NECK PAIN

NECK PAIN

The neck (cervical spine) is composed of vertebrae which begin in the upper torso and end at the base of the skull. The long vertebrae along with ligaments provide stability to the spine. The muscles allow for support and motion.

Neck pain or cervical spine pain is a common ailment occurring in all age groups affecting 50 – 70% of people. Prevalence of neck pain was diagnosed to be common in women 48% than in men 38%.

The neck can be vulnerable to injury and disorders that produce pain and restrict the motion. Since, it is less protected than the rest of the spine.

The most common cause of neck pain is soft tissue abnormalities due to injury or prolonged wear and tear. The factors which cause repetitive strain on soft tissues are prolonged sitting postures in computer professionals with out adequate support, forward head posture, faulty postures during sleep, and overhead tasks in electricians, painters and machine operators.

Proprioception is defined as the perception of positions and movements of the body segments in relation to each other. When there is damage to the mechanoreceptors in the joint, the persistent presence of pain inhibits the surrounding musculature to contract, which impairs the threshold of Proprioception leading to the recurrence of the symptoms.

Cervical spine pain is treated depends on what diagnosis it reveals and most patients are treated successfully. A better understanding of the variety of spine pain population is to cost-effective assessment and management necessary for primary spine care specialist.

To make the rehabilitation holistic, it is necessary to retrain Proprioception of the joint which helps in the reduction of neck symptoms and improvement in general health for self-experienced working ability.

OSTEOPOROSIS

Five Fundamental steps to maintain bone health

A. Encage in regular PHYSICAL ACTIVITY 30 minutes per day for 3 to 5 days per week

B. Take medications if need and do check for Bone mineral density once a year.

C. Consult family doctor about bone health and maintenance.

D. Intake of recommended amount of Calcium and vitamin D.

E. Avoid smoking and Excessive alcohol.

Geriatrics

Geriatrics is the branch of medicine dealing especially with the problems of ageing and diseases of the elderly. People are classed as elderly on reaching up to the age of 60 years, but in the 21^st century due to the high standards of living have increased the life expectancy up to 75 years.

The increasingly ageing population presents unique challenges for rehabilitation medicine. One third of the population over age 65 – 75 years experiences one fall per year. In the elderly population Falls are common in old age, Falls have been highly associated with the muscle strength, alternation, altered stride characteristics balance etc..

Frequent Falls and difficult in doing functional abilities are particularly likely to occur due to ageing process or weakness. These impairments may have an addition or interactive effect on an individual’s level of mobility mainly on doing functional tasks.

Fall is an event in which a person comes to rest inadvertently on the ground. A fall can result in disability by decrease in confidence, restricting mobility causing injury and debilitation and resulting in loss of independence. Old people need to strengthen their muscles in order to reduce their risk of falling and improve their functional ability. (Simpson 1993). Strict observation in home circumstances is necessary to achieve the sufficient intensity to the exercise program as in hospital setting.

Functional activities are highly skilled movement pattern which have been developed and refined with many years of practice. The leading factor to a decline in function in elderly people is lack of practice to these functional activities leading to a downward spiral in ability.

Exercise is a great way to keep older people active and function, but should be approached with caution. Exercises should not to be vigorous to be beneficial. Mild, regular and functional exercise is the key factor for staying healthy and happy.

EXERCISES BOOST IMMUNE SYSTEM

EXERCISES BOOST IMMUNE SYSTEM

• Increase oxygen
• u Clearing the body toxins
• u Deepening the breath & stimulate lymph system
• u Delivering immune cells to their sites of activity
• u Shifting out the adrenaline mode
• u Stimulation of Neuro transmitters that provide a sense of well being.
• u Boost production of macrophages

• u During exercise the immune cells circulate throughout the body more quickly and are able to kill bacteria and viruses

• u Regular exercises help to build up the Immune system and also it prevent diseases.

PROTOCOLS

u Duration : 20—30 minutes

u Frequency : 4 days per week

u Walking

u Bicycling

u Light Gym workouts

u Playing Golf, Shuttle..

Bony Configuration LUMBAR

Lumbar spine is a single functional unit composed of 5 vertebras forming a motion segment connected in series each motion segment consist of 2 adjacent vertebral bodies and connected by Intervertebral disc, Ligaments and muscles^1,4,6.

Bony Configuration

Vertebra consists of anterior block of bone – The body.

Posterior bony ring consist of Neural arch – containing articular, transverse and spinous processes.

Neural arch consist of two pedicles and two lamina from which arises the seven processes – one spinous processes, Two Transverse processes and four articular facet^.

Adjacent Vertebra is connected together by Intervertebral disc, contributing 20 – 30 % of the spinal length^.

Ligaments

Six Ligaments

Anterior longitudinal Ligament, Posterior longitudinal Ligament, Capsular Ligament, Ligamentum Flavum, Interspinous Ligament, Supraspinous Ligament.

CAUSE OF LOW BACK PAIN

Physical work factor

Heavy manual work

Lifting and twisting

Postural stress – sitting and driving

Whole body vibration

Psychosocial work factors

Societal influences

Monotonous work

Lack of personal control – Tension, Stress, Anxiety, fear and depression.

