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.

Kegel Exercises: The Complete Guide

Kegel exercises are designed to strengthen the muscles of your pelvic floor, providing support for your bladder and bowel function. These exercises involve a simple clench-and-release technique that targets the pelvic floor muscles. The pelvic floor refers to a collection of muscles and tissues that form a sling or hammock-like structure at the bottom of your pelvis, supporting your reproductive organs. Weakness in the pelvic floor can contribute to problems like loss of bladder or bowel control. By regularly performing Kegel exercises, you can enhance the strength and functionality of your pelvic floor muscles.

Why Do Kegel Exercises?

  • Both women and men can benefit from performing Kegel exercises to strengthen their pelvic floor muscles.
  • Various factors, including pregnancy, childbirth, aging, and weight gain, can contribute to the weakening of the pelvic floor muscles in women.
  • The pelvic floor muscles are responsible for supporting the womb, bladder, and bowels. When these muscles are weak, the pelvic organs may descend into the vagina, causing discomfort and potentially leading to urinary incontinence.
  • Men can also experience a decline in the strength of their pelvic floor muscles as they age. This can result in both urinary and fecal incontinence, especially for those who have undergone prostate surgery.

Finding the pelvic floor muscles in Women

  • When beginning Kegel exercises, it can be challenging to identify the correct set of muscles to target.
  • One method to locate these muscles is by gently inserting a clean finger into the vagina and then tightening the vaginal muscles around the finger.
  • Another way is to attempt to halt the flow of urine while urinating. The muscles engaged in this action are the pelvic floor muscles.
  • Familiarize yourself with the sensation of contracting and relaxing these muscles.
  • However, it is important to note that stopping and starting urine regularly or frequently doing Kegel exercises with a full bladder is not recommended, as it can lead to incomplete bladder emptying and increase the risk of urinary tract infections (UTIs).
  • If you are unsure whether you have correctly identified the pelvic floor muscles, it is advisable to consult with your gynaecologist for guidance.
  • Your gynaecologist may suggest using a vaginal cone, which is inserted into the vagina and held in place using the pelvic floor muscles.
  • Biofeedback training is another helpful method for identifying and isolating the pelvic floor muscles. This procedure involves the insertion of a small probe into the vagina or the placement of adhesive electrodes on the external area of the vagina or anus.
  • During the training, you will be instructed to perform a Kegel contraction. A monitor will display whether you have engaged the correct muscles and the duration of the contraction.

Finding the pelvic floor muscles in Men

  • Men can encounter similar difficulties in identifying the appropriate group of pelvic floor muscles.
  • To locate these muscles, men can try inserting a finger into the rectum and attempt to squeeze it, while ensuring that the muscles of the abdomen, buttocks, or thighs are not tightened.
  • Another helpful technique is to contract the muscles responsible for preventing the release of gas.
  • If difficulties persist, practicing the interruption of urine flow can be a reliable method. However, it is important to note that this should not become a regular practice.

Goals and Benefits of Kegel Exercises

  • Always empty your bladder before performing Kegel exercises. As a beginner, find a quiet and private place to sit or lie down for your exercises. As you practice, you will discover that you can perform them anywhere.
  • When you start doing Kegel exercises, tense the muscles in your pelvic floor for a count of three, and then relax them for a count of three. Repeat this sequence for 10 repetitions. Over the next several days, continue practicing until you can hold the muscle tension for a count of 10. Aim to do three sets of 10 repetitions every day.
  • Do not be discouraged if you do not see immediate results. According to the Mayo Clinic, it may take a few months for Kegel exercises to have an effect on urinary incontinence.
  • Additionally, Kegels work differently for each person. Some people experience significant improvement in muscle control and urinary continence, while for others, Kegels may help prevent the condition from worsening.


  • If you experience pain in your abdomen or back following a session of Kegel exercises, it indicates that you are not performing them correctly. Remember that while contracting your pelvic floor muscles, the muscles in your abdomen, back, buttocks, and sides should remain relaxed.
  • Lastly, it is important not to overexert yourself during Kegel exercises. Working the muscles excessively can lead to fatigue and hinder their ability to perform their essential functions.

How Can you do Kegel Exercises?

  • Both men and women can perform Kegel exercises using the same approach.
  • To begin, it is important to locate your pelvic floor muscles, often referred to as PC muscles. You can identify these muscles by interrupting the flow of urine while urinating.
  • The muscles engaged in stopping the urine flow are your PC muscles.
  • These muscles also play a role in controlling the release of gas. In men, contracting the PC muscles may cause the testicles to rise.


Try the Easiest Kegel Exercises

  • After locating your PC muscles, you can begin practicing flexing them.
  • Contract and hold your PC muscles for a duration of 5 to 20 seconds.
  • Subsequently, release the contraction.
  • Repeat this exercise 10 to 20 times consecutively, three to four times a day.
  • Gradually increase the number of contractions and the duration of each contraction.
  • Over time, this straightforward exercise can contribute to strengthening your PC muscles.
  • This, in turn, may lead to improvements in bladder control and sexual function.

