ARTICLES _______________________________________________________

Musculoskeletal disorder: Orthopaedic problems (Bone & Joints)

Sports Injury:

The term sports injury refers to the kinds of injuries that commonly occur during sport or exercise. Sport and exercise can be very beneficial to health. They can reduce the risk of heart disease, stroke and obesity and help to beat depression.
However, exercise can also cause injuries, particularly if you do not prepare properly or use proper safety equipment. It is very important to warm up before exercise, and to cool down afterwards, see the 'prevention' section for advice about how to do this safely.
Some sports require supervision from a qualified professional or someone who is able to administer first aid.
Most people get sports injuries through accidents, but professional and competitive athletes often develop overuse injuries. An overuse injury is usually a sprain, strain or fracture to part of the body that has been used repetitively. An example of this is a javelin thrower, who may be vulnerable to arm and shoulder injuries.

Cervical Spondylosis (Neck pain)

Cervical spondylosis is a common degenerative condition of the cervical spine. It is most likely caused by age-related changes in the intervertebral disks. Clinically, several syndromes, both overlapping and distinct, are seen. These include neck and shoulder pain, suboccipital pain and headache, radicular symptoms, and cervical spondylotic myelopathy (CSM).
·Neck and shoulder pain are the most common symptom. Types of neck and shoulder pain include: stiff neck, most often one of the very first signs. Neck stiffness tends to grow progressively worse over time.
·Radiating pain to the bottom of the skull and/or to the shoulder and down the arm. This radiating pain may seem like a stabbing or a burning, or it might present itself as a dull ache.
·Along with pain, cervical spondylosis can be accompanied by parathesias and muscle weakness in the neck, shoulders, arms and hands, and a syndrome called “numb, clumsy hands”.

Shoulder

Shoulder joint is a complex joint, having Glenohumeral joint, acromioclavicular joint, sternoclavicular joint, scapulothoracic joint.

Common conditions which affects shoulder are :

FROZEN SHOULDER: Two main types are 1)painful shoulder: pain around shoulder with no true contracture of joint capsule,conditions such as tendinitis of rotator cuff, sprain and tears of rotator cuff, bicipital tenosynovitis,synovitis of shoulder.Limitation of movement is mainly because of pain.
2)Adhesive capsulitis: capsular adhesion form as result of inflamation in capsule and synovium.with relative immobility of shoulder.

PAINFUL ARC SYNDROME : Shoulder arc eabduction elevation is painful from 45 to 160 degrees, problem with supraspinatus tendon, subacromial bursa or greater tuberosity of humerus.

LESIONS OF THE ROTATOR CUFF : Arm raised actively to 45degrees after which flexion and also abduction is by elevation of shoulder girdle.

SUPRASPINATUS TENDINITIS : Total loss of active abduction , stiffness of shoulder , loss of voluntary abduction.

INFRASPINATUS TENDINITIS : Pianless weakness and painful arc with loss of 30degrees of lateral rotation at shoulder.

SUBSCAPULARIS TENDINITIS : Resisted medial rotation is painful.

LONG HEAD OF BICEPS BRACHII TENDINITIS : Occurs in elderly, because of degenerated tendon, subjected to repeated strain.

SUBACROMIAL BURSITIS : Limits abduction and internal rotation of shoulder.

Back pain

Back pain is a common condition and it is the largest cause of work-related absence. Back pain can be very uncomfortable, but it is not usually serious.

Back pain can affect anyone, regardless of age, but it is more common in people who are between 35 and 55 years of age.
In the majority of cases, the cause of back pain can be linked to the way that the bones, muscles and ligaments in the back work together.
The structure of the back

The back is a complex structure consisting of:
·24 small bones (vertebrae), that support the weight of your upper body and form a protective canal for the spinal cord.
·Shock-absorbing discs (intervertebral discs) that cushion the bones and allow the spine to bend.
·Ligaments that hold the vertebrae and discs together.
·Tendons to connect muscles to vertebrae.
·A spinal cord, which carries nerve signals from the brain to the rest of the body.
·Nerves.
·Muscles.

The lower part of your back is known as the lumbar region, which is made up of five vertebrae, known as L1, L2, L3, L4 and L5. The lumbar supports the entire weight of your upper body (plus any extra weight that you are carrying), and it is under constant pressure, particularly when you are bending, twisting and lifting.