Low job satisfaction

Physiological factors

Low physical fitness

Inadequate trunk strength

Personal risk factors

Heredity, sex, age, body built, smoking, social class.

Patellofemoral pain syndrome (PFPS)

Patellofemoral pain syndrome (PFPS) is one of the prevalent musculoskeletal injuries seen by physiotherapist and sports medicine practitioners. (Clement et al., 1981). The etiology of PFPS is not clearly understood. It may occur due to variety of factors including lower leg and foot mal alignment. Abnormal position of the Rear foot tends to cause abnormal movement in the associated joints like Knee, Hip, Pelvic & SI joint.

Patellofemoral pain may affect as many as 25 % of athletic population.( Mcconnell. 1986). Patellar problems are common in adolescents and distance athletes (runners, cyclists). (Christopher Hess,2003). Patient usually active and Young complain of retropatellar or peripatellar Pain. It results from physical and biochemical changes in the patellofemoral joint. (Rothbart BA, Estabrook 1998).

Excessive Pronation of the Subtalar Joint leads to Patellofemoral Pain. (Buchbinder 1979).The Excessive subtalar joint Pronation may delay External rotation of leg, and therefore inhibit supination of Foot. (Donatelli, 1987). Excessive Rear foot Pronation leads to Tibial Internal rotation which translates abnormal stress in Knee cause pain in anterior area of knee. (Buchbinder et al., 1979, Donatelli 1987, Kaufman et al., 1999).

Patients with patellofemoral pain syndrome have anterior knee pain that typically occurs with activity and often worsens when they are descending steps or hills. It can also be triggered by prolonged sitting.( Cutbill JW 1997.) It is precipitated by sitting for prolonged periods (Movie – goer sign).One or both knees can be affected. Consensus is lacking regarding the cause and treatment of the syndrome.

BYSSINOSIS

BYSSINOSIS

Derived from Greek—Flax

Clinical Symptoms:

Tightness of the chest Cough
Asthmatic wheezing
Fever
Also called as Monday fever or Monday sickness Since after a day breaks the person’s feel reappearance of symptoms.

Pathology :
Mechanism of bronchial reaction is not uniformed in all patients
Initially it produces Broncho spasm,
Oedema of respiratory mucosa Lung muscles (i.e) Smooth muscles & Mucous glands of central airway are hypertrophied.
It has both features of Chronic bronchitis & Emphysema.

GRADES :

• Grade 0 – Symptom less on Monday
• Grade ½ – Occasional chest tightness on the 1st working day of the week or mild symptoms such as irritation of the respiratory tract.
• Grade 1 – Chest tightness or Breathlessness on the 1st day of the working week only.
• Grade 2 – Chest tightness or Breathlessness on the 1st day & other days.
• Grade 3 – Chest tightness or Breathlessness accompanied by permanent respiratory incapacity from reduced ventillatory capacity

TREATMENT: Same as COPD No special tretment is for THIS

HAZARDS IN MEAT CUTTING INDUSTRY

HAZARDS IN MEAT CUTTING INDUSTRY

The Hazards are grouped as follows
1) Back injuries
2) Cumulative trauma disorders
3) Falls
4) Infectious diseases.
5) Knife cuts
6) Toxic substances

Back Injuries

Repeated bending activities roots to back injuries
Heavy carrying luggage’s on the back
Lower cutting table causes more stress to low back
Prolonged standing also cause stress to back

Cumulative trauma disorders

Tendonitis – Inflammation of tendon sheath due to repeated activities
Carpal tunnel syndrome – Repeated Movement of wrist cause compression at the nerve and other structures around the wrist results in Pain , Numbness, Paresthesia.
Prolonged condition leads to motor loss and sensory loss.

Falls :

Represent greater source of serious illness Causes of Falls are
 Animal fat accumulate on the floor
 Blood
 Floor surface tend to wet
 Leaking Pipe
 Nature of work,
 Poor drainage &
 Slippers

Infectious disease:

Brucellosis, Erysipeloid, Leptospirosis, Dermatophytoses & Warts.

Brucellosis:
It is a Bacterial infection Transmitted by handling cattle
Signs
1. Head ache
2. Joint Pain
3. Loss of appetite
4. Night sweat
5. Running fever
6. Weakness

Erysipeloid :

It is a Bacterial Infection Spread through animals
Signs
1. Redness
2. Irritation

Leptospirosis :

It is a Bacterial Infection Spread through Direct contact with Infected Animal, water, Soil
Signs
1. Muscle ache
2. Chills
3. Eye irritation
4. Fever
5. Kidney/ Liver damage
6. Vomit

Dermatophytoses

Also known as Ring worm It is a Fungal Infection
Transmitted by contact with hair & skin of infected person
Sings
1. Hair fall
2. Small yellowish cup like crest to develop in scalp

Verruca Vulgaris:

It is a Viral Infection Transmitted by use of Towel, Meat, Fish Knife and Work tables

KNIFE CUTS

It is the major cause of Cuts and Abrasions to the Hands and Torso.
Workers have also been cut by other worker as they remove their knife from a slab of meat (Neighbor Cuts) Occur in over crowding working conditions.

