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Physiotherapy In Delhiblog
By Arunalaya 0 Comments blog, Physio, Therapy, Toe Walking

Understanding Lateral Ligament Injury of the Ankle

Lateral ligament injury is among the most prevalent types of sports injuries addressed by physiotherapists. Men and women are estimated to suffer from lateral ankle sprains at roughly the same rates.

A lateral ligament injury of the ankle is a common injury that occurs when the ligaments on the outer side of the ankle are damaged. The most frequently affected ligaments are the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL), and the posterior talofibular ligament (PTFL). These ligaments are responsible for providing stability to the ankle joint.

Lateral ankle sprains are also known as inversion or supination ankle sprains. The complex of ligaments on the lateral side of the ankle is torn by varied degrees as a result of a forced plantarflexion/inversion movement.

Individuals who sustain multiple recurrent ankle sprains have been documented to have functional and mechanical instability, as well as an increased risk of re-injury. Small fractures surrounding the ankle and foot (e.g. Pott’s fracture) and straining or rupture of the muscles around the ankle (e.g. calf, peroneii, tibialis anterior) should also be avoided even if they are the less prevalent causes of ankle pain.

Lateral Ankle Ligament Tear Types:

Lateral ligament injuries of the ankle can be classified into three main types based on the ligaments involved and the severity of the tear:

Anterior talofibular ligament (ATFL) injury: This is the most common type of lateral ligament injury and often occurs in isolation. It involves the stretching or tearing of the ATFL, which connects the talus bone to the fibula. It is commonly associated with ankle inversion injuries.

Calcaneofibular ligament (CFL) injury: The CFL is located slightly below the ATFL and connects the calcaneus (heel bone) to the fibula. CFL injuries typically occur along with ATFL injuries or in more severe sprains. In some cases, the ATFL and CFL can be injured together, resulting in a higher-grade ligament tear.

Posterior talofibular ligament (PTFL) injury: The PTFL is the least commonly injured ligament in lateral ligament injuries of the ankle. It connects the talus bone to the fibula at the back of the ankle. PTFL injuries usually occur in severe ankle sprains or high-energy trauma.

CAUSES

Ankle sprain: The most common cause of a lateral ligament injury is an ankle sprain, which typically occurs when the foot rolls inward, resulting in stretching or tearing of the ligaments on the outer side of the ankle.

Sports injuries: Activities that involve quick changes in direction, jumping, or running on uneven surfaces increase the risk of ankle sprains and ligament injuries.

Trauma: Direct trauma or impact to the ankle joint, such as a fall or a collision, can cause damage to the lateral ligaments.

CLINICAL FEATURES

  • Pain on the outer side of the ankle
  • Swelling and bruising
  • Difficulty walking or bearing weight on the affected foot
  • Instability or a feeling of the ankle giving way
  • Limited range of motion in the ankle joint.

RISK FACTORS

Body mass index, slow eccentric inversion strength, quick concentric plantar flexion strength, passive inversion joint position sense, and peroneus brevis reaction time were all linked to an elevated risk of lateral ankle injury.

ASSESSMENT OF ANKLE JOINT

  • Amount of instability present by assessing the grade of the sprain;
  • Loss of Range of motion (ROM);
  • Loss of the muscle strength;
  • Level of reduced Proprioception.

OBSERVATION

Any symptoms of injury, inflammation, skin colour changes, or muscle atrophy or hypertrophy are noted. Following that, the foot and ankle are observed in two separate positions: non-weight bearing and weight bearing. Take note of the gait pattern, degree of limp (if any), and facial expression when bearing weight.

HISTORY

Mechanism of injury: A plantarflexion/inversion injury would indicate damage to the lateral ligament, whereas a dorsiflexion/eversion injury would indicate damage to the medial ligament. Previous history of injury on the same side will give clues as to whether the ankle was unstable to begin with, or that a previous injury wasn’t properly rehabilitated.

History of injury on the other side as well may indicate a biomechanical predisposition towards ankle injuries.

GRADES

Grade 1: Mild sprain with minimal stretching or tearing of the ligament fibers. There may be slight swelling, tenderness, and minimal loss of function.

