Class 4 Laser Therapy

Your body has amazing systems that it can use to heal itself. However, sometimes it needs a little external help to get these systems fired up and working to your benefit. Class 4 laser therapy harnesses these processes using focused light. It stimulates a process called photobiomodulation (PBM).


Mechanism of action of class 4 laser:

  • The therapeutic effect of laser light is based on biostimulation and the acceleration of cellular processes that contribute to pain reduction and faster recovery after injury. The photomechanical wave stimulates nerve endings, which leads to pain relief. Biostimulation of the affected tissue increases oxygen uptake and improves blood circulation.
  • The unique combination of 30 W power and 1064 nm wavelength targets deep-lying tissues, maximises pain relief, and delivers strong thermic therapies within a short time.

Effects of class 4 laser therapy:

  • Reduced pain and swelling
  • Improved range of motion
  • To reduce pain and inflammation in musculoskeletal disorders and injuries and joint pain.
  • Increases tissue regeneration
  • Accelerates soft tissue and bone repair
  • Improve nerve regeneration & function as well as impact your cells to increase cell metabolism, enzymatic responses, collagen production, and promote angiogenesis
  • Improve your musculoskeletal health

What Are The Side Effects Of Laser Therapy?

  • Redness, swelling and itching. Treated skin may be itchy, swollen and red
  • Acne
  • Infection
  • Changes in skin color
  • Scarring
  • Turning of the eyelid

Rehabilitation of Hamstring Injuries

High-speed running, kicking, and sprinting frequently cause athletes to experience hamstring injuries, which primarily affect the muscle group known as the hamstrings.

To ensure successful rehabilitation for these injuries, it is important to adhere to the following general principles:

1. Train Movements and Muscles

The hamstrings, a muscle group consisting of three individual muscles, play different functional roles based on their anatomical positions. During sprinting, the biceps femoris (BF) undergoes the highest strain, the semitendinosus (ST) experiences the greatest lengthening velocities, and the semimembranosus (SM) primarily generates force. Therefore, it is important to target the injured muscle with specific exercises that aim to develop its particular functional role.

2. Prescribe Strength exercises to achieve a specific goal

Eccentric Training

The terminal swing phase of sprinting generates high eccentric forces. Modifying eccentric force deficits is essential as they contribute to the risk of future hamstring injuries. Hence, rehabilitation should prioritize training to develop the capacity for generating high eccentric force.

Get Long and Strong

The shortening of fascicles can predispose the hamstrings to (re-)injury, and eccentric training can help overcome this problem. Previous studies have demonstrated significant improvements in eccentric strength and fascicle lengthening with high-volume eccentric training programs incorporating the Nordic hamstring exercise. However, recent research has shown that similar improvements can be achieved with a low-volume program consisting of 2 sets of 4 repetitions once a week.

Isometric Training

During the swing phase’s conclusion, the hamstrings’ contractile element can remain relatively isometric, as the tendon primarily elongates the muscle-tendon unit. Maintaining a good isometric condition of the muscle reduces mechanical load and facilitates the tendon’s spring-like behavior during the stretch-shortening cycle.

As hamstring injuries are consistently associated with fatigue, and most injuries occur in the final third of sprint training sessions, incorporating strength training under fatigued conditions has shown substantial reductions in injury rates. Isometric training of the hamstrings, such as utilizing the single-leg Roman chair hold, can enhance hamstring muscle endurance and serve as a valuable addition alongside the traditional Nordic hamstring exercises.

After an injury, the body’s response involves reducing myoelectric activity in the muscle as a protective mechanism to unload healing tissues. In some cases, this selective inhibition may persist and requires targeted rehabilitation. Isometric contractions have been shown to elicit higher voluntary muscle activation, making them effective in overcoming selective muscle inhibition. It is advisable to incorporate high-load isometric exercises to improve motor unit recruitment. In injuries where pain and disability are the primary concerns, isometric loading may be a more feasible approach before progressing to eccentric loading of the tissues.