TOXIC SUBSTANCES :

Workers exposed to Ammonia Ammonia used in refrigerators which leaks result in irritation in skin & Mucous membrane
Ammonia gas also irritate to Eyes, Head ache, Salivation, nausea, Perspiration, Vomiting, & even deaths.
It also aggravates Cardiac problems and Respiratory problems.


PREVENTIVE METHODS

Sharp knife prevent Musculo skeletal injuries, since sharp blades reduce grip force & cutting time
 Cut away from not towards—cutting stand to the side of the cut to keep blade away
 Replace or Tighten the Hand grips of Knives.
 Use correct Knife
 Use cutting board for chopping
 Use food pusher in advanced machines, not Fingers
 Use stabilizing tools don’t use finger since it may cause cut
 Wear appropriate gloves

FIBROMYALGIA

FIBROMYALGIA

It is a disorder causes Muscle Pain & Fatigue
Fibromyalgia subjects have “Tender points” in their body

SYMPTOMS

Pain through out the body
Especially Shoulder, Buttock, Neck, Low back
Sleep Disorder
Morning Stiffness
Head ache
Painful Menstrual cycles
Tingling or Numbness in Hand & Feet
Problem in Thinking & Memory ( Fibro Fog)

CAUSES:

Stressful traumatic events
Repetitive injuries
Illness
Certain diseases

PREDISPOSING FACTORS:

Rheumatoid Arthritis
SLEAnkylosing spondylitis
Stress
Weather

TREATMENT

Medications ( Analgesics, NSAID, Antidepressant)
Sleep
Diet
Massage
Exercises
Work environment Modification


SELF CARE:

Reduce stress
Well Sleep
Exercise
DIET
Massage

REDUCE STRESS:

Avoid situation that cause Stress
Take time to relax
Breathing Exercise
Guided Imagery
Meditation
Yoga

SOUND SLEEP

Go to bed early
Avoid caffeine
Good mattress
Say no to alcoholic

EXERCISES:

Stretches
Low intensity Aerobics
Walking, Swimming
Bicycle
Calisthenics
Tai Chi

DIET

Avoid Caffeine
Avoid Alcohol
Proper Vitamin
Balanced Diet
Quit Smoking

Effect of OCCUPATIONAL INJURY

Spinal problems: One of the commonest areas which get problem due to Lifting activities, prolonged standing, lengthened walking and frequent stair climbing. The common problem area is at the Neck and Back. Low back pain is more prevalent in physiotherapist. It is about 48 % of the physiotherapy population. ( Mary .w. kelly. 2005). 

Neck pain is also one of the common problems encountered by physiotherapists, It occurs due to prolong bending of the neck during treatment or during computer operation for discharge summary or documentation. About 33% of individuals are suffering with Neck pain. 

Hand & Fingers: Hand and fingers are the other common area which gets involved following physiotherapeutic treatment. Finger strain occurs as a result of massage application for a long duration or Quite a lot of patients. Thumb strain occurs as a result of the application of manual therapy techniques for a long time. Approximately 23% affected following thumb injury. Wrist problems occur as a result of application of massage technique or by administration of Chest physical therapy techniques (Clapping). 

Large Joints: Weight bearing or large joints go for degenerative changes following prolong occupational hazard. Standing for a long duration causes abnormal loading in joint tends to cause damage to the articular surface (Structure present in the bony ends) which results in degeneration. PREVENTIVE MEASURES: Variety of measure taken to prevent occupational Hazards in Physiotherapy practice. There are certain things therapist can do to combat their risk of injury. Simple steps done before and during tasks can help the body counter strains that come with the occupation. 

Stretching : Warming up prior to the activity makes general body conditioning and prevent fatigue and muscle strains. 

Correct Posture and Positions: Performing each Task in correct posture and position prevent excessive stress in the joints. Frequent break between the work. Outsourcing : Obtain assistance from another individuals to reduce load during task like transferring patient or working with heavy patients. 

Modify : Modifying techniques or environment to avoid stress put on the therapist body prevent injury. Make adjustment to posture by modifying Bed height, Pause to stretch and frequent change in positions. Avoid bending activities which cause Low back pain. 

Reactive : Respond to discomfort or injury. If use of thumb mobilization cause pain then change to Knobbler (A hand held plastic equipment use to treat) which replace role of thumb, Choose an Electro modality to treatment for replacing manual therapy techniques. Reducing the working hours till the wound gets healed. 

Use of Aids : Use belts for transfer as well as treatment. Use stool to obtain any equipment from the upper berth. Use Mask while treating patient in ICU. Earth circuit should connect to prevent shock. Proper aid should be used for prevention from exposure of radiations like wearing Goggles, aprons, Ect...