Lower back pain

Lower back pain, also known as lumbago, affects seven out of 10 people at some time in their lives. Lower back pain is a pain or ache on your back, in between the bottom of your ribs and the top of your legs.

Lower back pain can come on suddenly or gradually, and is sometimes the direct result of a fall or injury. The complex structure of your lower back means that even small amounts of damage to any part of the lumbar region can cause a lot of pain and discomfort.

Pain in your lower back is usually a symptom of stress or damage to your ligaments, muscles, tendons or discs. In some cases, if a nerve in your back is pinched or irritated, the pain can spread to your buttocks and thighs. This is known as sciatica (go to 'Useful links' for more information).
In most cases of back pain your back will heal itself, and staying active and continuing with your usual activities will normally promote healing. Back pain will usually last from a few days to a few weeks. Pain that lasts longer usually clears up after about six weeks.
However, in severe and persistent cases of back pain, it is important to seek medical advice so that a correct diagnosis can be reached and appropriate treatment given. Treatment for back pain will usually depend on the underlying cause of the condition. For example, pain that is caused by some types of arthritis may be treated using specific medicines

Knee pain:

The knee joint is one of the largest joints in the body. It is comprised of two bones, the femur and tibia that are connected by four strong ligaments. These ligaments serve to stabilize and control the motion of the knee joint. The bones are cushioned by a gelatinous cartilage called meniscus that lays between them. All of these structures are at risk for damage.
The knee is the most commonly injured joint in all age groups. It is especially succeptible to damage during athletic activities and exercise. Many knee injuries can be treated conservatively with rest, ice, mobilization, and physical therapy. However, other knee injuries will require surgical intervention.

Elbow:

Dislocation of the elbow joint usually occurs as the result of a fall on the outstretched hand, the ulna and radius being displaced posteriorly or postero laterally.It is a common injury in children and also occurs in adults.There may be an accompanying fracture but the dislocation and associated soft tissue injuries are the more important. In fractures around the elbow there is a danger of damage to the brachial artery which could result in a Volkmann’s ischaemic contracture.
Tennis Elbow : There is pain and acute tenderness on the outer side of the elbow, caused by excessive use of wrist extension like carrying a heavy suit case, wrong technique at sports.
Golfer’s Elbow : This is a condition of the pain and acute tenderness on the inner side of the elbow, caused by carrying a heavy suit case, wrong technique at sports.
The pain is made worse by bending the wrist and grasping objects tightly. There may be discomfort in extending (straightening) the wrist also, due to stretching of the affected flexor muscles

Wrist and Hand:

Example: mallet finger, cut tendons, avulsed tendons, boutonnier deformity, swan neck deformity, carpal tunnel syndrome

Foot & Ankle

The bones of the lower limb are mostly weight bearing and so fractures may cause a loss of mobility as the patient may be unable to walk or may need to use crutches, sticks or a frame.
DEFORMITY treated at our clinic for: Club foot, CTEV, Scoliosis, Kyphosis, Lordosis…

Neurological problems / Pediatric Neurology

Cerebral palsy:

The human brain is made of 3 main parts, the cerebrum which accounts for 85% of the brain, the cerebellum and the main stem. The cerebrum is responsible for the voluntary movements of the muscles, thinking, communication and is also associated with the senses of touch, sight etc. Damage to the cerebrum causes problems and the nomenclature attached to these problems is " cerebral Palsy". "Cerebral" means brain and "Palsy" refers to problem in muscle movement. It is essentially associated with children and affects them in different ways. Some children could have severe muscular problems while others might encounter learning problems while still others might encounter speech problems. Children in the first years of life encountered great difficulty in walking, crawling or holding objects. Initially called Little's disease, it is now called spastic diplegia and is grouped under the term "cerebral Palsy".

Is genetic with high concentration of CPK in skeletal muscle. DMD is common.
Clinical presentation is generally clumsy, slow walking, lumbar lordosis, waddling gait (Duck like walking), getting up from the floor starts from going to prone then uses hand to assist in standing and holds his/her knee (Gowers manoeuvre)

Stroke:

A stroke is a serious medical condition that occurs when the blood supply to the brain is disturbed.

Like all organs, our brain needs the oxygen and nutrients provided by our blood to function properly. If the supply of blood is restricted or stopped, brain cells begin to die. This can lead to brain damage and possibly death.

Strokes are a medical emergency, and prompt treatment is essential because the sooner a person receives treatment for a stroke, the less damage is likely to happen.