Apply a multivariate model and target contributing factors to injury risk

Poor motor control of the pelvis can increase strain on the hamstrings and contribute to deficits in force production. Therefore, it is advisable to incorporate training for the lumbo-pelvic region, targeting movement in different planes.

Apart from the lumbo-pelvic region, the hip plays a vital role in maintaining optimal hamstring function. Weakness and decreased activation of the gluteus maximus serve as risk factors for hamstring injuries. Insufficient hip flexion exposes the hamstrings to a higher risk of injury, as the body compensates by increasing pelvic rotation during high-speed running, consequently placing greater strain on the hamstring muscles.

Cyclist’s Palsy

Cyclist’s palsy, also known by various names such as handlebar palsy, ulnar tunnel syndrome, ulnar nerve compression, Guyon Canal Syndrome (GCS), bicycler’s neuropathy, or tardy ulnar palsy, is an overuse injury that primarily affects the hands and fingers. It occurs when the nerves in the wrist or the side of the palm near the pinky finger become compressed due to repetitive stress.

Cause of cyclist palsy

  • Cyclist’s palsy can cause both motor and sensory symptoms.
  • The motor symptoms can include weak hand grip and difficulty using fingers for precise tasks.
  • Whereas the common sensory effects include numbness, tingling, and pain.

Although cyclist’s palsy is increasingly common, it is often underreported among cyclists. In fact, a study revealed that 7 out of 10 participants reported experiencing motor or sensory symptoms. Severe nerve injury can lead to paralysis or irreversible loss of sensation in the affected hand.

The pressure exerted on the handlebars during prolonged cycling can irritate the nerves in the palm. The highest pressure occurs where the median and ulnar nerves enter the hand, which corresponds to positions like “tops,” “ramps,” “hoods,” and “drops.” The “drops” position applies the most pressure on the ulnar nerve, while the “hoods” position applies slightly less pressure. The “tops” position places significant pressure on the palm at the base of the ring finger. The “drops” position can also cause excessive wrist extension, increasing pressure on the carpal tunnel. If a cyclist already has nerve compression at the neck or elbow, it can be more easily triggered at the palm, potentially leading to carpal tunnel syndrome or cubital tunnel syndrome.

Signs and Symptoms

  • include numbness, tingling, and sensory changes in the little finger and the ring finger on the side closest to the little finger
  • the palm in that area may also become numb, while there is no numbness on the back of the hand.
  • The symptoms can vary depending on the location of pressure. Sometimes manifesting as numbness or weakness, or a combination of both.
  • When the median nerve is affected, numbness and tingling occur on the palm side of the thumb, index, long, and ring fingers (on the side closest to the middle finger). But there is no numbness on the back of the hand.
  • Prolonged or severe pressure on the nerves can also weaken the associated muscles. Some cyclists may experience pain along with hand numbness.


Limiting cycling is the most effective treatment for cyclist’s palsies. However, there are other measures that can allow cyclists to continue their activity while reducing the risk of exacerbating the condition. These include :

  • Limiting the length or distance of the ride
  • Having enough rest between longer cycling sessions
  • Changing positions of grip on the handlebars
  • Changing to a transverse handlebar
  • Adjusting the seat height
  • Using gloves to reduce or distribute pressure. The pressure can be reduced with foam or gel padding in the palm of the glove.

Top 3 Cyclist Palsy Exercises

In addition to these measures, exercises play a crucial role in long-term recovery and preventing recurrence of cyclist’s palsy. These exercises primarily focus on strengthening the muscles, ligaments, and tendons in the hands. The top three recommended exercises for cyclist’s palsy are as follows:

  1. Finger bending exercise: Begin by stretching your hand and then bend the fingers of the affected hand at a right angle, holding them in that position for approximately 10 seconds. Ensure that your fingers remain straight during the exercise. Repeat this process five times.
  2. Finger squeeze: Take a small object like a coin or a sheet of paper and squeeze it between two fingers, holding the grip for 10 seconds. Repeat this exercise five times for each set of fingers.
  3. Grip strengthening exercise: This exercise targets a weak hand grip. Squeeze a rubber ball with the affected hand and hold for 10 seconds and then release. Repeat 10 times, and that’s one set. Aim for 3 sets of 10 as you gradually build up grip strength.


