Foot Types.

Foot Types.

1. Fore foot varus – in this deformity the fore foot is inverted relative to the hind foot in subtalar neutral position (also known as metatarsal adductus or varus). Deviations of the fore foot greater than 5° will ultimately lead to foot pain and needs to be treated. The first metatarsal becomes hypermobile. To compensate and allow the fore foot to bear weight during walking, the subtalar and the midtarsal joints pronate. The hind foot is in valgus position.
2. Rear foot varus – in this deformity the posterior surface of the calcaneum is inverted in relation to the ground with the subtalar joint in neutral. As a result of this the plantar surface of the foot becomes inverted and the patient tends to walk on the lateral surface of the foot. During weight bearing, this is compensated by pronating the foot to bring the medial side to ground contact. The first ray is plantar flexed.
3. Fore foot valgus – this is where the fore foot is everted in relation to the calcaneum with the subtalar joint in neutral position. This causes the medial side of the foot to come in contact with ground very early in the gait cycle. The foot may compensate by dorsiflexing the first metatarsal joint (lower first metatarsal), to allow the lateral side to come in contact with the ground. If this movement is insufficient then the midtarsal and subtarsal joints may supinate
4. Rear foot valgus – this happens as compensation to fore foot varus. This may be defined as a deformity in which the heel is everted in relation to the midline of the leg with the subtalar joint in neutral. This causes pronation of the leg and internal rotation of the leg.

Osteoporosis

Osteoporosis
It is a generalised diseases of bone in which there is a marked decrease in the amount of Bone.
· Acc. To WHO Less than 2.5 SD consider as Osteoporosis.
· Common in Post menopausal women, due to decrease of Oestrogen
Common Sites are : neck of femur, proximal Humerus, proximal Tibia, Pelvis, metatarsal bones
Risk Factors:
· Age = Over 50 Yrs
· Sex = women > men
· Race = whites > blacks
· Body type = Small frame > large frame.
· Family history
· Post menopausal.
· Nutritional Factors
· Life style factors
· Medical factors
· Mensural cycle disturbance
Treatment:
· Exercise
· Oestrogen replacement
· Increase calcium consumption
· Weight bearing exercises
· Strengthening exercises
· Walking best exercise increases strength of Lower extremities and Spine

Geriatric Rehabilitation

Geriatric Rehabilitation
Ø Geriatric Rehabilitation is the branch of rehabilitation dealing with alleviative or remedial, preventive or social aspects of the elderly disabled and disadvantaged.Geriatrics is the Branch of medicine dealing especially with the Problems of ageing and disease of the elderly
PRINCIPLES
Ø Ascertain level of function.
Ø Ascertain available resources and options
Ø Avoid im-mobilization
Ø Beware of altered physiological reactions
Ø Determine patients Goals & Motivation.
Ø Determine family expectation.
Ø Differentiate between delirium, dementia, depression.
Ø Emphasis function, management.
Ø Emphasis task specific exercises, simplify program
Ø Encourage socialization and stimulation
Ø Minimize medications
Ø Realize the function may not be regained, recognize that patients have multiple interacting impairments.Understand that improvement occurs in slow increment

OVERUSE INJURY

OVERUSE INJURY
n Anatomical factors
n Excessive body weight
n Imbalance in muscle strength
n Improper shoe wear (specific to activity)
n Improper technique
n Pushing too hard (not allowing for rest)
n Repetition of exercises – no variety
n Training errors (too much, too soon)
n Training surfaces
n Training Climate
n Improper Warm up or Cool down Phase

