Archive | Physiotherapy RSS feed for this section

Pendulum by night – Frozen Shoulder

12 Jan

Pendulum by night:

Many a time patients with frozen shoulder, complain of pain in the night. we as therapists, run out of ideas after a while when nothing works!!

The challenging part with adhesive capsulitis stage 1 and 2 (the inflammation & freezing stages ) the patients feels so uncomfortable in the night.,whatever the position they adopt is uncomfortable. They resort to painkillers, hot packs and end up sleeping in sitting the whole night.

I have advised them not to sleep on the affected shoulder and to lie flat.,but to no avail. So what helps??

If anyone says i can get frozen shoulder alright in two sittings please don’t believe it. I tell all my patients it will take time.,i give them atleast 3-4 months..I will discuss this in detail in another post.

Even when you sleep on the painfree shoulder, the weight of the top hand itself will increase the tension in the shoulder. I have found relief in my patients by asking them to support it on a pillow while sleeping on tummy up and on their pain free sides. kind of a distraction effect.

Recently i understood.,that the pain in the night could be because of the migration of the humeral head towards the acromion and reducing the subacromial space and causing compression of the inflammed tissues and thereby pain.

in the day , the gravity does a wonderful job of distracting the shoulder.,so i have started recommending pendulam exercise in the night.,roll on to the tummy leave your hand out of the cot, pick up the waterbottle next to you and swing 30 reps * 2 sets and trust me it helps. ( just make sure the bed is high enough to swing without hurting your hand, if not get next to the bed, take support, bend your knees slightly and swing)

It gives a traction effect and thereby relieves pain and the patients appreciate this simple tip. Managing pain is very important to get patient satisfaction and we have to do so using our physiotherapy skills , technique and most importantly common sense in most cases!!!

The Six pack secret!!!

29 Aug

Many a times, i have been countered with this question.,How do i get a six pack?? Yes its a sign of a healthy , super fit body.,with our without musculoskeletal injuries, a price you sometimes pay for pushing the limits.

Once one of my celebrity client said.,the 6 pack fad is so rampant that all the film stars want one.,even a cart puller or a farmer in the village or fisherman has one!! The truth is it looks great on some and not so great on few.,the reason you lose fat all over the body and not selectively over abdomen ( There is no spot reduction ). Every man and sometimes women (wash board abs) want it., why my 7 year old nephew was trying to show me one recently.

How do we achieve it?? For me its your lifestyle.,i have seen young tennis / cricket players have six pack without hitting the gym or doing any form of specific drills..its their lifestyle (sport) that gives them.

Well then what about you and me?? Yes of course its possible.,its all about how badly??

In my experience you need to have 3-5% body fat only to have a 6 pack for men. If you are someone looking at a six pack thats what you need to aim at. Give yourself time and work towards it.

Exercise:

You need to burn fat.,moderate intense cardiovascular exercise.,( cycling/swimming/jogging/walking) interspersed with high intensity bouts (cross fit / functional training / boot camp) amounting to not less than 700 calories a day.

Add to that your core training and good strength training (as you may lose your muscle in the process if you don’t train them). The predominant focus should be on cardio vascular activity.

Nutrition / Diet :

Diet plays a major role.,its not about how much you eat.,its about what you eat. what does a farmer get to eat / drink?? The ragi / rice kanji, the buttermilk, milk, vegetables, fish, eggs may be. Cutting of oil, sugar, anything that tastes sweet, be it even fruits.,and switching to millets/cereals, low calorie, low fat, low sugar natural foods is the key,

Plenty of fluids and spaced out mini meals, i recently learnt about eating every hours and handful amount of right kind of food and thats what your body needs. The bottom line you don’t need to starve.

Do not stock high calorie stuffs at home.,or your temptation foods.,that are high in sugar and fat. Do not eat when stressed or when you have nothing to do.,if you have to, snack on fresh vegetables and fruits.

Do not resort to supplements, fat burners or steroids.,may give you short term, quick results in a short time.,but are potentially harmful, most of them, if not all.

Life style:

Its not those two hours you spend in the gym.,its about the rest of 22 hours that matter..if you are a software guy, sitting in front of the computer for 10 hours a day.,its gonna be difficult. if you are a sportsmen, trainer, physio you have a much better opportunity to get one and maintain it.

Stay active is the key!!

Genetics:

If you are blessed with a good gene, with a good resting / basal metabolic rate you are lucky.

Now go get it guys, its simple.,all it takes is only a lot of determination!!