Low Back Pain Relief

Most types of low back pain are often referred to physical therapy as one of the first-line treatments. Physical therapy for low back pain includes guided therapeutic exercises that strengthen the lower back muscles and condition the spinal tissues and joints.

The short- and long-term goals of physical therapy for back pain typically include the following:

  • Decrease painful symptoms in the lower back and/or leg
  • Improve low back function to tolerate daily activities as independently as possible
  • Increase the spine’s flexibility and improve its range of motion
  • Formulate a maintenance program to prevent the recurrence of back problems

The exercises are intended to provide flexibility and strength training to the entire kinetic chain—groups of body segments, joints, and muscles that work together to perform bodily movements.

Physical therapy helps restore the patient’s ability to perform daily activities with little-to-no discomfort. Large-scale studies have shown that physical therapy can provide up to 60% improvement in lower back pain and other symptoms.

Four Categories of Therapeutic Exercises for Back Pain

Therapeutic exercises are typically performed or learned under the guidance of a physical therapist and use a combination of the approaches described below.

  1. Core-Strengthening Exercises

In simple terms, the body’s core can be described as the area surrounded by the stomach muscles in front, the spinal and buttock muscles at the back, the bottom of the lungs or the diaphragm on top, and the muscles of the pelvis and hip at the bottom.  A weak core distributes weight unequally throughout the spine and into the legs, causing back pain or worsening existing back pain. Core-strengthening exercises help build strength and endurance in the core muscles, significantly reducing pain and improving functionality in the lower back.

Easy-to-perform core-strengthening exercises to relieve back pain include the pelvic tilt, cat-cow pose, bird dog, high and low planks, crunches, and exercises performed using a Swiss Ball.

  1. Lumbar Stabilizing Exercises

A strong spine needs strong hips and legs to support the lower body, and to walk, bend, and twist effortlessly. Inefficiency of the muscles in the hips and legs has been proven to cause spinal instability and pain. Stretching exercises can activate and strengthen these muscles, such as the iliopsoas and hamstrings; improve coordination between the hip and spine; and aid in the transfer of forces across the lower back, pelvis, and legs.

Hip and leg exercises for beginners with lower back pain typically include hamstring stretches, squats, downward dog, planks with leg lifts, and lunges.

  1. Aerobic exercises

Aerobic or cardiovascular exercise not only helps maintain a healthy heart but also heals the spinal muscles. Cardiovascular exercise involves synchronized movement in the body, which increases the heart rate, thereby improving circulation, oxygen content within the cells, and energy production in the tissues. Through these mechanisms, the painful spinal muscles respond by becoming less stiff and more mobile.

Simple aerobic exercises for back pain include brisk walking, a stationary bike, and an elliptical trainer. Low-impact aerobic conditioning can be achieved through aquatic exercise. The buoyancy of water supports the body’s weight, reducing stress on the spine and allowing for a greater range of motion.

  1. Postural Training

Supported posture minimizes strain on the body by maintaining a balance of the muscles and bones.  Unsupported posture can result from habit, painful symptoms, or ergonomics at work or home. Specifically in the spine, using incorrect posture can limit the movement of the tendons and muscles, making regular day-to-day movements difficult and painful.  Posture correction exercises aim to stretch and strengthen the back and abdominal muscles and the kinetic chain, which help stabilize the spine.

Common posture correction exercises include calf stretching, seated squats, pelvic tilts, and abdominal strengthening exercises.

Physical therapy is a multi-component program that includes education, training, strength, flexibility, and endurance. A physical therapist plays a key role in designing a program suitable to the needs and limitations of the patient. A therapist’s goal is to teach the proper exercise technique, so the patient can perform the exercise on their own.

Duration of a Physical Therapy Program for Low Back Pain

The total length of an exercise program depends on the severity and duration of the low back symptoms.