The brain damage caused by strokes means that they are the largest cause of adult disability.
People who are over 65 years of age are most at risk of having strokes, but they can affect people of any age, including children.

developing diabetes and heart disease, which are two conditions that can cause strokes.
Smoking, obesity, poor diet and excessive alcohol consumption are also risk factors for stroke. Also, conditions that affect the circulation of the blood, such as diabetes or hypertension (high blood pressure), increase your risk of having a stroke.

Strokes can usually be successfully treated and they can also be prevented. Following a healthy diet, taking regular exercise, drinking alcohol in moderation and not smoking will dramatically reduce your risk of having a stroke.

Strokes can be treated using a combination of surgery and medicines. However, many people will require a long period of rehabilitation after a stroke, and not all will recover fully.
Diabetes is also a risk factor, particularly if it is poorly controlled, because the excess glucose in the blood can damage the arteries.

Another possible cause of ischaemic stroke is an irregular heartbeat (atrial fibrillation), which can cause blood clots that become lodged in the brain. Atrial fibrillation can be caused by:
·

• high blood pressure,
• coronary artery disease
• mitral valve disease (disease of the heart valve)
• cardiomyopathy (wasting of the heart muscle)
• pericarditis (inflammation of the bag surrounding the heart)
• hyperthyroidism (overactive thyroid gland)
• excessive alcohol intake, and
• drinking lots of caffeine - for example tea, coffee and energy drinks.

CARDIOPULMONARY REHABILITATION:

Respiration and circulation both are vitals of life.

Lungs derive fresh air from atmosphere and supply it to body through blood and its circulation. Due to atmospheric pollution, smoking, family history , or obstruction in the airways or improper coordination of the lung and heart …. There may be obstruction in airway.
Patient may have problems like cough , wheeze, dyspnoea, cyanosis, sputum retension, deformity(eg;barrel chest), poor posture,respiratory pattern may change

Work related problems:

Repetitive Stress and Work-Related Injuries

Common work injuries include spine disorders – particularly in the heavy machinery industries – and cumulative trauma from repetitive motions, which causes carpal tunnel syndrome and tendinitis. The incidence of cumulative trauma continues to increase as computer usage grows.

For the busy body that you are ………….sitting infront of a computer for long periods often causes neck and shoulder stiffness and occasionally lower back pain.

Physiotherapy has a strong understanding of ergonomics and can work to teach correct posture and behavior modification to prevent injuries. Early stages of patient care include medication, testing and therapy. For chronic problems, the PM&R physician may medicate to reduce pain and prescribe exercise to improve a patient’s physical fitness.

Physiotherapy in obstetrics & Gynaecology:

Antenatal (during) & postnatal (after) pregnancy
Physiotherapist’s role in obstetrics and gynaecology, from the basic sciences through to incontinence, a symptom which causes great distress and restriction of life to so many women and one which can so often be helped by the skills of the physiotherapist.

Obstetric physiotherapists take part in providing education in preparation for childbirth and parenthood. This is an important form of preventive medicine and health education, and parents derive maximum benefit where a team approach operates.

The role of obstetric physiotherapist is to help the women adjust to the physical changes throughout pregnancy and the puerperium so that stress may be minimized.

Physiotherapist will assess and treat any skeletal and muscular problems such as backache and is a skilled teacher of effective relaxation, breathing awareness and positioning and thus helps to prepare the women for labour.

In the post-natal exercises and where necessary give specialized treatments.

Physiotherapy for Senior citizens:

As we age, our bones lose mass as part of the natural aging process – so we are all at risk of osteoporosis. It is estimated that osteoporosis – one in three women and one in 12 men will suffer from the condition over the age of 50. The consequences of osteoporosis can be devastating. Problems range from multiple fractures, specifically in the spine, hip and wrist, changes in posture, deformity such as dowagers hump (collapse of the spine), height loss and pain, all of which could be avoided if people start doing something about it early.

Osteoporosis is a major public health problem that affects both men and women. Women are at higher risk of developing the condition due to the menopause but men can also be affected by the disorder. There are many risk factors associated with osteoporosis such as an early menopause, family history, and smoking to name a few where bone mass levels begin to decrease.”

Physiotherapists are exercise specialists who know what should and shouldn’t be done physically when it comes to treating the condition. They can identify postural problems, locate the source of physical pain and can provide appropriate treatment. They are also experts in prescribing strengthening exercises and can advise on the best ways to manage the condition