Fascia, the new fitness focus.

2 Jan

Fascia is a systemic net of connective tissue an extra-cellular matrix (ECM), which includes everything in your body that isn’t cellular. It’s a web that wraps your muscle and attaches to the bone. Its also found in internal structures, the viscera etc.

Remodeling and Tensegrity

Just as your muscles remodel themselves in response to training, the fascia remodels itself in response to direct signaling from the cells ; injury; long-held mechanical forces; use patterns; gravity; and certain chemistry within your body

The idea of tensegrity (tension and integrity) and the phenomenon of remodeling are the basis for structural therapy, including yoga and the forms of soft tissue manual therapy, including foam rolling. Change the demand and the fascial system responds to that new demand.

How to Train the Fascia

1.      Specific training can enhance the fascial elasticity

What’s in: Plyometrics: Make use of elasticity of the muscle

Jump drills:  When you land on the ball of your foot, you decelerate and accelerate in such a way that you not only make use of but actually build elasticity into the tendons and entire fascial system.

Stretch – Shorten Fascia:  : Preparing for a movement by making a countermovement—for example, winding up before a pitch makes maximum use of the power of fascial elasticity to help make and smooth out the movement.

2: The fascial system responds better to variation than to a repetitive program.

The evidence suggests that the fascial system is better trained by a wide variety of vectors—in angle, tempo and load

What’s in

Whole-Body Movements. Engaging whole-body movements is the better way to train the fascial system. Every exercise is stimulating multiple nerves, involving multiple muscles and employing fascial tissues all around the site of effort, as well as “upstream” and “downstream” from it.

Proximal Initiation. It’s best to start movements with a dynamic pre-stretch (distal extension) but accompany this with a proximal initiation in the desired direction, letting the more distal parts of the body follow in sequence, like an elastic pendulum. Imagine Throwing.

Adaptive Movement. Complex movement requiring adaptation.

Variable loads build different aspects of the fascia. Sticking with near-limit loads will strengthen some ligaments but weaken others. Varying the load is the better way.

Varying the tempo of your training allows different fascial structures to build strength and elasticity.

3: Proprioception and kinesthesia are primarily fascial, not muscular.

What’s in:

Skin and Soft Tissue Stimulation Enhance Proprioception. Rubbing / foam rolling and moving the skin and surface tissues is important to enhance fascial proprioception.we have seen our ancient wrestlers and kabaddi players rubbing some sand and tapping the muscle before performance.

Feel the Fascial Tissues. Focusing on multiple joint/fascia stretch in a yoga pose can help prevent injury and make the perception of kinesthesia more accurate and fully informed, rather than focusing on an isolated muscle stretch.

Shift from ligaments to Joint-Receptor for stability. Given that the ligaments are often tensed by the muscles, the emphasis on joint receptors for joint position sense, co-ordination and balance with a more general attention to the whole area, from the skin on down to the joint.

A deeper understanding of the role of fascia in training changes your perspective, your work, your words and your effect. Fascia is not just a sling or a wrap. It has a life of its own!!

4. Stretch as a Whole

What’s in

Fascia is a wholistic structure, not starts from one joint and finishes in the next like the muscle. Stretching the biceps or quadriceps alone are not the way ahead.

Stretch your body as a whole, your posterior chain of muscles, anterior, lateral, spiral chain etc.,

Isolated muscle stretches are out and wholistic stretches like yoga, taichi, gymnastic (ballistic) stretches are in!!

 

Prevent Sore Neck / Neck Strain During Ab Workout.

29 May

It’s fairly common to hear exercisers complain about neck soreness or strain from abdominal workouts. This discomfort is most often caused by improper form and it’s very easy to correct.When the head is pulled forward during abdominal exercises, immense strain is placed on the posterior neck muscles. Many exercisers lace their fingers behind their head and pull forward during crunches, for example, thereby making the crunches easier – but also placing unnecessary pressure on the neck muscles.

To prevent neck soreness, change the placement of your hands. Instead of placing your hands behind your head, fold them across your upper abdomen. Alternatively, keep them by your sides. If you want to keep your hands by your head, just touch your ears lightly with your fingertips to prevent any forward pull. In addition, it may be helpful to concentrate on the ceiling. Doing so prevents your head from lifting forward. It may also be helpful to imagine an apple tucked under your chin allowing for space between your chin, neck and chest.