  • For chronic low back pain, physical therapy typically starts with an 8-week program performed under the guidance of a physical therapist.
  • A longer-term maintenance or rehabilitation therapy is prescribed after the guided phase, which can be done at home.

The duration of the guided program may increase or decrease based on the outcome of the treatment.

Physical therapy may be combined with other nonsurgical treatments for the lower back to improve the overall pain outcome. Hands-on alternative treatments, such as massage therapy, manual therapy, and accupuncture may be beneficial when performed in combination with a physical therapy regimen.

Understanding Asperger’s Syndrome: Insights into a Unique Neurodevelopmental Condition

Asperger’s Syndrome is a developmental disorder characterized by challenges in social interaction and rigid, repetitive behavior and thinking patterns.

Children and adolescents with Asperger’s Syndrome generally have the ability to communicate verbally and perform reasonably well academically. However, they struggle with comprehending social situations and subtle forms of communication such as body language, humor, and sarcasm. They may exhibit a tendency to focus excessively on one particular topic or interest and prefer a limited range of activities. These intense interests can become all-consuming and disrupt daily life.


The symptoms of Asperger’s Syndrome include difficulties in social interactions, obsessions, unusual speech patterns, limited facial expressions, and other distinctive mannerisms. Children with Asperger’s Syndrome may engage in repetitive routines and display heightened sensitivity to sensory stimuli.

While every child with Asperger’s Syndrome is unique, their notable traits lie in their atypical social skills and fixated interests. When observing a child with Asperger’s Syndrome, one may notice one or more of the following symptoms:

  • Inappropriate or minimal social interactions
  • Conversations that almost always revolve around themselves or a certain topic, rather than others
  • Not understanding emotions well or having less facial expression than others
  • Speech that sounds unusual, such as flat, high-pitched, quiet, loud, or robotic
  • Not using or understanding nonverbal communication, such as gestures, body language and facial expression
  • An intense obsession with one or two specific, narrow subjects
  • Becoming upset at any small changes in routines
  • Memorizing preferred information and facts easily
  • Clumsy, uncoordinated movements, including difficulty with handwriting
  • Difficulty managing emotions, sometimes leading to verbal or behavioral outbursts, self-injurious behaviors or tantrums
  • Not understanding other peoples’ feelings or perspectives
  • Hypersensitivity to lights, sounds and textures

Children with Asperger’s Syndrome typically demonstrate normal language development without significant delays. They often exhibit strong grammar skills and possess an extensive vocabulary. However, their use of language may be characterized by a literal interpretation of meaning, making it challenging for them to navigate social contexts effectively.

Regarding cognitive development, there is typically no noticeable delay in children with Asperger’s Syndrome. While they may struggle with attention span and organization, their intelligence quotient (IQ) tends to fall within the average range.


  • The causes of Asperger’s Syndrome are unknown.
  • Genetics and brain abnormalities may be involved.
  • We do know that Asperger’s Syndrome is NOT the result of a child’s upbringing or poor parenting.
  • It is a neurobiological disorder, meaning it is just a part of the child’s brain development, whose causes are not fully understood.


Treatment usually includes:

  • Social skills training
  • Behavior supports
  • Cognitive behavioral therapy
  • Parent education and training
  • Speech-language therapy
  • Occupational therapy

Physiotherapy Treatment

  • Physical therapy for individuals with Asperger’s Syndrome primarily focuses on improving gross motor skills such as crawling, sitting, rolling, walking, and running.
  • As children with Asperger’s Syndrome grow older, physical therapy may involve more advanced tasks like jumping, stair climbing, throwing, and catching.
  • These motor skills are crucial for both physical development and active participation in play and sports.
  • During physiotherapy sessions, the individual’s physical abilities will be assessed and evaluated to determine the nature and extent of any challenges, leading to the formulation of an appropriate treatment plan.
  •  The physiotherapist will develop a personalized treatment plan based on the individual’s specific needs and abilities.
  • Physiotherapy will encompass a range of exercises and therapeutic programs aimed at improving physical abilities, coordination, and balance.
  • Collaboration between physiotherapists and educational professionals is vital to ensure awareness of any gross motor skill challenges and to provide effective strategies and interventions for managing these difficulties.