Grade 2: Moderate sprain with partial tearing of the ligament fibers. This grade is characterized by increased swelling, bruising, pain, and difficulty walking or bearing weight on the affected ankle.

Grade 3: Severe sprain with complete tearing or rupture of the ligament. Significant swelling, bruising, pain, and instability are commonly observed. Walking or weight-bearing may be extremely difficult or impossible.

SPECIAL TEST

An anterior draw is performed to assess the ATFL and CFL integrity. The heel is grabbed with the ankle in plantarflexion, and the tibia is stabilised and dragged anteriorly.
The talar tilt is used to evaluate the integrity of the ATFL and CFL laterally, as well as the deltoid ligament medially. The heel is grabbed again, the tibia is stabilised, and the talus and calcaneus are pushed laterally and medially.
Beginning with a simple single leg stance, proprioception can be measured in a variety of more challenging methods. The patient can do it on the normal side first to give the therapist a sense of what is typical, and then try it on the injured side.

DIFFERENTIAL DIAGNOSIS

  • Ankle fracture (medial/lateral malleolus, distal tibia/fibular)
  • Damage to the medial ligament
  • Dislocated ankle
  • Other soft tissue damage (peroneal tendons, muscle strain)

TREATMENT

REDUCE PAIN AND SWELLING

The RICE regimen (Rest, Ice, Compression, and Elevation) can be used to minimise pain and swelling in the first 48-72 hours after an acute lateral ligament damage.

If weight bearing is too painful, the patient can use elbow crutches for 24 hours and remain non-weight bearing. However, it is critical to begin at least partial weight bearing as soon as possible, along with a regular heel-toe gait pattern, since this will help to reduce pain and swelling.

Gentle soft tissue massage and light stretches can be conducted to help with the clearance of oedema, as long as they are painless.

Range of motion exercises: These exercises aim to restore the normal range of motion in the ankle joint and may involve gentle ankle rotations, ankle pumps, and alphabet exercises.

Strengthening exercises: Strengthening the muscles around the ankle joint helps provide support and stability. Common exercises include calf raises, toe raises, ankle inversions and eversions (using resistance bands or manual resistance), and single-leg balance exercises.

Proprioceptive and balance exercises: These exercises improve the body’s awareness of joint position and enhance balance and stability. Examples include standing on one leg, balance board exercises, and wobble board exercises.

RETURN TO FUNCTIONAL ACTIVITY

  • Twisting
  • Jumping
  • Hopping on one leg
  • Running
  • Figure of 8 running

Before returning to full functional activity the patient should have full range of pain free movement in the ankle, normal strength and normal proprioception. If returning to sports, the athlete should be encouraged to wear an ankle brace or to tape the ankle for a further 6 months to provide external support.

By Arunalaya 0 Comments blog, Physio

Revitalize Your Knees: The Art of Patellar Mobilization

Patellar mobilization is the application of pressure or force on the kneecap in order to restore normal up and down movement in trochlea. The patella, often known as the kneecap, is the biggest sesamoid bone in the body. A sesamoid bone is one that is embedded in a tendon, such as the quadriceps tendon in the patella.

This tendon, along with other muscles in and near the quadriceps, helps hold the patella in place so that it may accomplish its most crucial role, which is to protect the knee joint.

Location

The patella sits between the femur and tibia, protecting the knee joint while also connecting muscles in the femur’s front to the tibia.

  • Articular cartilage exists beneath the patella and at the end of the femur, allowing the patella and femur bones to move in tandem.
  • This cartilage provides protection as well as increased mobility with every knee movement.
  • Patellar mobilisations are a type of hands-on treatment that is used to relieve movement restrictions in the knee joint.

The patella (or kneecap) is a bone positioned at the bottom of your thighbone (femur) in a shallow groove called the trochlea. This crucial anatomical structure connects to both the quadriceps muscles (through the quadriceps tendon) and the tibia bone (via the patellar tendon) and influences the knee’s capacity to bend and straighten. Patellar mobility restriction can change the range of motion and function of the knee joint, necessitating this treatment.

