechanics of foot due to joint misalignment.
Management of Hanglund deformity
First Non surgical treatment will be recommended .
Although there is no treatment to cure this deformity. Surgical interventions may also cause
bony bump again.
Some nonsurgical treatment choices include:
1) wear a shoe having rigid back.
2)placing heel lifts in shoes to help bring the heel up and avoid friction.
3)using heel pads inside the backs of shoes to help reduce irritation and friction on the heel.
4)people having high arches can use arch support inside the shoes.
5) analgesics can help in releiving pain symptom
6)cryotherapy can be done to reduce the inflammation and pain.
7) stretching exercises should be done for tight Achilles tendon.
8)avoiding climbing and running up hill. It will put more friction on bony prominence and will
alleviate pain.
9)use a soft cast that will reduce friction on the bone.
● If conservstive treatments will not relieve symptoms, the doctor may recommend surgery to
remove the part of the heel bone that sticks out.
Exercises therapy
According to the american college of foot and ankle surgeons,
1) heel raise
Stand with both feet flat on the floor, shoulder width apart. If you need support, steady yourself
with your hand on a wall or table. Hold for a few seconds, then lower the heels.Hold for 5–10
seconds, and then slowly lower the heels to the ground.
Repeat this exercise 10 times twice a day.
2) Heel drop
Begin by standing with one foot on a step and the heel raised up. Slowly lower the heel down
keeping the leg straight untill the foot is parallel to the ground but not further. Then come to the
starting position. Hold for 5 to 7 secs. Repeat to the normal position and repeat 10 times twice
a day.
3) heelcord stretch
While sitting on the ground, place the center of the towel around the ball of your foot while
holding each end of the towel with your hands. Lay on your back and raise your affected leg
while you pull on the towel ends untill you feel a stretch behind your leg.Hold for 7seconds.
Repeat this exercise 10 times twice a day.
4) towel stretch
Sit on the floor with both legs out .
Wrap a towel around one foot, holding both ends.Gently pull on the towel, pulling the ball of
the foot toward the body. There should be a gentle stretch in the calf muscle.Hold for 30
seconds and relax for 30 seconds. Repeat this exercise 10 times twice a day.
5)Towel scrunches
Keep a towel on the ground in front of the chair, then sit down on the chair with your heels on
the edge of thetowel. With one foot, reach out and use your toes to grab the towel, then pull the
towel towards you under your feet. Repeat this until you run out of towel, then repeat the whole
exercise 10 times thrice a day.

Tension headache
By Arunalaya blog

Tension headache

Headache caused by tensions feels like a mild to moderate pain on forhead , scalp and neck and
are often relived by taking painkillers and paracetamol.
CAUSES
Tension headaches usually occurs when cervical muscles becomes stiff and contracts in
response to stress, workload, any headinjury or anxiety. Adults are more prone to tension
headaches.
When our neck is in uncomfortable position for long duration it can cause headaches. Some
activities like typing work on laptops , mobiles or any activitiy which keeps our neck flexed may
trriger headaches.
Other triggers could be –
1) taking lot of caeffine
2) emotional stress
3) viral infections
4) alcohol or smoking habbits
5) ophthal problems
6) dental problems
7) dehydration
Several types of tension headaches are as follows
1) Sinus : In this type of headache pain is feel behind the eyebrow bone and cheekbones.
2) Cluster: throbbing pain is feel in and around one eye.
3) tension: pain feels like tight band over the forhead.
4) migraine: pain, nausea and visual changes are typical of classic form.
Treatment
Painkillers are the first line of treatment for tension headaches.
Common treatment include acetaminophen, NSAIDS
Physical therapy sessions including manual muscle release, dry needling electrical stimulation
modalities may provide relief from headaches.
Tension headache prevention
1) meditation
2) yoga and daily exercises
3) adequate fluid intake
4) correct posture at work
5) limit stress
6) eat balanced and healthy meals

