Cervical Spondylosis self Assessment tool and treatment

19 Year old with Subacute back pain,aggravated with walking and relieved with rest

DISC RELATED BACK PAIN 
APPROACH AND RESTORATION OF NORMALCY


Seeing his on and off pain,and finally her mother  has to drag him from gym where he was ready to ignore his radiating pain.

Young adults are so fascinated about gym obsessed with bloated up curvish body that they go to any extent.

What made me alert is positive Crossed leg SLR and SLR rt leg 30 degree. Reduced knee Jerk(L3-4),EHL power is within normal limits.

history revealed his weight lifting acts.

Look at the graph above to appreciate how bad is lifting weight for our disc.

The Posterior (back wall) is thinnest at Lumbar level,So constant pressure of nucleus populous on the annulus fibrosis first make bulge then herniate and press the exiting nerve roots,Which becomes cause of sciatica.

When we rest in prone (face down and bhujangasana ) the bulge retracts in,and wall of annulus fibrosus get a chance to heal.

So rest from "provoking" factors are MOST ESSENTIAL  ingredient of treatment programme.

 Provoking mean those actions which increases intradiscal pressure.

I saw all 99.0% patients through with their problems of pain,sciatica,listing. )1% are those who could not comply with advises of  active rest or restricted activity.

Residual pain was treated with neural stretching exercises.

BEST EXERCISE or POSE TO REST IS ↓ YOU CAN PROGRESS THROUGH ALL THE FOLLOWING STAGES ONE B Y ONE starting from top to bottom image.

Here in this video you can see how you should lift heavy things.

• My observation has consolidated a lot in last 20 years on disc problems whether acute or chronic.
• In fact to be more precise I would say I treated severe and aggravated cases with this this new understandings on discs. 
• Proper discipline and increased understanding of us regarding disc has led to much improved result now with much  lesser bed rest.
• Earlier I used to go to home after referral from orthopedic for putting patients on 10 days of continuous traction. MEANS STRICT BED REST FOR 7 TO 10 days  with bed pan for toilet activities.

ATMNIRBHAR BHARAT- UNDERSTAND YOUR SHOULDER

Something clicked into my mind very recently when our Prime Minister Spoke on AtmNirbhar Bharat. I thought why not to empower our citizens with enough knowledge so that they can save their time,Money and energy for seeing a doctor straightaway

  
I am starting with shoulder pain today as someone in his 40 hasjust seeked my help as he is having pain in his shoulder since Feb 2020,He gave a history of sudden stuck by his shoulder while rising up,Now his chief complaints are that he cant raise his arm above shoulder height without severe pain.He also explains that while resting on that arm brings lot of pain,Plus it pains while  changing feel like a sudden blow.
WHIlE EXAMINATION I observed that when shoulder is elevated in internal rotation position of shoulder it pains,whereas there is NO pain in doing elevation when shoulder is in external rotation.Video of how to do simple examination of shoulder by ONE-SELF

With simple advise of REST from provocation of pain and with some support from Physiotherapy and Non steroidal Ant inflammatory drugs ,he is 90% better and is feeling he has improved to such extent.MY CONCLUSIONS ARE :

•  Identify root of one's problem by the methods I told,one can easily treat oneself. 

• Its the Diagnosis which is important . Diagnosis is mostly possible without any Xray/CT/MRI scan. (especially in cases I am telling here or intend to tell in future).

• In this case the Rest from Provocation is doing magic. He completely refrained from raising arm with internal rotation,avoided resting on arm.

For more on my work please visit  www.facebook.com/DhirajPhysioclinic 

                                      THANK YOU                                                

YOUR KNOWLEDGE IS YOUR DOCTOR

YOUR KNOWLEDGE IS YOUR DOCTOR SO KEEP IT AS CLOSE TO YOU AS POSSIBLE

KNOWLEDGE IS WISDOM ISN'T IT ?

Here is again a COVID19 Special post !!

Why I said so is because  that in this little socialization time,when we are still in unlock 2,we still tend to keep getting only negative thoughts,negative information more often. Being a Medical person I also couldn't avoid it.

BUT I NEVER CAN AFFORD TO FORGET

I would suggest to follow SEVEN STEPS TO COUNTER COVID19

1.USE MASK WHENEVER OUT,EVEN IF YOU THINK  NO BODY IS AROUND

2.KEEP WASHING HANDS REGULARLY.

3.GARGLE TWICE FOR TWO MINUTES

4.STEAM INHALATION TWICE FOR ONE MINUTE EACH.