What Is Patellar Mobilization?

When you straighten or extend your knee, the patella is pulled upward in the trochlear groove in a fully functioning joint. When your leg is bent or flexed, your knee cap glides downward in the groove in the same way.

Patellar mobilization is the application of pressure or force on the kneecap in order to restore normal up and down movement in trochlea. If the kneecap is not tracking well in the groove, side-to-side mobilisations may be used. Depending on the goals of the mobilisation and the causes of the restricted mobility, movements applied by the therapist on the kneecap might be rhythmic and gentle or more vigorous and sustained.

Post-Operative Rehab

  • ACL or other ligament reconstructions
  • Partial or total knee replacements (arthroplasty)
  • Meniscal repairs
  • Partial meniscectomy
  • Microfracture procedures

ROLE OF PATELLAR MOBILIZATION

Patellar mobilisations are frequently used in:

  • Regaining any lost range of motion.
  • Bending and straightening your knee become simpler by restoring normal patellar mobility in the trochlear groove.
  • Everyday function improves.

Exercises

Along with hands-on knee mobilisation, exercises are usually prescribed to maintain your improvement moving forward.

By Arunalaya 0 Comments blog, Physio, Therapy

The Benefits of Physiotherapy at Home in Delhi and How to Find the Right Physiotherapist for You

Physiotherapy at home is becoming increasingly popular in Delhi due to its many benefits. Here are some of the benefits of physiotherapy at home in Delhi:

  1. Convenience: You don’t have to worry about traveling to a physiotherapy clinic, which can save you time and money.
  2. Personalized treatment: Physiotherapy at home allows for personalized treatment plans that cater to your individual needs.
  3. Privacy: You can receive treatment in the comfort and privacy of your own home.
  4. Family involvement: With physiotherapy at home, family members can be involved in the treatment process, which can lead to better outcomes.

To find the right physiotherapist for you, follow these steps:

  1. Ask for referrals: Ask your doctor, friends, or family members for recommendations.
  2. Check credentials: Ensure that the physiotherapist is licensed and has the necessary certifications.
  3. Experience: Look for a physiotherapist with experience in treating your specific condition.
  4. Communication: Choose a physiotherapist who communicates well and is able to explain the treatment process in a way that you can understand.
  5. Cost: Consider the cost of treatment and whether the physiotherapist accepts your insurance.
  6. Availability: Choose a physiotherapist who is available to provide treatment at a time and location that is convenient for you.

Overall, physiotherapy at home in Delhi can be a convenient and effective way to receive personalized treatment for your condition. By following these steps, you can find the right physiotherapist to help you achieve your goals.

What is Physiotherapy & What are the Benefits of Having it at Home?

Physiotherapy is a type of healthcare that involves the treatment of physical conditions, diseases, and injuries through exercise, manual therapy, and other modalities. Physiotherapy is designed to improve the movement, function, and quality of life of individuals who may be suffering from various conditions, including chronic pain, neurological disorders, sports injuries, and musculoskeletal conditions.

Physiotherapy at home involves receiving treatment from a physiotherapist in the comfort of your own home. This can be beneficial for a number of reasons, including:

  1. Convenience: Having physiotherapy at home means you don’t have to travel to a clinic or hospital for treatment, saving you time and effort.
  2. Personalized treatment: Physiotherapy at home allows for personalized treatment plans that are tailored to your individual needs and requirements.
  3. Comfort: Being in your own home can help you feel more relaxed and comfortable during treatment, which can help to improve the effectiveness of the treatment.
  4. Improved family involvement: With physiotherapy at home, family members can be involved in the treatment process, which can lead to better outcomes.
  5. Cost-effective: Physiotherapy at home can be a cost-effective alternative to receiving treatment at a clinic or hospital, as you won’t have to pay for transportation or parking fees.
  6. Greater privacy: Some people may feel uncomfortable receiving physiotherapy in a public setting, so having it done at home can be a more private and comfortable option.

In summary, physiotherapy is a type of healthcare that aims to improve the movement, function, and quality of life of individuals with physical conditions or injuries. Having physiotherapy at home can be beneficial in terms of convenience, personalized treatment, comfort, family involvement, cost-effectiveness, and privacy.