SHORTNESS OF BREATH
By Arunalaya blog

Shortness of Breath

Introduction- shortness of breath is the uncomfortable sensation of not getting enough air
to breathe. This may occur while walking, climbing stairs, running or even when sitting still. It
is also termed as dyspnoea. Sometimes it can be harmless as the result of exercise or nasal
congestion. In other situation, it may be a sign of a more serious heart or lung diseases.
CAUSES –
1) Anaphylaxis ( allergic reaction)
2) Asthma
3) Carbonmonooxide poisoning
4) COPD
5)Coronavirus disease 2019
6) Heart attack
7)Heart arrhythmia
8) Pneumonia
9) Pneumothorax
10) Pulmonary embolism
Diagnosis
1) Blood tests- Arterial blood gases and blood oxygen saturation may be measured.
2) Exercises test- blood pressure, heart rate and changes in breathing rate can be measured
during exercises and rest
3) Electrocardiogram- An ECG records the electrical activity of the heart and shows abnormal
rhthym.
4) Echocardiogram- An echo uses ultrasound waves to produce a moving pictures of the heart
and heart valves
5) Chest x rays- An x ray will help assess lung conditions
6)Ct scan of the chest.
Severity of dyspnea
Modified Medical Research council dyspnoea scale.
Grade 0- strenous exercises
Grade 1- hurrying up or walking up a hill
Grade 2- walks slower than people of same age or stops for taking breath
Grade 3- stops for breath after walking 100m
Grade 4- breathless while dressing and underdressing breathless to leave the home.
Types of dyspnea
Orthopnea- it is the feeling of dyspnea in the recumbent position, releived by sitting or standing.
Paroxysmal nocturnal dyspnea- its a sensation of dyspnea that awakens the patient, often after
1 or 2 hours of sleep, and is usually relieved in the upright position.
Trepopnea – it is a sensation of dyspnoea that occurs in one lateral decubitus position as
opposed to the other.
Platypnea- it is a sensation of dyspnoea that occurs in the upright position and is releived with
recumbency.
Management
Treatment will depend upon the cause of the problem.
In severe cases , supplemental oxygen will be needed . Those with asthma or copd may have an
inhaled rescue bronchodilator to use when necessary.
If dyspnoea is linked to asthma, it typically responds well to medications such as bacterial
pneumoniae , antibiotics can bring relief.
Other medication such as opiates, NSAIDS and anti- anxiety drugs can also be effective.
Physiotherapy management
Physiotherapist can offer a variety of treatments to both adults and children who suffer from
shortness of breath, giving them back the independence and control of their symptoms. Some
of the treatments and techniques used are:
1) Breathing techniques
2) Manual techniques
3) Postural drainage
4) lifestyle advice
5) flutter valve
6) incentive spirometery
7) ACBT
Breathing exercises1) pursed lip breathing helps empty the lungs of dead spaces air that occurs in COPD.
To perform pursed lip breathing:
1) relax your neck and shoulder muscles.
2) slowly breathe in through your nose for two counts, keeping your mouth closed.
3) purse your lips as if you are about to whistle.
4) breathe out slowly and gently through your pursed lips to the count of four.
Sitting forward supported by a table.
1) Sit in a chair with your feet flat on the floor, facing a table.
2) lean your chest slightly forward and rest your arms on the table .
3) Rest your head on your forearms or on a pillow.
Diaphragmatic breathing
1) Sit in a chair with bent knees and relaxed shoulders, head and neck.
2) place your hand on your belly.
3) Breathe in slowly through your nose . You should feel your belly moving under your hand.
4) As you exhale, tighten your muscles . You should feel your belly fall inward. Breathe out
through your mouth with pursed lips.
5) Put more emphasis on the exhale than the inhale. Keep exhaling for longer than usual before
slowly inhaling again.
6) Repeat for about mins.

