ASTHMA

ASTHMA or HYPERACTIVE AIRWAY DISEASE
Asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role, in particular, mast cells, eosinophils, T lymphocytes, macrophages, neutrophils, and epithelial cells. In susceptible individuals, this inflammation causes recurrent episodes of wheezing, breathlessness, chest tightness and coughing, particularly at night or in the early morning. These episodes are usually associated with widespread but variable airflow obstruction that is often reversible either spontaneously or with treatment. The inflammation also causes an associated increase in the existing bronchial responsiveness to a variety of stimuli.
Factors predisposing asthmatic symptoms-
Allergic-pollens, animals, feathers, molds, food, household dust.
Non allergic-Inhaled irritants, dust, cigarette smoke, pollution, chemical.
Ambient environment-High humidity, cold air
Respiratory Infections-common cold, bacterial bronchitis
Drugs-aspirin
Emotions-stress, excitement
Exercise
During an asthma attack, the lumen of the airways is narrowed or occluded by a combination of bronchial smooth muscle spasm, inflammation of the mucosa and overproduction of viscous, tenacious mucus.
Clinical Features-
Patient has a rapid rate of breathing and uses the accessory muscles.
Expiratory phase of breathing is prolonged with audible wheezing.
Frequent unproductive cough
Feeling of tightness in the chest.
Lung volume and flow rates are reduced.
X-ray findings-Lungs may appear hyperinflated or show small atelectatic areas.
Arterial Blood Gas analysis-Partial pressure of oxygen decreases, partial pressure of carbon dioxide increases and pH,7.3 (if attack progresses)
Treatment –
Acute cases-Bronchodilators, Corticosteroids
-supplemental oxygen
-breathing control
-avoid bronchial irritants
-controlled unforced coughing manuovers in optimal body positions.
Reduce the overall oxygen demand including that associated with an increased work of breathing.
Reduce activity
Body positioning improving breathing efficiency
judicious sleep and rest periods
Restricted diet
adequate hydration
Maintainance of a thermal environment
Rest
Reduced arousal and environmental stimulation.
Sensitive indicators of ensuing compromise in oxygen transport-Bedside spirometry and Peak Expiratory Flow Rate (PEFR)
DURING EXERCISE-Focus on low intensity warm up and prolonged cool down.

VESTIBULAR REHABILITATION

Physical therapy for dizziness and imbalance is called as vestibular rehabilitation, or more generally, balance rehabilitation.

Symptoms of vestibular dysfunction include but are not limited to imbalance, nausea, dizziness, true vertigo, and blurry vision, and poor depth perception, loss of balance when walking, falling, confusion, and disorientation.

Vestibular rehabilitation therapy (VRT) has been a highly effective modality for disorders of the vestibular or central balance system. It includes combined specific head and body movements with eye exercises. If the exercises are correctly performed, muscle tension, headaches, and fatigue will diminish, and symptoms of dizziness, vertigo, and nausea will decrease.Most VRT exercises involve head movement, and head movements are essential in stimulating and retraining the vestibular system.

Goals of VRT (Vestibular Rehabilitation Therapy)

• Improve balance
• Minimize falls
• Decrease subjective sensations of dizziness
• Improve stability during locomotion
• Reduce overdependence on visual and somatosensory inputs
• Improve neuromuscular coordination
• Decrease anxiety and somatization due to vestibular disorientation

These conditions can benefit from Vestibular Rehabilitation Therapy:

• BPPV (Benign Paroxysmal Positional Vertigo)
• Bilateral & Unilateral dysfunctions
• Otolith Dysfunction
• Vestibular Labyrinthitis
• Acoustic Neuroma or vestibular neuritis.
• Ototoxicity
• Meniere’s Syndrome
• Neurologic Disorders (stroke, brain injury, multiple sclerosis)

VOR stimulation exercises

Gaze stabilization is the ability to hold the visual world steady while the head and/or body are moving. The vestibulo-ocular reflex (VOR) helps to provide gaze stability when the head moves.