Individual Joints involvement:
n Back: (low back pain syndrome) caused by anatomical, lack of stretching, imbalance of muscle strength, impact exercise
n Feet/Ankle: (Plantar Fasciitis, stress fractures, bunions, achilles tendonitis) caused by anatomical, improper shoes, lack of stretching, impact exercises.
n Hips: (Psoas bursitis) caused primarily from lack of stretching, improper technique, anatomical, overuse.
n Knees: (Chondromalacia, Patellar tendonitis) usually caused by running everyday, downhill running/walking and muscle imbalance.
n Legs: (Shin splints, Anterior compartment syndrome, Stress fracture) caused by lack of stretching, improper shoe wear, uneven surfaces, repetitive running, muscle imbalance between calves and shins (anterior tibialis)
n Shoulder/Arms: (Subacromial bursitis, Rotator cuff tendonitis) caused by overuse, lack of stretching, muscle imbalance, lifting too much weight, improper technique using weights.
Treatment
Treatment usually given is RICE.
n REST: Essential for healing
n ICE: Reduce pain and swelling
n COMPRESSION: Help to reduce swelling and provide support to injured area
n ELEVATION: Reduces pain and swelling

LATE RESPONSE

LATE RESPONSE IN EMG/ NCV
F- WAVE

l The F wave results from Antidromic activation of motor neurons involving conduction to and from spinal cord and occurs interface between the peripheral and central nervous system.
l Name attributed – Foot muscles. (Magladery & Mc Dougal 1950).
STIMULATION: Supramaximal from any distal muscles by stimulating appropriate nerve.
l 25 % above maximal.
l Not more than 0.5 Hz frequency.
l Electrode placed on a belly tendon montage similar to MNCV.
l Amplifier Gain 200- 500 μv.
l Sweep speed 5-10 ms / div.
l Slight voluntary contraction may enhance F waves.
l F- wave requires amplitude more than 20μv.
l Clinical purpose 10-20 F waves are adequate.
l For study persistent 20 responses desirable.
l Latency, chronodispersion, persistence and amplitude.
l F latency is related to Height, Limb length and Age.
l The correction for these improves sensitivity.
l F latency usually expressed as Minimal latency.
l F wave calculate NCV as well as Proximal conduction time.
l It refers to difference between minimal and maximal latency in a series of F wave.
l It measures range of conduction of F wave.
DURATION
l Tells the number of motor units used
AMPLITUDE
l Refers the Size of motor units
PERSISTENCE
l The Number of Occurrence of response divided by the number of stimuli.
l Refers to the Antidromic activity of a particular motor neuron POOL.
l F amplitude to the associate M is a measure of proportion of motor neuron pool activated by Antidromic stimulation.
l Mean is used to calculate FM ratio.
l Normal F latency in adult 31ms for Hand & 61 ms for Foot.
l Rt to Lt asymmetry 2ms in Hand & 4 ms in Foot.
l Chronodispersion of F wave for abductor pollicis brevis is 3.6+/- 1.2
l F wave amplitude is 5% of M wave.
l Persistence of F wave ab.dm is & adductor hallucis are 0.8 – 0.9
l F differ b/w neonates, child, and limb length.
l Elders have long latency than men.
l F latency in Men 31 ms and women is 34.4 ms
l The Latency can be sensitive measure in Polyneuropathy.
l Abnormal seen in distal motor conduction are unremarkable.
l GBS slowing of F wave.
l Abnormality seen in PNL, Radiculopathy, peripheral neuropathies.
l ALS reduced persistence
l Chondrodispersion increased in Polyneuropathies.Duration prolonged UMN lesions

ARE YOU FIT ?

ARE YOU FIT ?

Fitness is not something that belongs to the young – it’s everybody’s right, no matter what the age…
& How many of you feel that “fitness” is an important part of your job?
& How many of you work out more than 6 days a week?
& How many of you feel that management supports your “wellness”?
Why Fitness?
n Fitness improves overall health.
n An established fitness regime improves personal attitude.
n Helps decrease absenteeism and increase productivity in the workplace.
n Maintaining good physical fitness can improve work and cope up with stress.
In order to have an effective fitness program – you MUST balance all of the fitness components. …… No Short Cuts!
Program starts with
n Warm-Up ( 10—15 Mins )
n Aerobics (Exercise with O2)
n Dumbbell Exercise
n Flexibility (stretching)
n REST…….and Relaxation….. simply named Cool down ( 5—10 Mins)