By Arunalaya blog

Rheumatoid arthritis

Rheumatoid arthritis is an autoimmune disease and inflammatory disease. RA commonly
afffects joints in the hand, wrist and knees. In a joint with RA the linings of the joint becomes
inflamed, causing damage to the joint tissue. This tissue damage leads to severe joint pain and
deformities.
RA can affect other tissues throughout the body and can cause problems in organs such as
lungs,heart and eyes.
Sign and symptoms of RA
1) pain in more than one joint
2) stiffness in more than one joint
3) tenderness and swelling in one or more than one joint.
4) deformities
5) the same symptoms on both sides of the body
6) weight loss
7) fever, fatigue, weakness.
Risk factors of RA
1) age- RA can begin at any stage , but the likelihood increases with advanced age. Most
common in sixties.
2) sex- women are more prone to this than men
3) genetics- people born with certain genes are more likely to develop RA . These genes are HLA
( human leukocyte antigens) class 2 genotypes, can also make your arthritis worse.
4) smoking- smoking increases a person’s risk of developing RA and can make the disease
worse.
5) history of giving birth- women who have never given birth may be at a greater risk of
developing RA.
6) obesity- being obese can increase the risk of developing RA.
Diagnosis of RA
Rheumatologists will look for sign and symptoms and medical history.
1) looking for swelling and redness.
2) examining joint function,ROM
3) to check warmth and tenderness
4) examining for skin nodules.
5) testing for reflexes and muscle strength.
Since no single test can detect RA. They may also request certain imaging test such as x ray,
MRI, Ultrasound.
Blood test for RA:
1) rheumatoid factor test- this check for a protein called rheumatoid factor. High level of
rheumatoid factor are associated with autoimmune disease .uu9uuu99uu9uu
2) Anticitrullinated peptide antibody test- this test looks for an antibody thats associated with
RA . People have this antinody usually have this disease . The anti ccp test is more specific for
RA then RF blood test and is often positive before the RF test.
3) Erthrocyte sedimentation rate: The ESR helps to determine the degree of inflammation
anywhere in your body. However it doesnot indicate the cause or site of inflammation.
4) C reactive protein test: A severe infection or significant inflammation anywhere in your body
can trigger your liver to make C reactive protein. Higher levels are associated with RA.
TREATMENT
Note- There is no cure for RA.
Treatment aims to reduce the inflammation and symptoms.
1) NSAIDS- it can releive pain and lessen inflammation . It includes ibuprofen and naproxen
sodium. Side effects could be heart problems, kidney damage, stomach irritations.
2) Steroids: prednisone reduces inflammation and slow joint damage side effects may include
thinning of bones, weight gain, diabetes.
3) Conventional DMARDs : these drugs can slow the process of joint damage. Common
DMARDs are methotrexate, lefluonomide, hydroxychloroquine. Side effects may include liver
damage and lung infections.
4) Surgery includes synovectomy, tendon repair, joint fusion, total joint replacement.
5) Exercises can improve joint range of motion, apply heat or cold to ease pain.
Rheumatoid hand: it includes the joint deformities of hand in RA.
1) Boutonniere deformity- it occurs when the middle or proximal interphalangeal joint of a finger
is flexed and the distal joint is extended.
2) swan neck deformity- the most common in RA . It occurs when there is weakness or tearing
of ligament due to inflammation . This laxes the joint of the finger and flexion of the distal joint.
3) Hitchhiker’s thumb: it occurs when the thumb flexes at the metacarpophalangeal joint
hyperextends at the interphalangeal joint. It is also called z shaped deformity.
4)Rheumatoid nodules: these are hard lumps that form under the skin near the joints. They can
occur in multiple areas, most commonly near your elbows. Usually these are not painful.
PHYSIOTHERAPY MANAGEMENT:
Assesment and evaluation
1) Assesment of posture
2) Testing muscle strength and power
3) Measuring joint movement
4) gait analysis
Treatment
1) cold therapy in acute phase for 10 to 20 mins twice a day.
2) Heat therapy in chronic phase for 20 to 30 mins twice a day
3) TENS will give short term pain releif.
Exercises for acute phases1) assisted movement through normal range .
2) static muscle contraction helps to maintain muscles tone without increasing inflammation.
3) for chronic cases we can progress the above exercises to include light resistance.
4) postural, core stability exercises.
5) Swimming, walking, cycling to maintain cardiovascular fitness.
6) gentle stretching of tight muscles.
7) maintaining muscle strength is important for joint stability & preventing injury.
8) Muscles can become weak following reduced activity.
9) Muscles length can be affected by prolonged positions and immobilization and tightness can
limit daily activities.
10) Splints will be provided for every deformity to keep the joint in correct position.
11) Advanced physiotherapy techniques like dry needling, manual muscle release will be
unbeatable in correcting muscle stiffness and releiving joint pains.
12) Iontophoresis is believed to work through the transcutaneous deleivery of charged
medications like lidocaine,corticosteroids, salicylate, antibiotics. It is used for deleivery of
substances that need local penetration in order to avoid systemic effects.
13) orthotic devices can make activities of daily living much easier, leading to a greater degree
of independence.