5.DRINK ONE CUP OF  HOT WATER TWICE.


6.TAKE ONE GLASS OF IMMUNITY BOOSTER KADAS IN SIPS THROUGHOUT A DAY.

7.DEEP BREATHING/WEIGHT TRAINING/ STRETCHING FOR FLEXIBILITY.

THE ABOVE ↑ 7  THINGS WOULD HARDLY TAKE YOUR 1 HOUR TOTAL IN A DAY.

FULL COMPLIANCE WITH ABOVE WOULD KEEP YOU 99 %UNAFFECTED BY COV19.

IF YOU STILL FIND YOURSELF POSITIVE DONT FEAR ,

1.BE CALM FIRST THING
2. UNTIL UNLESS YOU HAVE BREATHLESSNESS ON WALKING SIMPLE DISTANCE 
3.UNTIL YOUR PULSE OXIMETER SHOWS LESS THAN 92.
4. UNTIL YOUR ESR IS LESS THAN HALF OF YOUR AGE 
5. UNTIL YOUR IL 6 IS LESS THAN 20 

NO NEED TO WORRY IF IT IS MORE STILL NO WORRY 

BECAUSE NOW RECOVERY IS RULE AND DEATH IS EXCEPTION

 BY - DR.KK AGGARWAL ,PADMSHRI

HOW TO PREVENT MENISCUS INJURY

Meniscus Tear is tough to prevent since they are usually result of an sporty or like accident.

BUT SOME PRECAUTIONS MIGHT LOWER THE RISK OF INJURY.

1.Keep your thigh muscles strong by regular exercises.

2.warm up with light activities before taking part.

3,Give yourself enough time between workouts because fatigued muscles can increase your risk of injury.

4.Maintain flexibility.

5.Never abruptly increase your speed of workout.Make changes slowly.

IN CASE YOU LAND UP AN INJURY 

1.APPLY ICE PACK 15 to 20 mints every 3-4 hours for three days.

2. Avoid weight bearing if its is painful.

3.Use crepe bandage to prevent swelling.

4.Elevate your knee with pillow under heel while sitting or lying.

5.Take Non steroidal anti inflammatory medicines as prescribed by your doctor.

6.Don't do impactful activities.

 Source: WEBMD and me.

THREE MOST IMPORTANT EXERCISES FOR PAINFUL OR WEAK KNEE

Our knee movements are controlled by two important group of muscles  1.Quadriceps  2.HamstringsSO WHY  I AM TELLING ABOUT KNEE MOVERS.?ANSWER IS THAT with knee pain,irrespective of reason ,we unconsciously avoid using knee in a way we usually do,So with different usage there is lesser use of knee and its two major movers Quadriceps and Hamstrings.1.Isotonic Exercises of knee (Watch the Video)

2.Quadriceps Isometrics Exercises

3.Hamstring Static Exercises 

  

COVID19 and Physiotherapy

YOU MUST HAVE HEARD ABOUT HOW PNEUMONIA AFFECTS YOUR BREATHING CAPACITY.

COVID 19 in its severe form is almost always accompanied by Pneumonia ,which is inflammation of lung tissues.

How does COVID-19 affect the lungs? 

People with COVID-19 pneumonia experience changes in their lungs, including:

• inflammation that may be so severe, it damages the lungs’ alveoli(look at pic above)
• fluid accumulation in the lungs

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• gas exchange difficulties that make it hard to get enough oxygen or expel enough carbon dioxide
• fluid leaking out of blood vessels in the lungs.

Symptoms of pneumonia

The symptoms of pneumonia can vary from mild to severe. However, typical symptoms include:

• coughing
• loss of appetite
• nausea
• vomiting
• shortness of breath
• fever
• difficulty breathing deeply

Pneumonia is severe when a person is having difficulty breathing and experiences respiratory distress.

Who is most at risk of COVID-19 pneumonia? 

People with conditions that weaken the lungs or immune system may be more vulnerable to COVID-19 pneumonia.

Those conditions include:

• Cancer
• Diabetes
• High blood pressure
• Severe heart disease

• Kidney or liver disease

• Asthma and other breathing disorders

Additionally, people over 65 years of age have a much higher risk.

Treatment for COVID-19 pneumonia

• According to the CDC, inpatient care for those with severe cases of COVID-19 typically focuses on managing the complications.
• If a doctor suspects that a person is experiencing pneumonia, they may prescribe antibiotics even though this will not treat COVID-19.
• People with more severe pneumonia may need to stay in the hospital. While in the hospital, a person may receive intravenous (IV) fluids and monitoring. People with breathing difficulties may need a ventilator or oxygen therapy.

