Tag: Clinic

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.

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

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

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

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.

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.

How does playing a sport improve quality of life?

There has been overwhelming evidence that physical exercise has its benefits on health.  But do we know it can do much more that? Especially playing a Sport can improve the overall quality of life.

Every kind of sports has its own health benefits. Having to maintain fitness with time, family and work pressure is getting more and more difficult. An easy and quick solution would be to inculcate games in your everyday lifestyle and rejuvenate yourself all throughout the day.

As we know our country is not known to be a sporting nation. Our recreation methods are limited to strolls, drives, shopping, movies, friendly gatherings etc. Sports is not seen as a part of our life and if it is, it is only for competitive or professional purpose.

However there has been a major shift in the paradigm in the last couple of years where everyone has started focusing on health and fitness in a major way. There has been a boom in the fitness industry over the last few years.

But does just exercising mechanically improve the quality of life? Physical activity definitely has its benefits but picking up a sport and playing a sport, part from the physical benefits boosts the mental health and also helps improve life skills in a big way.

Being a sports lover since childhood and cricket (a team sport) being my sport of choice (though now I work with Olympic Sports), I have been able to reap the benefits of having played it. I would just like to highlight a few Physical and mental benefits of playing a sport

Physical Benefits

1. Weight management
2. Improved cardiovascular health
3. Reduced blood pressure
4. Improved muscular strength and endurance
5. Control cholesterol
6. Improved Bone Health
7. Improved Immunity

Mental Benefits

1. Improved Concentration
2. Improved sleep
3. Reduce stress and depression

Life skills

1. Improved self esteem
2. Learning discipline
3. Improved Time management skills
4. Developing leadership quality
5. Understanding Team work
6. Dealing with tough life situations
7. Perseverance is more important than winning or losing
8. Goal setting

Pick up any sport you enjoy! Every sport gives you something to learn. You will reap mental and physical benefits if you play safe and smart. Sports improve in overall Personality development of an individual which reflects in every walk of their lives.

Happy Playing!!