Types of Injuries & Conditions that can be Treated with Home Physiotherapy in Delhi

There are a wide range of injuries and conditions that can be effectively treated with home physiotherapy in Delhi. Here are some common examples:

  1. Back pain: Home physiotherapy can help to relieve back pain caused by issues such as herniated discs, sciatica, and muscle strains.
  2. Joint pain and stiffness: Joint pain and stiffness caused by conditions such as osteoarthritis, rheumatoid arthritis, and gout can be treated with home physiotherapy.
  3. Sports injuries: Home physiotherapy can help athletes recover from sports injuries such as sprains, strains, and fractures.
  4. Stroke and neurological conditions: Physiotherapy can be used to improve mobility, balance, and coordination for individuals who have suffered a stroke or have neurological conditions such as Parkinson’s disease or multiple sclerosis.
  5. Post-surgical rehabilitation: After surgery, home physiotherapy can help to speed up recovery, reduce pain and inflammation, and improve mobility.
  6. Respiratory conditions: Individuals with respiratory conditions such as chronic obstructive pulmonary disease (COPD) or asthma can benefit from home physiotherapy to improve breathing techniques and lung function.
  7. Posture correction: Poor posture can lead to a range of issues such as back pain, neck pain, and headaches. Home physiotherapy can help correct posture and improve overall alignment and balance.

Overall, home physiotherapy can be an effective treatment option for a wide range of injuries and conditions, helping individuals to improve their quality of life, reduce pain and inflammation, and regain mobility and function.

 

What is the process for starting physiotherapy at home in Delhi?

The process typically involves contacting a physiotherapy service provider, discussing your needs and requirements, scheduling an assessment with a physiotherapist, and creating a personalized treatment plan.

How do I know if physiotherapy at home is right for me?

Physiotherapy at home may be a good option if you have mobility issues, are unable to travel to a clinic or hospital, or prefer the comfort and privacy of your own home. It is best to discuss your needs with a physiotherapist to determine if home physiotherapy is appropriate for you.

How long does a physiotherapy session at home typically last?

The duration of a session can vary depending on the individual’s needs and requirements, but a typical session may last 30-60 minutes.

What equipment is needed for physiotherapy at home?

The equipment needed for home physiotherapy can vary depending on the individual’s needs and requirements, but may include exercise bands, weights, and balance aids such as stability balls or foam pads.

Are there any risks or side effects associated with physiotherapy at home?

While physiotherapy is generally safe, there may be risks or side effects associated with certain treatments or exercises. It is important to discuss any concerns with your physiotherapist and follow their instructions carefully to minimize the risk of injury or adverse effects.

How do I find a qualified physiotherapist for home treatment in Delhi?

You can find qualified physiotherapists in Delhi by asking for referrals from your doctor or friends and family, searching online, or contacting a physiotherapy service provider. Be sure to check the physiotherapist’s credentials and experience before starting treatment.

By Arunalaya 0 Comments blog, Physio, Therapy

The Ultimate Guide to Finding the Top Physiotherapists in Delhi

Physiotherapy is a form of healthcare that focuses on the treatment of physical injuries, disabilities, and impairments. It is a widely recognized medical field that helps patients with movement problems or dysfunction in their physical bodies. In Delhi, there are many physiotherapists, but finding the best one can be a challenge. In this guide, we will explore some of the key steps you can take to find the top physiotherapists in Delhi.

  1. Do your research

The first step to finding a top physiotherapist in Delhi is to do your research. You can start by looking up physiotherapy clinics or hospitals in Delhi and reading reviews online. Make a list of potential physiotherapists and clinics that have good reviews and ratings.

  1. Check their qualifications and experience

It’s important to ensure that the physiotherapist you choose is qualified and has experience in treating the specific condition or injury that you have. Check their credentials, education, and experience before booking an appointment. You can also ask for referrals from your doctor or friends who have undergone physiotherapy.