PIRIFORMIS SYNDROME

Piriformis syndrome is an often misdiagnosed cause of sciatica, leg, or buttock pain, and disability. The sciatic nerve may be compressed within the buttock by the piriformis muscle, with pain increased by muscular contraction, palpation, or prolonged sitting.
The piriformis syndrome is a condition in which the piriformis muscle irritates the sciatic nerve,
This referred pain, called "sciatica", often goes down the back of the thigh and/or into the lower back.
Patients generally complain of pain deep in the buttocks,
Worse by sitting,
Climbing stairs, or
Performing squats.
The piriformis muscle assists in abducting and laterally rotating the thigh.
This is the action of the right piriformis muscle
It balance the left foot, move the right leg directly sideways away from the body and rotate the right leg so that the toes point towards the ceiling.

TREATMENT:
§ Stretching exercises and
§ Massage.
§ Anti-inflammatory drugs prescribed.
§ Cessation of running, bicycling, or similar activities may be advised
Stretching:Lie flat on the bed. Bend the legs to 90º the knee, lifting the feet in the air. Let the feet spread apart from each other, keeping the knees together

DIABETICS -- An Introduction

IDDM

IDDM is associated with inflammation of the ilets of the pancreas and appears to be an autoimmune response.
Infection with Coxsackie’s viruses B has been shown to be the likely trigger of the autoimmune response
Other Etiological factor is inherited susceptibility after infection with virus, the beta cells inappropriately express an antigen.
The antigens on the beta cells are recognized and destroyed by circulating T cells.
The process of cellular destruction is marked by the appearance of Islet cell antibodies.
Some time the Pancreas will attempt to produce near – normal or normal levels of insulin during a “Honey Moon” Phase. Usually noticed after initial diagnosis. This phase may last upto 6 months or longer, but in true DM, the patient will develop signs of hyperglycemia again.

NIDDM

Refractoriness to insulin in the cell membrane receptors causes NIDDM
In Obesity, the pancreas cannot compensate for problems in the receptors by increasing insulin production. Some newer theories suggest that over time, the high levels of circulating insulin that occur with obesity “Insulinise” the cells, making them resistant to the action of insulin

DIAGNOSTIC ASSESSMENT:
1. Blood Glucose
2. Fasting Blood Sugar
3. Post Prandial Blood Sugar
4. Blood Glucose finger sticks
5. Glycosyloted haemoglobin
6. Glucose tolerance test. (GTT).

MEDICAL MANAGEMENT:

There is No cure for Diabetes.
Diabetes control depends on the proper interaction of 3 factors.
1) Diet.
2) Insulin or oral medication to lower blood glucose.
3) Exercise.

DIETARY:
The dietary management is the cornerstone for diabetes. The balanced nutritional plan for patients with diabetes has a two fold purpose
1) To discourage the ingestion of food with high sugar and fat content
2) To correct or avoid Obesity
The current recommendation for the distribution of calories are
-55 to 60 % of CHO
-30 % of FAT
-12 to 20 % of PROTEIN

PHARMOCOLOGICAL MANAGEMENT:
Oral hypoglycemic agents:
Oral hypoglycemic agents are not insulin. They lower the Blood glucose in part by stimulating the pancreatic beta cells to release insulin.

First generations:

1) Talbutamide (orinage)
2) Tolazamide ( tolinage)
3) Acetohexamide (dymelor)
4) Chlorpropamide ( diabinase)

Second generation:

1) Glyburide
2) Glipizide

Insulin therapy:

Patients with IDDM must inject insulin daily to survive. Some patients with NIDDM may require insulin if diet , exercise & oral hypoglycemic agents are ineffective.
Some medications such as Prednisone may elevate blood glucose levels & necessitate insulin injection for a time.
Insulin lower blood glucose by
1) Promoting the transport of glucose into cells
2) Inhibiting the conversion of glycogen & amino acids to glucose.

TYPES OF INSULIN:

1) Rapid Acting – eg Hunulin R ( 6- 8) hrs duration
2) Intermediate Acting -eg Lente insulin ( 6- 12) hrs
3) Long Acting -eg Protamine zincinsulin ( 18 – 24) hrs
If Blood glucose is difficult to control, two different insulin can be mixed & administerd as a single injection.

EXERCISE:

A program of planned exercise can greatly benefit the patient with diabetes.
1) Lower blood glucose by increasing CHO metabolism
2) Facilitates weight reduction & proper weight maintainence
3) decrease Blood Pressure
4) Decrease Stress & tension

SURGICAL MANAGEMENT:
Pancreas transplants

MOTIVATION

Motivation is the process
a) of Arousing or initiating behavior
b) of sustaining an activity in progress
c) of Channeling of activity in the given course
Determinants of Motivation
Unending process.
A psychological concepts.
The whole individual is motivated.
Motivation may be financial or Non financial.
Frustrated cannot be motivated
Goals are motivators

Unifying force
Motivation can be positive or negative
Motivation & job satisfaction are different

Determinants of motivation

Ø Forces operating within the individuals
Ø Forces operating within the organizations Forces operating in the Environment

A STUDY TO DETERMINE THE EFFECTIVENESS OF VERTICAL OSCILLATORY PRESSURE ON PAIN AND CARDIOVASCULAR RESPONSE FOR NECK PAIN PATIENTS.