Swiss ball exercises

Swiss ball exercises
The exercise ball (or Swiss ball or Physio ball) is a versatile piece of exercise equipment available to help people with pain. In particular, many Swiss ball exercises are designed to bring movement to the joint in a controlled manner to keep the joint nourished.
The exercise ball has additional applications in areas such as
 General fitness,
 Strength or weight training, and
 Exercise for pregnant women.
Role of Swiss Ball on Low back pain :
Reducing Back Pain,
Strengthening Core Body Muscles
“The exercise ball - also called a Swiss ball or Physio ball - is a conservative treatment option for back pain sufferers and is designed to help prevent further episodes of low back pain as part of a rehabilitation program. The exercise ball is effective in rehabilitation of the back because it helps strengthen and develop the core body muscles that help to stabilize the spine.
The muscles used to keep in balance on the Swiss [exercise] ball become stronger. Individuals build strength of back muscles and abdominal muscles.
The benefits of Swiss ball are.
Improved muscle strength
Greater flexibility and range of motion of the spine
Enhanced balance and coordination of core muscle groups used to stabilize the spine and control proper posture while using the exercise ball
Increased tendency to maintain a neutral spine position during exercise
Exercise are simple and easy to do
Easy Home programme
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PHANTOM PAIN

PHANTOM PAIN
Phantom pain is described as "cramping, shooting, aching, hand clenched in a tight fist, toes out of joint, frozen or rigid joints, or any combination of these" and usually subsides within a year after surgery
WHY IT OCCURS ???
• Prior experience with pain prior to amputation
• Incorrect surgical procedure
• Climatic conditions
• Stress
• Inactivity

HOW TO TREAT IT ??????
• Psychological Counseling
• P.T Modalities like TENS, US, Massage
• Bandaging, Acupuncture.
• Regular exercise,
• Stretching.

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Effect of ligaments and Muscles in Osteoarthritis

Effect of ligaments and Muscles in Osteoarthritis
Effect of OA Changes in Ligaments
Abnormal joint alignment stresses
Effect of OA Changes in Muscles
Immobility shortens pain, causes guarding and reflex inhibition, leading to weakness
Effect of OA Changes in Bones
Subchondral bone remodeling changes shock-absorbing properties, joint-margin spurring leads to bony blockade and pain
Effect of OA Changes in Extra articular system
Increased energy expenditure from abnormal movement patterns
Effect of OA Changes in Synovium
Abnormal joint alignment stresses
Effect of OA Changes in Articular cartilage.
Thickening to softening, to thinning to loss
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CAN YOU STRETCH YOUR NERVES ?????

CAN YOU STRETCH YOUR NERVES ?????
The muscles, ligaments, tendons even bone has elastic properties and has elastic limit. But we still don’t know the exact limit of elasticity of Nerve. I have certain queries to find out the behavior of nerve when application of tensile stretch.
1. How much load does the nerve requires to cause a conduction block?
2. At what percentage of stretching cause rupture of nerve?
3. When the nerves will behave a plastic property?
4. After releasing of stretch does the nerve regenerate?
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TRANING EFFECT ON LIGAMENTS

Physical training has found to increase the tensile strength of ligaments,
Physical training produces considerable effect on ligaments.
Tipton et al., tries to find out the strength of MCL in dogs.
He concluded in his study that the strength of MCL develops in dogs as a result of training. The ligaments in the trained group are stronger and stiffer than the control group.
Immobilization found decrease strength in Ligaments--Aminel et al.,
Following immobilization when a load is applied to ligaments results in failure
Noyes et al., found there is about 39 % of decrease of stress tolerance in ligaments following immobilization
Immobilized ligaments displayed more elongation and significantly less stiff.
Following immobilization if ligaments are trained it need considerable time to develop its strength.
Aminel et al., found strength training to ligament injury has to be started as soon as possible to get back the ligament in normal

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