  1. Look for specialization

Different physiotherapists have different specializations. Some may specialize in sports injuries, while others may focus on back pain or neurological disorders. Depending on your condition, look for a physiotherapist who specializes in treating that specific condition.

  1. Check the facilities

The facilities at the physiotherapy clinic can also make a difference in your treatment experience. Check if the clinic has the necessary equipment and facilities for your treatment. Also, make sure that the clinic is clean and hygienic.

  1. Evaluate their communication skills

Effective communication is crucial in physiotherapy. A good physiotherapist should be able to explain your condition, the treatment plan, and the progress made in a way that you can understand. Evaluate the communication skills of the physiotherapist during the first appointment to ensure that you can work together effectively.

  1. Look for a customized treatment plan

Each patient is unique and requires a customized treatment plan. Look for a physiotherapist who can create a personalized treatment plan that is tailored to your specific needs and goals. This will increase the chances of a successful outcome.

  1. Consider the location

The location of the physiotherapy clinic is also an important factor to consider. Look for a clinic that is conveniently located near your home or workplace, so that it’s easier for you to attend appointments.

Conclusion

Finding the top physiotherapists in Delhi requires some effort and research, but it’s worth it in the long run. By following the steps above, you can find a physiotherapist who is qualified, experienced, specializes in your condition, has good communication skills, and can create a customized treatment plan. This will help you achieve your goals and get back to your normal routine as soon as possible.

What is Physiotherapy and How Can It Help You with Your Health and Wellbeing?

Physiotherapy is a healthcare profession that focuses on the assessment, diagnosis, treatment, and prevention of physical impairments, disabilities, and pain. Physiotherapists use a variety of techniques to help restore movement and function to the body, improve mobility, reduce pain, and prevent further injury.

Physiotherapy can be beneficial for a wide range of conditions, including musculoskeletal disorders, neurological conditions, respiratory problems, and cardiovascular diseases. It can also help with post-operative rehabilitation, sports injuries, and chronic pain.

The goal of physiotherapy is to help patients regain their physical independence and improve their overall health and wellbeing. Physiotherapists work with patients to develop personalized treatment plans that may include exercises, manual therapy, education, and lifestyle modifications.

Physiotherapy can help you with your health and wellbeing in the following ways:

  1. Reduce pain and discomfort: Physiotherapy can help reduce pain and discomfort by using techniques such as manual therapy, acupuncture, and ultrasound.
  2. Improve mobility and flexibility: Physiotherapy can help improve mobility and flexibility by using exercises and stretches to strengthen muscles and improve joint mobility.
  3. Prevent injuries: Physiotherapy can help prevent injuries by identifying and addressing risk factors that may lead to injury.
  4. Enhance sports performance: Physiotherapy can help enhance sports performance by improving strength, flexibility, and balance.
  5. Improve overall health and wellbeing: Physiotherapy can help improve your overall health and wellbeing by reducing stress, promoting relaxation, and improving your ability to perform daily activities.

5 Benefits of Seeking Professional Physiotherapy Services in Delhi

Here are five benefits of seeking professional physiotherapy services in Delhi:

  1. Personalized Treatment Plans: A professional physiotherapist in Delhi will provide a personalized treatment plan based on your specific needs and goals. They will assess your condition and develop a treatment plan that will help you achieve your goals and improve your overall health and wellbeing.
  2. Pain Management: A physiotherapist can provide effective pain management by using various techniques, such as manual therapy, electrotherapy, and dry needling. They can also provide exercises that help reduce pain and discomfort.
  3. Faster Recovery: A professional physiotherapy service in Delhi can help speed up the recovery process after an injury or surgery. They can provide exercises and techniques that can help improve mobility and reduce pain, helping you to recover faster.
  4. Improved Mobility: Physiotherapy can help improve mobility by increasing strength, flexibility, and range of motion. This can help you perform daily activities with more ease and confidence.
  5. Improved Quality of Life: Seeking professional physiotherapy services in Delhi can improve your quality of life by reducing pain and discomfort, improving mobility, and helping you to achieve your goals. This can lead to better physical and mental health, and an overall improved sense of wellbeing.
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.

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.

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

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.

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

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.