A STUDY TO DETERMINE THE EFFECTIVENESS OF VERTICAL OSCILLATORY PRESSURE ON PAIN AND CARDIOVASCULAR RESPONSE FOR NECK PAIN PATIENTS.
AUTHOR : B.ARUN.MPT,CMPT*. B.GANESAN. MPT**.
*Physiotherapist, K.G.Hospital, 18, Arts College Road, Coimbatore-18.
** Principal, Infant Jesus College of Physiotherapy, Bangalore.
Purpose of the Study:
This study was aimed to ascertain the immediate response of Neck pain to Vertical Oscillatory pressure and to establish the effect of Cardio vascular responses.

Methods: An experimental Pre Test Post Test Same Subject design was selected for the study.20 subjects with Neck Pain were selected by Cervical Mobility Test. Pre treatment assessment of Pain, Blood Pressure and Heart Rate were Measured. Post Treatment assessment of Pain Heart rate Blood pressure were measured immediately and After 5 Mins following Vertical Oscillatory Pressure.
Parameters: Borg Scale, and Sphygmomanometer.

Result:
Neck pain Intensity decreased from very Uncomfortable to very mild after Treatment (t = 12.83, p > 0.05%)
There are no significant changes in Heart Rate Systolic Blood Pressure Diastolic Blood Pressure In Immediate and 5 Mins after Vertical Oscillatory pressure.

Conclusion:
Vertical Oscillatory pressure relieves Neck Pain with out inducing significant myocardial stress or alteration in cardiovascular function suggested by variables measured in the study

A CORRELAITON STUDY TO ANALYSE THE RELATIONSHIP BETWEN REAR FOOT VALGUS AND ANTERIOR KNEE PAIN.

A CORRELAITON STUDY TO ANALYSE THE RELATIONSHIP BETWEN REAR FOOT VALGUS AND ANTERIOR KNEE PAIN.
AUTHOR : B.ARUN.MPT,CMPT*.
*Physiotherapist, K.G. Hospital, 18, Arts College Road, Coimbatore-18.

INTRODUCTION:
Abnormal position of the Rear foot tends to cause abnormal movement in the associated joints like Knee, Hip, Pelvic & SI joint. Excessive Rear foot Pronation leads to Tibial Internal rotation which translates abnormal stress in Knee cause pain in anterior area of knee.
Purpose of the Study:
Purpose of the study is to determine the relationship between the Rear foot abnormality (Valgus) and anterior knee pain.
Methodology:
A total of 50 subjects were selected by convenient sampling method with the age group range form 18—27 yrs. Subjects were chosen following an inclusive criteria and an informed consent was obtained. Study was conducted for duration of 6 months. And the parameters are Anterior knee pain and the Rear foot abnormality was assessed to the subjects. Anterior knee pain was assessed by using VAS pain scale, where as the Rear foot abnormality was measured using Goniometer, before measurement of rear foot abnormality Subtalar neutral was found.
Result:
The results were calculated using Kearl pearlson’s correlation coefficient.
It analyses the relationship between the Anterior knee pain and Rear foot Valgus. The result found that it has a strong negative correlation of 0.90. This shows that the anterior knee pain occurs following abnormal rear foot positions.

Conclusion:
The study concluded that abnormality in the Rear foot will cause a significant changes in Knee tends to cause knee pain.

FORWARD HEAD POSTURE

FORWARD HEAD POSTURE

Forward head posture is a clinical entity that has been identified by multiple authors as a significant factor in a variety of musculoskeletal pain syndromes .
Donatelli R, Wooden M. 1989
Cailliet R , 1977
Haughie L J, Fiebert IM ,1995
Adaptive shortening of soft tissues and muscle weakness, caused by prolonged poor postural habits is considered to be a Postural dysfunction.
KISNER AND COLBY.
Therapeutic Exercise, 3rd edition,
Each inch the head is held forward of neutral, requires the exertion of 15 to 30 pounds of extra muscle tension to hold the head erect.
Increasing chronic loading on the vertebrae and intervertebral discs.
Rene Calliet, MD, 1985.
Dysfunction Mechanics
Mal-Posture is the common for causing Mechanical Dysfunction.
Cervical spine is stabilized by Soft tissues surrounding the joints.
In abnormal posture, Head & Neck is Counter balanced by passive tension in soft tissue structures.
The Most common dysfunction in Neck is Forward Head Posture.
FHP mechanics
A Neutral & Erect posture of Head & Neck provided by
Optimal balance,
Muscular coordination,
Minimal energy expenditure and
Minimal stress on supporting structures.
Any alteration in the Normal result in poor posture.

COMMON COMPLAINS
u Head ache
u Cervical Dysfunction
u Thoracic Outlet syndrome
u Cervical Spondylosis
u Breathing Difficulty
u TMJ Dysfunction
u Shoulder Impingement syndrome

Prevention & Treatment
u Strengthening of neck muscles by
Ø Stretching
Ø Breathing exercises
Ø Neck support by pillows
Ø Posture correction
Ø Ergonomic Advices

REDESIGN THE ROLE PHYSIOTHERAPIST IN COMMUNITY SETTINGS

REDESIGN THE ROLE PHYSIOTHERAPIST IN COMMUNITY SETTINGS

“Limit the disability and Lead the Quality Life”

Author : B.Sharmila, K.Kadhambari.BPT,

K.G. College of Physiotherapy,

K.G. Hospital, Coimbatore.