By Arunalaya Physio

Psoriasis

It is an autoimmune disease which causes cells to develop rapidly on the skin. The overgrowth
an lead to thick, scaly plaques which causes itch and discomfort.
Parts of the body which are affected by psoriasis are
1) elbows and knees
2) face, scalp
3) genitals
4) low back
5) arms, palms and feet
Types of psoriasis
80 to 90% of the psoriasis type is plaque psoriasis. Other types are
1) inverse psoriasis- this appears in skin fold. It looks like thin pink plaques without scales.
2) guttate psoriasis – it may appears after sore throat as it is caused by streptococcal infection.
It looks like small, red drop shaped scaly spots.
3)pustular psoriasis- has small, pus filled bumps on top of the red patches.
4) sebopsoriasis- appears on the face and scalp as red bumps and plaques with greasy yellow
scale.
Note- psoriasis is most common in winter , when people gets less sunlight. And male gender are
most prone. The rash is not contagious . You can’t get it from affected ones. Psoriasis has no
cure.
Risk factors1) family history- psoriasis can run in genes. If one of the parent is carrier then 50% of the
chances are there that one of the child will have psoriatic symptoms .
2) stress- excessive stress can hamper your immune system, increased level of stress can
become the cause of this disease
3) smoking- smoking will play a vital role in the initial development and will deteriorate the
condition.
Complications of psoriasis
1) eye conditions such as blepharitis, conjunctivitis.
2) hypertension
3) depression
4) cardiovascular disease
5) type 2 diabetes
6) psoriatic arthritis
7) chron’s disease, celiac disease, scelerosis, inflammatory bowel disease
Treatment
Main aim of the treatment is to reduce the growth of the cells and releive symptoms like itching,
dry skin. Common treatment includes
1) steroid creams
2) moisturizer for dry skin, aloevera gel.
3) retinoid creams, vit d based creams, coal tar.
For severe psoriasis treatment includes
Light therapy which includes ultraviolet light on the skin. PUVA is a treatment includes psoralens
tablet with ultraviolet rays.
Psoralen tablets should be taken 2 hours before sunlight exposure. Psoralen Mgs will be
dependable on patient’s weight and age.
10mg for less than 30 kg
20mg for 30 to 50 kg
30mg for 51 to 65kg
40mg for 66 to 80kg
50mg for 81 to 90kg
60mg for 91 to 115kg
70mg for more than 115kg

By Arunalaya blog

How Physio can Help with Asthma?

Asthma is a long term condition affecting children and adults. The air passage in the lungs
becomes narrow due to inflammation and tightening of the muscles around the small airways.
This causes asthma symptoms: cough, wheeze, shortness of breath and chest tightness. These
symptoms are intermittent and are often worse at night or during exercise. Other common
“triggers” can make asthma symptoms worse. Triggers vary from person to person, but can
include viral infections (colds), dust, smoke, fumes, changes in the weather, grass and tree
pollen, animal fur and feathers, strong soaps, and perfume.
Symptoms of asthma
1) Coughing at night, laughing or during exercise.
2) tightness in the chest
3) shortness of breath
4) difficulty talking
5) anxiety and panicking
6) fatigue, chest pain
7) rapid breathing
8) sleep interruptions
9)confusion
10)dizziness, pale lips and fingernails
Triggers include:
Respiratory infections, exercise, allergens, pests, enviornmental irritants, intense emotions,
extreme weather conditions.
Diagnosing asthma:
Pulmonary function test confirms the asthma. This can detect the stenosis in the lumen of
airways. Asthma is usually suspected by a healthcare provider based on a pattern of symptoms
and response to medicine called a bronchodilator that can releif the squeezing of the muscles
around the airways. Blood test to check for increased levels of eosinophils and immunoglobulin
E .
Management of asthma:
1) Bronchodilators that relax muscles around the airways.
2) Antibiotics to fight for any bacterial pneumonia and bronchitis.
3) Anti- inflammatory medications such as inhaled corticosteroids for long term, and oral
steroids for acute attacks
PHYSIOTHERAPY MANAGEMENT
Main aim of physiotherapy management will be to ease breathing and remove lung secretions
through chest physiotherapy.
Instructions are given from the respiratory therapist to how to cope up with the dyspnoea.
1) Decreasing breaths taken ( reducing respiratory flow).
2) taking smaller breaths ( reducing tidal volume)
3) Deep breathing ( diaphragmatic breathing through use of abdominal muscles and lower
throacic chest movements).
4) pursed lip breathing . Deep inhale from nose and exhaling through mouth like blowing air out.
5) relaxation plays vital role in managing asthma attacks. Sitting in semi flexed position keeping
4 to 5 pillows on the back for support will ease breathing .
6) deep breathing techniques. Inhale deep for 4 sec hold for 5 sec and blow out through mouth
slowly in 6 sec.
7) removal of secretions is very important as it triggers cough. Removal of chest secretions
through
a) percussions ( frequency should be more than intensity, intensity should be extreme low in
osteoporotic patients, or use vibrators in such patients)
b) shaking
c) vibrations
d) postural drainage
e) FET by huff cough.
8) Range of motion exercises for bed ridden patients to avoid any contractures.
9) Educate the patient about use of bronchodilators and breathing exercises.
10) correct posture in standing and sitting which will assist in the management of asthma
attacks by allowing the chest to expand appropriately and lungs to function optimally.
INSPIRATORY MUSCLES TRAINING: it can be trained for both strength and endurance
with an external resistive device. Exercise induced bronchoconstriction as well as chronic
bronchoconstriction in asthmatics is associated with increased inspiratory muscle work. It is
reasonable to suggest that increasing the strength of the inspiratory muscles in people with
asthma may reduce the intensity of dyspnea and improves exercise tolerance.
Breathing exercises, inspiratory muscle training, physical training and airway clearence are the
most relevant treatment options for asthmatic patients.