Alternatively, you can try exercises such as the reverse crunch that work the abdominal muscles without involving much upper body movement. Beyond preventing neck soreness or strain, you’ll also be increasing the effectiveness of your abdominal workout. Because lifting your head forward makes the exercise easier, some intensity and effectiveness is lost in the process.

If muscle soreness persists, it’s always a good idea to consult with your physician.

Choosing the Right Foot Wear!!!

7 Mar

Walking and running are a popular form of exercise for many. Trekking is becoming a favorite past time and Running is gaining popularity, with increasing number of mini, half and full marathons happening in our city and so are running injuries. What matters is, are we wearing the right kind of foot wear? Improper foot wear can lead to a lot of Lower body injuries and increased stress on the spine. We see a lot of Increase in the Heel pain, foot, ankle and shin in recent times. Most times caused by improper foot wear. The common foot problems caused by improper foot wear include Calluses, Corns, Plantar fasciitis, heel spur(heel Pain), metatarsalgia (fore foot pain), Tendinitis of the foot muscles, ankle pain, pain in the top of the foot, pain in the lower leg, calf pain, stress fractures of the leg and foot, knee pain etc., There is a lot of misconception, when it comes to picking up the shoe. Some say they pickedup the most expensive shoe, some say it’s a light weight shoe, five finger Vibram, glute toners, rocker bottom and other fancy names to sell the shoes. But what is important is to pick up the right shoe for your foot!!!

Foot Types:

Normal foot : Absorbs Shock well, Well supported with Muscles and has a good alignment of bones. In the pronated(flat foot) and Supinated (High Arch) foot, there is a muscle imbalance and there is improper alignment of the bones and joints leading to improper bio mechanics there by adding stress to the lower limb.

How to choose the right foot wear:

The first step in finding an appropriate shoe is to determine your foot type. The key is to recognize how the foot functions when it’s in motion; however, thinking of the footsteps you leave walking on a sandy beach can be helpful. The over-pronator will leave a full impression of the foot while the under-pronator will leave

only a crescent shape impression with much of the arch missing. Running shoe companies make shoes for the three foot types discussed above.

1.Make sure the shoes have good cushioning, Remember, Only sprinters wear light weight shoes, so do not look for light weight shoes, which most times doesn’t have enough cushioning to absorb the shock.

2. Make sure the mid portion/waist is nice and broad at the bottom if you have a flat foot and the insole/sock liner has an arch support in the inside of the shoe.

3. The shoe should not be too flexible nor too rigid, ideally you don’t want the fore foot of the a shoe to touch the heel pad when you fold. Half way to three fourth would just be fine.

4. Make sure the heel counter is rigid and holds your ankle. Also check if the shoe has adequate Achilles tendon padding.

5. Make sure the toe box is wide and the tongue of the shoe has enough padding.

6. The sole of the foot also is important. If you are going to do a lot of trekking/slippery surface then shoes with rubber studs/cleats will help.

7. Remember to pick up your shoes in the evening change your shoes every 500kms.,those who are diabetics, should consult their physician before picking up the shoes and should inspect their foot quite often and follow good foot care practices as poor circulation and impaired sensation might have caused blisters and infections.

Keep your foot smiling!!!

Preventing Shoulder Injuries

26 Feb

The shoulder is a Synovial joint with a ball & socket orientation allowing multiple degrees of freedom and hence more mobile and less stable, as the bony congruence does not give bony stability, and hence it depends on the soft tissues like capsule, ligaments and muscles around the joint making it vulnerable for injuries. The common shoulder injury in sports being the rotator cuff muscles.,These muscles primarily provide stability for the joint, which means, keeps the ball in the socket, while we do dynamic movements.,like a tennis serve or pulling the shirt etc. the pain in the shoulder can be excruciating and annoying, it painfully takes a long time to settle down.,

They are vulnerable because of the increased movement that’s available and they are precariously placed under the shoulder blade (acromion). Shoulder injuries can be prevented by 1. Reducing the repetitive use & overhead activity (being ambidextrous, bowl on dominant hand and throw on non dominant hand) 2. Strengthening the cuff muscles with a low load high rep program, 3.Good scapular control and posture of the spine and shoulder, 4. avoiding risk taking activities like extreme arm abduction and rotations or pressing more weight than actually you can, 5. ensuring proper flexibility of the shoulder capsule & larger muscles around the shoulder like the pecs, latts and deltoid. 6. Proprioceptive work, an awareness of where the shoulder is in space.,  7. Proper equipment and techniques for the sport or activity