Introduction :
Physiotherapists play a foremost role in all areas of Rehabilitation. Community rehabilitation is one of the central parts of Physiotherapists work.

Rehabilitation in Community is defined as training in the people with disabilities at their own area.
Recent survey shows there are about 3 lacks people with disabled live in INDIA. About 2 lacks are living in villages.
Appropriate rehabilitation at the community level is essential to prevail over the disabilities. Physiotherapist can play an immense role in rehabilitation undoubtedly in community setup.
Physiotherapist can be a Team leader in the community, Collaborative work is the nature in Community, and each and every member in the Team has a definite role to do. In community every one is accountable for the patient.

Vital role of Physiotherapist in Community

Physiotherapist care starts from the Root to the Fruit.
Physiotherapist not only Treat the patients in Community they also play a major role in Prevention of disease and Disability.
Physiotherapist should have abrupt knowledge in field so that he can do Diagnose, Prevent & Treat the diseases in community.

Levels of Prevention

Primoidal prevention
Ø By teaching Healthy habits we can prevent diseases &
Ø Routine exercises should be incorporated to prevent ailments.

Primary prevention
Ø Health promotion — Promotion of health helps in prevention of diseases
Ø Specific promotion — Promotion of particular habits to prevent rapid spreading of diseases

Secondary prevention
Ø Early diagnosis and treatment — Regular Screening at the school level or at the area helps in early diagnosing as well as preventing diseases and can given a proper treatment & advices.
Ø Limit the compilation — Early diagnosis helps in limiting complication of the diseases and check further dispersion of infections.

Tertiary prevention
Ø Restoration of Function
Ø Restoration of the capacity to earn a lively hood
Ø Restoration of family and social relationship
Ø Restoration of personal dignity and confidence.

There are lots of role Physiotherapist have to play in the community. If they develop their skills in earlier diagnosing and appropriate treatment they can excel in the community.
Conclusion
Physiotherapist aims to prevent the disease and there by promoting their abilities and they can limit the disabilities. As a Physiotherapist we can make the Disabled as Differently able.

“We care for your abilities and we cure your disabilities”

PHYSICAL THERAPY INTERVENTION FOR TREATMENT OF PREMENSTRUAL SYNDROME

PHYSICAL THERAPY INTERVENTION FOR TREATMENT OF PREMENSTRUAL SYNDROME

Author: G.Thilagavathi, BPT, MIAP.

Premenstrual syndrome (PMS), also known as premenstrual tension (PMT) or premenstrual dysphoric disorder (PMDD). It is a term used to describe some of the physical & emotional changes which occurs before the period. These changes can occur a few days to more than a week before the beginning of the period & usually resolves when the period starts.

PMS is very common because of the diverse life style which paves the way for this syndrome. PMS causes physical & emotional changes, which can be changed by appropriate Physiotherapy.

Symptoms of this syndrome are-
ü Headache,
ü Migraine,
ü Sleeplessness,
ü Tiredness,
ü Difficulty in concentrating,
ü Decreased efficiency,
ü Tension anxiety,
ü Mood swing (depression, irritability,& anger),
ü Food carving,
ü A bloated feeling in the abdomen.

Some women suffer many of these symptoms some only a few. In some women the symptoms are mainly physical and in others emotional symptom are the most prominent.

These symptoms will reduce the working stamina in both working place & in the home & this will alter the working environment Thus it can be reduced by
ü Exercise therapy
ü Diet
ü Nutritional supplement

EXERCISE THERAPY;
Women who exercise regularly report fewer headaches, less period pain. Studies have shown that regular exercise that increases your heart rate is beneficial for premenstrual symptoms. Exercise should be enjoyable and helpful
Lot of exercises useful for the syndrome.
ü Aerobics exercise
ü Yoga
ü Swimming
ü Cycling
ü Walking
ü Dancing

DIET
A balanced diet supplies vitamins & minerals necessary for good health. Heavy periods can lead to iron deficiency and result in anemia or excessive tiredness, so diet should iron rich food (liver, meat, sea food, dried fruits, wholegrain cereals, egg yolk &dried peas, beans & lentils).
NUTRITIONAL SUPPLEMENTS
Calcium supplement have been shown to be effective in PMS

CONCLUSION
In addition to Aerobic exercises and Yoga which relaxes the body and mind, Exercise programme, Diet and Nutritional supplement should also be used to reduce the
Symptoms.
There are many more problems like this, we physiotherapist should be aware.