By Arunalaya blog

Reactive arthritis

Reactive arthritis is joint pain and swelling triggered by an infection in another part of the body
mostly in genitals, intestines, genitals and urinary tracts.
This condition usually targets the knees, ankles and feet. Inflammation also can affect the eyes,
skin and the tube that carries urine out of the body (urethra). Previously, reactive arthritis was
sometimes called Reiter’s syndrome.
Sign and symptoms
Incubation period is 1 to 4 weeks.
Pain and stiffness- pain in joints of knee, ankles, low back, heels.
Eye – people who have this arthritis develops an eye inflammation ( conjunctivitis ).
Urinary problems: inflammation of prostate gland and cervix, discomfort during urination.
● Reactive arthritis occurs in reaction to an infection by certain bacteria. Most often, these
bacteria are in the genitals (Chlamydia trachomatis) or the bowel (Campylobacter, Salmonella,
Shigella and Yersinia). Chlamydia most often transmits by sex. It often has no symptoms but can
cause a pus-like or watery discharge from the genitals. The bowel bacteria can cause diarrhea. If
you develop arthritis within one month of a gastrointestinal or a genital infection especially with
a discharge see a health care provider. You may have reactive arthritis.
Reactive arthritis tends to occur most often in men between ages 20 and 50. Some patients
with reactive arthritis carry a gene called HLA-B27. Patients who test positive for HLA-B27 often
have a more sudden and severe onset of symptoms. They also are more likely to have chronic
(long-lasting) symptoms. Yet, patients who are HLA-B27 negative (do not have the gene) can still
get reactive arthritis after exposure to an organism that causes it.
Patients with weakened immune systems due to AIDS and HIV can also develop reactive
arthritis.
Diagnosis
There is no specific test for diagnosing reactive arthritis, but the doctor may check the urtheral
discharge for STD. Stool samples may also be tested. Blood reports shows positive for the HLAB27 genetic marker and alongwith wbc count esr increases. Patient will also have less rbc.
X rays reports shows bone loss, signs of osteoporosis , bony spurs , back joints and pelvis may
show abnormalities.
Doctor will also test for eye and UTI which can confirm the disease.
Treatment/ Medical Management
Microbial therapy is strongly recomended for 3 to 6 months for an microbial infection.
Antibiotics should be started soon without any delay. NSAIDS are the first choice of treatment.
Main goal is to reduce the symptoms and prevent complication.
Mechanical devices like orthotics, insoles can be used.
Medical management:
Goal of physiotherapy management
1) reduce inflammation
2) reduce pain
3) improve rom
4) increase cardiovascular fitness
Cryotherapy should be intiated to intiated early at acute stage to control inflammation and
swelling around the affected joints.
Electrical stimulations like TENS, IFT to ease pain . Range of motion and stretching exercises
for all joints to avoid any stiffness in the joint, strengtheing exercises will be intiated to improve
power of muscles.
Patient education – this is necessary to promote joint protection and proper body mechanics
when performing daily activities to maintain joint integrity.
Aerobic exercises should include low impact activities such as swimming, walking depending on
patient’s age and cardiovascular level.
Other advance techniques like dry needling and taping have shown great benefits in releiving
pain and stiffness.
Physiotherapy management will target the affected joint and its attachments