Add Variety to your Workout

  • To add variety to your Kegel workout, consider trying different variations of the basic exercise.
  • For instance, you can contract and release your PC muscles rapidly, performing several repetitions in quick succession.
  • Another option is to practice contracting the muscles slowly, emphasizing control and endurance.
  • Additionally, you can experiment with different positions while performing Kegel exercises, such as standing, sitting, or lying down.
  • While engaging in Kegel exercises, make a conscious effort to avoid tightening other muscles, such as your abdominal muscles, buttocks, or thighs.
  • It is also important not to hold your breath. Instead, maintain a relaxed and steady breathing pattern while keeping the rest of your body still and relaxed.

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.


Beyond Traditional Therapy: Harnessing the Potential of Dry Needling

Dry needling is a therapeutic technique that involves using a thin needle to target and treat muscular trigger points and areas of tissue tenderness.

It is commonly used to address various issues :

  • musculoskeletal issues like neck pain, low back pain
  • sciatica
  • muscle strains
  • IT band syndrome
  • plantar fasciitis
  • fibromyalgia, and more.

Every year, new treatment techniques claiming to be the latest and greatest in pain reduction and improved function emerge, but many of them fade away over time.

How is Dry Needling Different?

While dry needling may have recently caught your attention, it has been around for several decades. In the early 1940s, trigger points were injected with different substances to alleviate tender points. However, a study in 1979 revealed that needling alone, without injections, produced a unique pain-relieving effect. This discovery led to the development of dry needling as we know it today.

Understanding this brief history is crucial because it is not a new concept and has been used in some form for over 40 years. It is increasingly prevalent in physical therapy practice.

Effectively Releases Trigger Points

  • Dry needling specifically targets taut muscle bands known as trigger points, commonly referred to as muscle knots.
  • Trigger points can result from various factors such as tissue trauma, overuse, prolonged bed rest, stress, tension, and poor posture.
  • They can cause pain that radiates to other parts of the body. For example, a trigger point in the upper back can cause headaches, neck pain, back pain, or jaw pain.
  • By stimulating and releasing these muscle knots, it reduces tightness, alleviates pain, and improves muscle flexibility.

Reduces Reliance on Medications

Dry needling has become an integral part of pain management programs due to its effectiveness in addressing both acute and chronic pain, thereby reducing the need for medication reliance. It is often used in conjunction with other therapeutic modalities to achieve optimal outcomes such as :

  1. manual therapy
  2. massage
  3. exercise
  4. heat therapy/ hydrotherapy and
  5. kinesiology taping

The technique can also be employed to treat latent trigger points, which may not be causing evident pain yet but can become problematic if left untreated.

It is a generally well-tolerated procedure with very minor side effects, such as :-

  • soreness
  • discomfort, which subside just within a few hours after the treatment.

Dry Needling in Patel Nagar, Delhi

For exceptional physical therapy services in Delhi, we invite you to visit Arunalaya Health Care Physiotherapy Centre. We employ dry needling as one of our innovative treatment modalities to ensure the best possible outcomes for a wide range of musculoskeletal, neurological, and pediatric issues.

To learn more about dry needling and whether it is right for you, consult Dr. Chakshu Bansal (PhD. , MPT, BPT).

Contact us at: 8090080906, 8090080907

Reverse Clamshell Exerise: Benefits and Instructions

If you’re seeking exercises to strengthen your hips, one often overlooked option is the Reverse Clamshell exercise. This variation targets a different set of hip muscles compared to the traditional version and offers numerous benefits.

Benefits of the Reverse Clamshell Exercise

The Reverse Clamshell exercise is a variation of the clamshell, renowned for its ability to enhance hip stability. While similar, it possesses unique advantages that make it a valuable addition to your exercise routine, alongside other individual exercises. These advantages include:

  1. Enhanced hip joint strength, with a specific emphasis on internal hip rotation.
  2. Strengthening of the gluteal muscles, particularly the Gluteus Medius, which leads to improved muscle function and activation.
  3. Stabilization of pelvic muscles.
  4. Increased muscle definition in the thighs and buttocks.

By incorporating the Reverse Clamshell exercise into your workout regimen, you can reduce the risk of injuries and alleviate lower back pain.

What Muscles Does the Reverse Clamshell Target?

This exercise primarily targets the following muscle groups:

  1. Inner thighs (hip abduction)
  2. Gluteal muscles, specifically the deep Gluteus Medius muscle.
  3. Pelvic muscles.

Clamshell Exercise Vs. Reverse Clamshell Exercise

Here is an image illustrating the regular clamshell exercise:

Different Benefits

Although both starting from a similar position, the clamshell and reverse clamshell exercises offer distinct benefits for the body. While the clamshell primarily strengthens the gluteus minimus and gluteus maximus muscles, the reverse clamshell works the inner rotators of the him. Incorporating both exercises into physical therapy can be beneficial for the hip flexors.