NOW WHAT  PHYSIOTHERAPY IS SUPPOSED TO HELP IN COVID 19

Here are some of the problems that physiotherapists can assist with when people are in hospital with COVID-19.

•  Low blood oxygen

In moderate to severe cases of COVID-19, prone positioning (lying face down) is recommended. Lying face down for hours at a time can increase oxygen levels in the blood. This opens up areas of lung tissue to allow more gas exchange.

Physiotherapists may also recommend other positions, such as side lying, to assist lung function depending on the patient’s condition.

• Mucus in the lungs and difficulty breathing

While many people with COVID-19 have a dry cough and don’t have problems with excess mucus build up data from one Chinese study reported that 34% of patients with severe COVID-19 had excess mucus. This build up may happen after being admitted to critical care.

For some people very unwell with COVID-19, physiotherapists might deliver ventilator hyperinflation to mimic larger breaths, or use a flexible catheter to suction mucus out without the need to disconnect the person from the ventilator.

Patients can also be taught breathing exercises to help them cough up mucus on their own. Those experiencing breathlessness or difficulty breathing can be advised about positioning, relaxed breathing techniques, and about modifying their daily activities.

However, some breathing techniques used to clear mucus will result in coughing. This may spread coronavirus, so physiotherapists will need full personal protective equipment. A negative pressure room (where air can’t be circulated outside the room) is also useful for preventing further virus spread.

Weakness

A big focus of physiotherapy during the pandemic will be to get patients moving as soon as possible. But this can only happen when the patient is well enough.

This can start with simply getting patients to move their arms, legs and body in the bed. Physiotherapists will closely manage vital signs such as oxygen levels, respiratory rate and blood pressure to ensure movements are safely tolerated.

Rehabilitation will also vary depending on the patient’s condition. Tiredness or fatigue is reported in about 40% of patients, so physiotherapists will pace activity and potentially see patients more often for shorter treatment sessions. 

                                                                                            

Rehabilitation will be carefully planned and progress gradually to the patient sitting on the edge of their bed, standing, marching on spot, and walking, depending on how well each is tolerated.

People may also develop post-intensive care syndrome, which can develop after a critical illness. People commonly experience problems with their physical function, mental health, or cognitive ability. Where possible, physiotherapists will help patients make a full physical recovery so they can return home. Physiotherapists will work alongside a team to help patients during rehabilitation.

Since recovery and rehabilitation take some time, using technologies such as “tele-rehabilitation” or other forms of remote physiotherapy can help patients return to good health even after they’ve left the hospital.

Adding a Pic and News Today ..Date 17th june ↓

          THANKS

Please  post your comments and queries. Disclaimer : Most of contents are from https://theconversation.com/coronavirus ,However some images and editing done to make it comprehensible and what I wanted to say on this.

6 Exercise tips for stiff/Painful/frozen shoulder

Is Your shoulder stiff/Painful/frozen?

SIX IMPORTANT EXERCISES/THERAPY YOU SHOULD CONSIDER

1. SHOULDER STATIC EXERCISES

The above exercises should be done provided it doesnt realy increases your pain.This video  of 2mints 51 sec explains lot of things about its benefits.2.Codman Pendular exercises 

3. Wall & ladder Exercise/Finger step ladder  Exercise

4.Internal Rotation of Shoulder Mobilisation exercise

5. Scapular Muscle Strengthening Exercise

6. ICE PACK APPLICATION for 15 mints twice or thrice after the above exercises.

COVID-19: A psychiatrist's tips to stay mentally FIT

From a psychiatrist currently practicing in Texas, United States.USA, Dr Ashish Sarangi, Texas, FIT, United States.Added few things by Dr Dhiraj,PT

LOCKDOWN :Health Challenge Vs Benefit in terms of Exercises and with reference to COVID 19

MOST IMPORTANT TAKE AWAY OF THIS POST ARE :

1. HOW ANDROGEN,A HORMONE IS RELATED TO SEVERITY OF COVID 19.
2.TYPE OF EXERCISES THAT CAN BE/SHOULD BE  DONE

The extended lockdown in lot many ways is good for humankind existence,because the social distancing is the only treatment for the COVID 19 so far.

   However we cant keep this remedy of lock down for ever,whether vaccine come or not.So now after realizing this fact that we need more things for our survival ,for our coping abilities,I decided to to pen down the list of MOST ESSENTIAL things we need to have to deal with this essential lockdown.