W-Sitting: The Negative Impact on your Child

The w-sitting posture is sitting on the floor with both thighs rotated inwards and the feet outwards on both sides of the body (the legs make a W shape, hence the name).”

As we age, achieving the w-sitting posture becomes challenging for adults due to the gradual loss of hip mobility. This decline in mobility can be attributed to the natural growth of our muscles and bones, as well as the lack of exposure to extreme hip flexion in Western cultures.

In contrast, children find it easier to adopt the w-sitting posture. Their hip joints possess greater mobility, and they often spend significant amounts of time in positions with flexed hips. It is common for many typically developing children to occasionally transition into this posture during their playtime.

Children who have low resting muscle tone and/or joint hypermobility, characterized by “floppy” muscles, often find it effortless to adopt the w-sitting posture. They may even find it comfortable. Children with tight leg muscles, such as those with cerebral palsy, may have limited options and find the w-sitting posture as the only sustainable position for them.

Why Do Toddlers/Children W Sit?

  • Bone alignment/positioning in utero (how your child is built can predispose them to W sit)
  • Core/trunk weakness
  • Excessive hip flexibility and/or joint hypermobility
  • Low muscle tone (check out these exercises for hypotonia)
  • It’s easier! A wider base is easier, requires less muscle work, and is less fatiguing

Why physiotherapist don’t like W sitting?

Physiotherapists generally discourage the practice of W sitting for the following reasons:

  1. Inward rotation of knees: W sitting places the knees in a position of increased inward rotation. This can result in added stress on the knee joints, potentially leading to knee pain and discomfort over time.
  2. Potential for in-toeing: W sitting has the potential to contribute to in-toeing, particularly in children who are already hypermobile. In-toeing refers to a tendency for the feet to turn inward instead of pointing straight ahead. W sitting can exacerbate this condition, affecting the alignment and stability of the lower limbs.
  3. Leads to turned in toes: Feet turning in while they W sit day after day for several years can lead to turned-in toes in other activities, like standing, cruising, and walking.
  4. Makes walking difficult
  5. Limits Core strength and rotation
  6. Decreases Mobility in hips and ankles

To promote optimal musculoskeletal development and minimize the risk of knee-related issues and in-toeing, physiotherapists generally encourage alternative sitting positions that maintain proper alignment and promote healthy joint positioning.

What Can You Do About W Sitting ?

  1. Stretch

 You won’t be successful getting rid of W sitting if your child is tight. A good stretch needs to last at least 30 seconds. Singing songs or watching short videos can help pass the time!

  • Butterfly stretch
  • Hamstring stretching
  • Ankle stretching
  • Prevent in-toeing of the foot

  1. MFR
  5. Break the habit

Happy Puppet Syndrome


Happy Puppet Syndrome is a rare and complex genetic disorder that primarily affects central nervous system characterized by severe learning difficulties, motor dysfunction, seizure disorder, and often a happy, sociable demeanour.

People with Happy puppet syndrome often smile and laugh frequently, and have happy, excitable personalities.

Happy puppet syndrome was first described in 1965 by British paediatrician Harry, who identified a group of children with similar symptoms that he termed “happy puppet syndrome.” The term “puppet” referred to the jerky movements and uncoordinated gait that are characteristic of the condition.

The initial indicators of happy puppet syndrome are usually developmental delays that appear between the ages of 6 and 12 months. Seizures might start between the ages of two and three.

The condition is causes by a genetic mutation or deletion on chromosome 15, which leads to deficiency of protein called ubiquitin ligase E3A (UBE3A). This protein is important for normal functioning of nerve cells in brain, and its absence or deficiency can result in the neurological symptoms of happy puppet syndrome.

The prevalence of happy puppet syndrome is estimated to be around 1 in 12,000 to 20,000 individuals, although it may be underdiagnosed or misdiagnosed. The condition can affect individuals of any race or ethnicity, and there is no known gender predilection.