Different Muscle Groups

These exercises target different muscle groups. Unlike the clamshell, the reverse clamshell does not engage the gluteus maximus or the external rotators of the hip. Instead, it focuses on the inner rotators, which play a crucial role in stabilization and balance. During the reverse clamshell, you will feel the activation more in your outer thighs.

How to Perform the Reverse Clamshell Exercise

To perform the reverse clamshell exercise:

  1. Lie on your exercise mat on one side, with your legs stacked on top of each other and your knees bent at a 45-degree angle, as you would for the regular clamshell exercise.
  2. Keep your feet together. Rotate your top foot outward and raise it toward the sky. Take one second to lift your leg and three seconds to lower it, maintaining slow and controlled movements.
  3. Repeat for 10 to 15 repetitions before switching sides.

Some Tips

Here are some tips for performing the exercise:

  • Keep your upper body aligned and engage your abdominal muscles throughout.
  • Exhale as you engage your inner thighs, and inhale as you relax your muscles.
  • Avoid rolling forward, as having your top leg slightly more forward than your lower leg makes it easier to lift your foot. This can result in less activation of your glutes.

Make it Easier

If you find the exercise challenging, you can start with an easier exercise called the Single Leg Windshield Wiper stretch. Follow these steps as a beginner:

  1. Lie flat on your back, with your knees bent at a 90-degree angle and your feet flat on the floor.
  2. Move your feet slightly wider than hip-width apart.
  3. While keeping your left knee still, allow your right leg to fall toward the left leg. This inward rotation of your hip will create a stretch on the outside of your buttocks and hip.
  4. Hold this position for 20 to 30 seconds before returning to the starting position.
  5. Perform 10 to 15 repetitions before switching sides and allowing the left leg to fall. Ensure your core muscles are engaged throughout the exercise for added benefits.

Pain-Free Periods: The Transformative Influence of Physiotherapy on Menstrual Cramps

Menstrual cramps are a major problem for many women. The pain connected with the menstrual cycle can be debilitating in certain situations. Cramps are caused by a variety of factors, and understanding these factors might help you find relief.
Women are increasingly resorting to physiotherapy to alleviate period discomfort.
Many of the pain-related symptoms that women encounter each month can be reduced or eliminated with physiotherapy.

Minimising Menstrual Cramp Discomfort

Menstrual cramps can be relieved in a variety of ways:

  • Many women benefit from stretching treatments that focus on the low-back and abdominal muscles.
  • Furthermore, contract-and-relax techniques can be utilised to enhance blood flow to muscles and aid in the reduction of stress.

How Physiotherapy Helps with my Menstrual Cramps?

Muscle cramping is commonly felt in the lower back, abdomen, and hips soon before or during menstruation. Physiotherapy can help relieve cramps by using the therapies listed below.

1. Heat Pack

Heat packs help to relieve pain by increasing circulation and relaxing strained or tight muscles. Heating pads have the similar impact on uterine muscles when used to ease cramps, allowing them to relax more.

2. Modalities

Modality like transcutaneous electrical nerve stimulation (TENS) units can help reduce pain with periods. it is usually applied on the abdomen, hip, pelvis and low back.

3. Manual Therapy

If you are having pelvic pain with your periods, manual therapy like connective tissue release and massage done by physiotherapists can help in relieving the pain and also relaxing the tension around the pelvic area.

  • Pelvic floor muscles
  • to reduce muscle sensitivity and tenderness (both in the pelvic floor muscles as well as muscles around the pelvis) does seem to reduce cramping during menses.
4. Exercise

Period cramps can be relieved by exercises such as the cat cow and child pose. Pilates and breathing exercises can also help with menstruation cramps.


Movement is what we do in physical therapy, and certain exercises which help with movement of the spine and abdomen can be very helpful in improving pain levels.

There are few exercises that are contraindicated to do during menstruation cycle. Here is the list of few such exercises you should avoid.

To Avoid:

1. Intense cardio

    • Intense cardio can frequently cause excessive menstrual flow. As a result, this should unquestionably be avoided throughout periods. For healthy periods, some women must make little alterations to their workout.
    • Avoid engaging in strenuous cardiovascular exercises as they may place additional strain on your mind and body.

2. Cut the Duration

    • In addition to increasing the intensity, you should reduce the duration of your workout. It may take you a few days to get back into shape. So, for at least 4-5 days, *don’t workout for 90 minutes straight, but rather for 30-40 minutes with breaks.
    •  This reduces the likelihood of cramping and menstruation symptoms. Additionally, shortening the duration will allow your body to recoup and rest.

3. Weight Training

    • If you are suffering period cramps from the first day, skip the weight training portion.
    • Lifting weights will not help you and will instead disrupt your menstrual flow. This will also assist you in maintaining your strength and avoiding excessive exertion.
    • Lift light weights and take precautions to avoid injuries.


Anatomy of the Nervous system

Anatomy of the Nervous system

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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
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
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.
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.
Assesment and evaluation
1) Assesment of posture
2) Testing muscle strength and power
3) Measuring joint movement
4) gait analysis
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.


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