1. Added general immunity.
2. Fitness which is bound to go down if we keep idle.
3. Saving capital for non essential spends.

ALL OF ABOVE THREE THINGS ARE ESSENTIALLY RELATED TO OUR EXERCISE REGIMES.

SO LETS TALK ABOUT THE ABOVE THREE POINTS WHICH ARE ESSENTIAL TO BE TAKEN CARE ABOUT.

POINT # 1.

So how and why to add to our general immunity.As we know there are two types of immunity

1.General immunity and other is
2.Specific Immunity .We all know we develop specific immunity when we are exposed to a specific virus or bacteria.

It is from the materials present or synthesized by our body for building the general immunity we  develop the specific immunity(against COVID19 here in our case)

WHAT CAN BE DONE FOR IMPROVING THIS GENERAL IMMUNITY.

1.Here I would emphasize more on males ,because females are less susceptible for severe outcomes of covid 19.
https://www.medscape.com/viewarticle/930171?src=android&ref=share

The above article explains how and  why men are more likely to have severe outcomes in COVID-19 than are women. The potential explanation? Androgen.

2.So keeping the above point in mind,an idle sitting person is much more vulnerable for the severe outcomes,because of low androgen.

Weight Training Exercise

Body weight Training Exercise

Both of above exercise can be done at home without going to gym.

FITNESS:
  It is defined as ability to undertake sustained physical exertion without undue breathlessness.

 So why do we need this fitness to be taken care of.It is because of deconditioning,which takes place in following way

So  I am Listing few exercises which you can do in 2 to 3 sets of 8 to 10 reps

                                                                                                                                                                   

                

   POINT#3                                                                                                                                                                                                                                                                                                                    If you are healthy and fit ,only then you can raise capital,save.It has got a Psychological fitness connection with fitness and Immunity.Prolonged inactivity does make you depress,reduces your capacity to innovate .

So point #3 You must follow same principles as 1 and 2 .

SO PLAN YOUR DAY WITH EXERCISE,DIET,REGIME WELL!

STAY ALERT !

STAY SAFE!

CAUSE OF PERPETUAL COMPLAINT AFTER KNEE REPLACEMENT -STIFF FEELINGS

     The most heard,rather I would classify it as the ONLY complaint I hear after knee replacement is stiffness,stone like feeling

I thought to find the cause not because it stopped patient progress but because of unnecessary psychological and physical  burden of few other questions which are sometimes  associated with this main issue.

                                         

In order to find the cause I revisited Physiology and Pharmacology for this.

Physiology of muscles and bones post surgery,a reconstruction surgery like Total knee Replacement gives us a deeper understanding of reasons.

I came across lot of points but following I am sharing for the benefit of time and knowledge enhancement.

1.During a knee replacement surgery,surgeon makes a long incision over the middle of knee and cuts the muscle,tendon and ligament .So It implies there is more tissues cut and hence there is more requirement of time to heal them.

2.Up to 20% loss of muscle mass can be compensated by the high adaptability and regenerative potential of skeletal muscle.

3.Muscle regeneration relies on a heterogeneous population of satellite cells, interstitial cells, and blood vessels and is mainly controlled through ECM proteins and secreted factors.

4.Postoperatively, quadriceps strength  decreases by 62%.(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1167681/)

5.Voluntary activation  decreases by 17%

6. Maximal cross-sectional area  decreases by 10% in comparison with the preoperative values.

7.The existing evidence suggests that patients lose approximately half of their preoperative quadriceps strength in the first month after surgery.

8.The results of preliminary studies have confirmed that reduction in muscle activation contributes substantially to early postoperative weakness

9.The associated swelling/Edema doesn't realy go away because of slow  vascularity as a result of  natural operational trauma and poor mobility and resulting poor muscle contraction. This swelling also lead to feeling of tightness.

10 .So in totality the stiffness in result of three things ,foreign body in place,Swelling and Poor muscle functioning. AND ALL OF THEM OR THEIR EFFECT IS TEMPORARY ONLY

REMEDY IS

1.Isometric quadriceps ↟

2.Elevation and Quadricps static every one hour

3.Ice therapy every one hour initialy till one week,then every two hours.(ICE IS BETTER THAN GEL PACKs)                     

                                         
4.Ankle foot movement in lying position

                                                 

5.Heel Raises in Sitting position

                                                 

                                                                  THANKS 😊