  • Developmental delay and intellectual disability including no crawling or babbling at 6 to 12 months.
  • Seizures, usually beginning between 2 and 3 years of age.
  • Absence or minimal speech.
  • Hyperactivity and excitability.
  • Unsteady or jerky gait.
  • Difficulty in balance.
  • Sucking or feeding difficulty.
  • Trouble going to sleep and staying asleep.
  • Happy demeanour, frequent smiling and laughter, and an easily excitable personality.
  • Stiff or jerky movements.
  • Small head size, with flatness in the back of the head.
  • Tongue thrusting.
  • Hair, skin and eyes that are light in colour.
  • Unusual behaviours, such as hand flapping and arms uplifted while walking.
  • Curved spine (scoliosis).


The diagnosis of happy puppet syndrome is usually made based on clinical signs and symptoms, along with genetic testing to confirm the deletion or mutation of the UBE3A gene on chromosome 15.
A diagnosis is based upon:

    • a thorough clinical evaluation and identification of distinctive findings; and
    • a full history of patients.

Genetic testing, such as DNA methylation, must be conducted in order to confirm a suspected diagnosis. These tests may review:

    1. Parental DNA pattern: screens for three of the four known genetic defects that cause happy puppet syndrome.
    2. Missing chromosomes: A chromosomal microarray (CMA) can detect missing chromosomes.
    3.  Gene mutation: If your child’s DNA methylation test findings are normal, your doctor may request a UBE3A gene sequencing test to look for a maternal mutation.

Differential Diagnosis

  • Prader-willi syndrome
  • Rett syndrome
  • Mowat wilson syndrome
  • Pitt-hopkins syndrome


The treatment for happy puppet syndrome is primarily supportive and focuses on addressing specific symptoms, such as seizures, sleep disorders, and behavioral problems. Early intervention with physical, occupational, and speech therapy is important to improve mobility, communication, and social skills. Educational support and specialized services may also be required to help individuals with the syndrome reach their full potential.


Physiotherapy is an important part of the multidisciplinary approach to managing happy puppet syndrome.

The goals of physiotherapy are to improve movement, balance, and coordination, prevent joint contractures and deformities, and enhance overall physical function.

The physiotherapy treatment typically includes:

  • Assessment: The physiotherapist will perform a comprehensive assessment of the individual’s physical abilities.  It will include range of motion, strength, balance, and gait analysis.
  • Treatment plan: Based on the assessment results, the physiotherapist will develop an individualized treatment plan that addresses the specific needs of the individual.
  • Exercises: The physiotherapist will prescribe exercises to improve muscle strength, flexibility, and balance. Exercises may include stretching, strengthening, and balance training exercises.
  • Assistive devices: The physiotherapist may recommend the use of assistive devices such as walkers, orthotics, or braces to help improve mobility and prevent falls.
  • Hydrotherapy: Water-based exercises can be particularly beneficial for individuals with happy puppet syndrome. The buoyancy of the water can reduce the risk of injury while allowing for a full range of motion.
  • Functional training: The physiotherapist will work with the individual to improve their ability to perform daily activities, such as sitting, standing, and walking.
  • Education: The physiotherapist will educate the individual and their caregivers on safe movement techniques, fall prevention, and the importance of ongoing exercise and physical activity.

Shock Wave Therapy: How it Works?

Shock Wave therapy is a technique that uses high-energy sound waves rather than electrical shocks to aid in the healing process following an injury.

SWT is a cutting-edge treatment that uses acoustic shock waves to break up soft tissue calcifications, boost collagen production, release growth factors, and accelerate your body’s healing process in order to reduce pain and keep you active.

It’s a lesser-known physiotherapy technique, yet it can be beneficial.