Shifting the Borders of PHYSIOTHERAPIST in ACCIDENT & EMERGENCY DEPARTMENTS

INTRODUCTION:
As a Medical practioner, how many of us know the Emergency ambulance number to call ? Probably 95% would not know.
Accidents can occur at any times and any places usually at Odd times and at Places where a doctor would not be expected to be.
Injuries are a common cause of Death, Most of the Deaths due to injuries may be unavoidable, but prompt care saves life.1
Early skilled care can reduce the extend & duration of damage and return the patient into his community in earlier period.2
Emergency medical service is a life saving service, it is a chain of human & Physical resources, brought together to provide total patient care. 3, 4
Emergency triage is a process of sorting or classifying patients according to the need for Emergency treatment & potential for further injury. Triage comes from French. 5.
The health care industry is becoming more complex, there are considerable personal shortages in many of the professional disciplines.
Physiotherapists are responsible for providing quality services and care for patients. Still they can provide more services if they extend their area.
This article focuses role of physiotherapist in Accident & Emergency situations through Available literatures. The available literatures for the Role of Physiotherapist practioners in Emergency department are severely limited.
There are Major Benefits for employing Physiotherapist practioner in Emergency Department. 6, 7.
Ø Enhance the ability of department
Ø Reduce the Waiting time for patients.
Ø Reduce Hospital admissions
Ø Treatment applied on the site of injury
Ø Help to manage the increasing load
Ø Being a part of flexible & responsive work force
Ø Giving timely & Quality care
Ø Improving access to most appropriate emergency practioner.

The Major Disadvantage for not applying physiotherapist in Accident & Emergency situations are. 6
Ø Lack of Communication Skills
Ø Deficient in Hands on approach on First Aid.
Ø Insufficient knowledge in Emergency Code/ Colour.
Ø Not knowing to apply POP
Ø Poor Knowledge on Monitors.

Physiotherapist can reduce the number of admission in hospital. A study on COPD patients’ states that Exercises delivered in the Community will reduce the number of hospital admission and ease the burden on waiting list. 8
Physiotherapist work successful in all areas in U.K, Physiotherapy Triage was successfully trialed in the Emergency department of Royal Melbourne Hospital in 2004, where a Physiotherapist found vital in reducing waiting time and total treatment time for emergency patients with Musculoskeletal injuries.
Jibuike et al., conducted a study on “ Acute Knee screening service” shows that Physiotherapist can reduce number of patients in Trauma & Accident & Emergency clinics.
Jibuike et al., also found that Physiotherapy practioners could diagnose knee conditions better than Accident & Emergency Senior house officers. 9
The Role of the Accident and Emergency extend scope of Physiotherapy practioners with the ability to treat patients autonomously can be challenging for both the practioners & other health care providers whose professional boundaries have been crossed. 10
Conclusion:
There are clear advantages in having Accident & Emergency extend scope Physiotherapy practioner in emergency departments particularly for patients with Musculoskeletal injuries.
Physiotherapy practioner are already providing a valuable resources for the A& E team members and their role fits in with the ‘See and Treat’ and minor injury streaming systems that the department of Health. 12
Suitably trained and Qualified physiotherapy practioner can lead Accident & Emergency soft tissue injury review clinics, thereby freeing up senior doctors for other duties. 11

Bibliography:
1) John Norman (1978) “Management of injured patients” Mc Milan journal limited, USA.
2) Easton. K (1970) “The general practioner and the rescue services” community health. Bristol.
3) Herbert J. Proctor MD( 1979) “Management of Acute trauma” Year Book Medical publishers, USA.
4) Gene Weatherall. (1983) “Instructors guide for emergency care” Prentice—Hall Publishing, Mary land.
5) Jean H Roger.(1989) “Emergency Nursing—A Practical guide” William & Willikins, USA.
6) Bethel J (2005) “The role of the Physiotherapist practioner in Emergency departments: A critical appraisal, Emergency Nurse.
7) Department of Health (2003). “Work force matters: A guide to role redesign in emergency care. The stationary Offices, London.
8) Kathleen Philip (2006), “Physiotherapy can reduce Hospital admission” Australian journal of Physiotherapy.
9) Jibuike et al (2003). “Management of soft tissue knee injuries in an Accident & Emergency department.
10) Mike smith ( 2004). “Collaborative working” Emergency nurse.
11) Boyce S ( 2003) “ The Physiotherapist practioner: Extending the role of the physiotherapist. Emergency medicine journal.

Author: B. Arun., MPT, CMPT,

Efficacy of sensorimotor training in the rehabilitation of improving function and Proprioception of patient with Osteoarthrosis of Knee

The knee joint is commonly involved area which gets degeneration. The treatment requires great skill and perfection to bring the patient into the track of work.

Osteoarthrosis causes much musculoskeletal pain and disability. Patients suffer prolonged pain and disability some of the patients suffer with deformity of joint.

Apart form this many patient suffer with Q’ceps weakness, Proprioception deficit and postural instability.

Strengthening of Q’ceps muscle and the training to the joint improves patients Proprioception and postural stability.

QPER and DAPRE techniques commonly prescribed to improve the function and Proprioception.

ERGONOMIC ANALYSIS FOR PADDY WORKERS

• Musculoskeletal disorder is very common in all occupations.
• Surprisingly Agricultural workers are also having problems due to Poor positions & Awkward postures.

Agriculture is the very physical occupation where muscular aches & pain are often considered to be “Part of Job”

Susan.G.2003

Repetitive forces at the same muscle, tendon or region result in Trauma, injury & inflammation lead to Cumulative trauma disorders or Repetitive Stress Injury.