Injuries that can be treated

Shock wave therapy is used to treat musculoskeletal injuries, particularly those areas involving connective tissue and bone.
The following are some examples of common injuries treated with shockwave therapy:

  • tennis/golf elbow
  • rotator cuff tendonitis
  • calcification
  • stress fractures
  • trochanteric bursitis in the hip
  • patellar tendonitis
  • jumper’s knee
  • hell spurs
  • Achilles tendonitis
  • Morton’s neuroma in the foot

Shock wave therapy treatment has been shown to be an excellent approach to start the body’s healing process and reduce discomfort while regaining movement.
Most people require only three treatments per week.

This therapy improves blood circulation and hastens the repair of chronic musculoskeletal disorders in the bones, tendons, ligaments, and muscle.

How does it work?

  • Shockwave treatment stimulates self-healing by using radial acoustic shockwaves.
  • These shockwaves, which are not electrical but rather sound shockwaves, are administered through a special wand hand piece that dispenses the waves for a brief amount of time directly to the affected injured tissue areas.
  • The pressure from the shockwaves will be transferred to the tissue. As a result, special micro-cavitation bubbles form, expand, burst, and produce a force known as a resultant force.
  •  This passes through the tissue and stimulates the cells responsible for connective tissue and bone mending, so activating the body’s inherent self-healing mechanism.
  • These processes involve increased metabolism and blood circulation. It means that your damaged tissue receives better healing treatment from your body, and the damaged tissue will begin to regenerate itself, with an accompanying inflammatory response allowing the healing process to take effect.
  • Some people find it slightly uncomfortable to go through. However, these people are frequently in the minority, and the majority are able to handle the five-minute treatments with ease.
  • Though there will be no pain immediately following the treatment, there is a potential of discomfort in the hours that follow.
  • This discomfort can last for up to two days, therefore patients should limit their physical activity and avoid using anti-inflammatory drugs or ice.

How does it feel?

ESWT hurts, and the degree of pain varies from person to person. The majority of patients perceive it as slightly uncomfortable but not painful.
It also affects where we treat you. Body portions with less skin and muscle, such as above the hip bone, can be more sensitive than meatier areas, such as the calves.


Osteoporosis is a condition in which the bones in the body become weak and brittle as a result of tissue loss over time. This illness is most common in the elderly, but it can also occur in middle-aged patients.

Although this condition can affect any bone in the body, it most commonly affects the following:

  • Spine
  • Hips
  • Waist

Because of bone fragility, people with osteoporosis are susceptible to fractures.


While weak bone structures are caused by ageing factors, smoking, and excessive alcohol use, a prolonged sedentary lifestyle can also play a role. Cigarettes contain toxic substances that interfere with the bones’ natural ability to repair, while alcohol interferes with calcium absorption.

Habitual physical inactivity promotes the activity of osteoclasts (the cells responsible for bone resorption).

Another factor that contributes to osteoporosis is hormonal change associated with ageing. Women going through menopause may be more likely to develop osteoporosis later in life due to lower oestrogen levels (a hormone that helps manufacture bone mass).

Anyone can get osteoporosis, and the risk rises with age.

Role of Physiotherapy

Physiotherapy can aid in the prevention and management of osteoporosis.
Over the course of weeks and months, a physical therapist will design a personalised training programme to strengthen your bones and muscles.
This improves your balance and reduces your chances of falling.

Physical therapy can also aid in the recovery from an osteoporosis-related accident.

Physical therapy often involves performing stretches or exercises, usually done in repetition or sets. But physical therapists also use a variety of other techniques to improve movement.

These include:

  • Manual therapy
  • Kinesiology taping
  • Dry needling
  • suggestions for lifestyle changes
  • MFR
  • heat or cold therapy
  • ultrasound / electrical stimulation
  • Stability training

Benefits of PT

  • Physiotherapy treatments aid in the strengthening of bones and muscles
  • Regular and targeted exercise is essential for the prevention and management of osteoporosis.
  • Working with a physiotherapist can help you with the following:
    1. improve your balance
    2. lower your chances of falling
    3. stretch and strengthen your muscles
    4. correct stooped posture
    5. prevent further bone loss
    6. reduce pain

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.


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.


  • 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.


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.


  • 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.


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.


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.


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.


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.


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



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.


  • 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.