James 2006

Field crop production workers are at high risk for work related muscular disorders

Murphy 2003

Heavy physical work, repeated lifting & Twisting activity causes Low back Pain in workers. Marras et al., 1993

Repeated force to joints and soft tissues results in Pain. Musculoskeletal disorders affect the work force & Production.

Blondell et al.,1977.

“To forget how to dig the earth & to tend the soil is to forget ourselves.”

Mahatma Gandhi.

SUBCALCANEAL HEEL PAIN

SUBCALCANEAL HEEL PAIN

Pain in the plantar pad of heel in a common condition and has been reported in patients aged from 18 to 80.

It is a summation of series of micro trauma to the plantar fascia caused by a strain of the attachment of plantar fascia to the calcaneum.

AETIOLOGY:

Excessive Pronation of subtalar joint

Repeated stress over the fascia.

Pes cavus highly arched foot.

Occupational stress like prolonged standing and walking.

High heel shoes.

Obesity

Length and stride during running

Wearing shoes without sufficient

CLINICAL FEATURE:

• Sharp or acute pain over the heel.
• Pain is most severe when the athlete first puts weight on the foot.
• Pain occurs in the heel when no person getting out of the bed in the morning.
• Pain diminishes during activity.
• Pain increase when the activity stops.
• Tenderness over the calcaneal end of the Aponeurosis seen over the anterior medial tuberosity of the calcaneum.

INVESTIGATION

X-Ray

May reveal the presence of calcaneal spur.

MANAGEMENT:

Medical Management

Cortisone injection

Aspirin pills

Soluble steroid injection

Physiotherapy Management

Acute phase

Pulsed ultrasound

Electrical stimulation

Faradic foot bath.

Rehabilitation phase

• Continuous ultrasound
• Ionoto / phonopheresis
• Cryotherapy

Stretching

• T.A. Stretching
• Foot mobilization
• plantar fascia stretch
• intrinsic foot muscle strengthening

Foot Support

• Custom foot Orthosis

Home program

• Avoid prolonged standing
• Advice about suitable standing foot wear.
• Exercise for intrinsic foot muscle should be taught to the patient.
• Contrast bath
• Rest splits should be administered if necessary.

Exercise

• Pricking a golf ball and up your toes.

Lay a towel on the floor and scrunch it up with your toes

RECTUS ABDOMINIS DIASTASIS

RECTUS ABDOMINIS DIASTASIS

Rectus abdominis diastasis is a conventional term used to define the split between the two rectus abdominis muscles (Polden and Mantle 1990). However, as the two Recti muscles are attached in the middle by the linea Alba, the widening actually occurs as a result of stretching and thinning of the linea alba. It commonly occurs in childbearing women, third trimester. (Boissonnault and Blaschak 1988). It can persist in 30-60% of women during the post partum period at different sites along the linea alba. (Boissonnault and Blaschak 1988; Bursch 19987).

This can vary between a small vertical gap 2-3cm wide and 12-15cm long to a space measuring 12-20cm in width and extending nearly the whole length of the recti muscles.

Investigation

Checking for Diastasis recti should be done in the,

Beginning of second trimester and continue throughout the rest of pregnancy.

Post partum phase.

Patient Position

Supine Hook lying.

Procedure

Chin should be tucked

Arm extended to knees

Patient should raise her head, shoulders until the scapulae clear the Surface

Therapist check for Central budge in abdomen and with fingers placed Cephalo Caudally, measure the amount of seperation between the Rectus abdominis Muscles 2 inches above, below, al the level of umbilicus.

Common treatment given for diastasis recti includes Binder, Exercise and Rest. Binder helps to hold the abdomen tight and maintain the muscle length properly. Abdominal exercises helps to strengthen the abdominals and helps in maintain the posture

Patellar tendinitis

Patellar tendinitis or Jumper’s knee is a over use or repetitive trauma to the extensor mechanism of the knee, which commonly results from jumping or running sports such as ‘Basket ball’ and ‘Volley ball’.
The prevalence of Jumpers knee is 40-50% among elite volleyball and basketball players. Ferrati A, Panpandrea P -1990 ,Lion O, Holen K J -1996.
They are present with anterior knee pain and intermittent swelling.
The tenderness is localizes to the patellar tendon, primarily at its origin on the ‘Inferior pole of patella’ and the tenderness is appreciated with the knee in extension.
This often recurrent condition can severely limit or even an athletic career and recovery from each episode can be prolonged. Cook J L, Khan K M-1997.
Recent investigations have shown that squat performed on a 25 degree decline board ‘target knee extensor mechanism more specifically than the ‘Standard squat ‘ and it has been suggested that this may be relevant in the management of patellar tendinopathy Purdam C R -2004 , Cook J -2003.
The progressive eccentric strengthening forming the corner stone of most rehabilitation programmes. The treatment includes Ultrasound and Transfriction Massage.
Therapeutic ultrasound is one of the most common treatments used in the management of soft tissue lesions like tendon, ligament, and bursa.
Ultrasound induces thermal and non thermal physical effects in tissues. The thermal effects are increased blood flow, reduction in muscle spasm, increased extensibility of collagen fibers and an inflammatory response at the temperature level of 40-45 degree for 5 minutes.