Balance exercises

Static balance activities used for training include Romberg position and standing on one leg. Exercises are made more challenging and incorporate the use of the vestibular system as patients improve by altering the surface they stand on (e.g.: foam, trampoline, tilt board), performing activities with eyes closed and lastly incorporating head motions while maintaining balance.

Dynamic balance is trained by performance of activities including ambulation with head turns, full body turns and marching in place. Dynamic activities are made more challenging as the patient improves by altering the surface (e.g.: balance beam, treadmill), and performance with eyes open and eyes closed.

Cawthorne Cooksey Exercises

1. In bed or sitting

Eye movements -- at first slow, then quickly -up and down, from side to side and diagonally. Focusing on finger moving from 3 feet to 1 foot away from face

Head movements at first slow, then quick, first with eyes open and later with eyes closed -bending forward and backward and turning from side to side, tilting from side to side and moving diagonally.

2. Sitting

Eye movements and head movements as above

Shoulder shrugging and circling

Bending forward and picking up objects from the ground

3. Standing

Eye, head and shoulder movements as above.

Changing from sitting to standing position with eyes open and closed.

Throwing a small ball from hand to hand above eye level

Throwing a ball from hand to hand under knees

Changing from sitting to standing and turning to one side and then to another.

4. Moving about

Walk across room with eyes open and then closed

Walk up and down slope with eyes open and then closed

Walk up and down steps with eyes open and then closed

Sit up and lie down in bed

Sit down in a chair, then stand up

Recover balance when pushed in a specific direction.

Throw and catch a ball

Engage in any game involving stooping or stretching and aiming, such as bowling, volleyball, or shuffleboard.

Plantar fascitis/heel pain/bone spur/exostosis

Plantar fascitis/heel pain/bone spur/exostosis Plantar Fasciitis is a very common cause of heel pain. It is inflammation of the plantar fascia of the foot. It causes heel pain which may radiate to the toes. It can occur as a result of repetitive microtrauma. It’s an overuse injury. Plantar fasciitis is commonly caused by a heel spur which is a bony growth that occurs at the attachment of the plantar fascia to calcaneum. The Plantar Fascia is a broad, thick band of tissue that runs from medial tubercle of calcaneum of the heel to the front of the foot. It forms the longitudinal arch of the foot. SYMPTOMS ·                        Pain is usually on the medial side of the heel and under the heel. ·                        Pain is usually severe in the morning and decreases as the day progresses. Pain is worse on walking bare-foot. A limp may be present. ·                        Tenderness is present on the medial side of the calcaneum at the origin of the plantar fascia. CAUSES 1.      Tightness of calf muscles which can lead to pronation of the foot. This in turn produces repetitive over stretching of the plantar fascia leading to inflammation and thickening of the tendon. 2.      Foot arch problems- pes cavus and pes planus 3.      Excessive stress on the plantar fascia due to excessive running or obesity. TREATMENT – 1.      Use NSAIDS and take rest. 2.      Ice therapy can be applied to reduce pain and inflammation, 3.      Taping of plantar fascia can be done to support it and to reduce stress on plantar fascia. 4.      Stretching of plantar fascia and calf muscles is also important. 5.      Strengthening of intrinsic muscles of the foot. 6.      Silicon heel pads/cushioned heels can be used. PREVENTION It is possible by maintaining good flexibility of calf muscles, avoid prolonged standing.

 

Lowback Pain - Precautions

Precautions to be taken in Low Back Pain

1. Avoid any activity that increases low back pain like bending forward, lifting heavy weight etc.

2. Correct body posture. Maintain the lumbar curve.

3. Take back support while sitting, adjust the chair height so that feet should be placed firmly on ground or use a foot rest or foot stool.

4. Avoid stooping; always bend your knees while keeping the back straight while lifting anything from the ground or lower surface.

5. While exercising for back muscles also work for abdominal muscles to avoid any muscle imbalance.

6. Use firm mattress for sleeping.

7. While getting out of the bed, first take a side turn, then brings your legs down and then finally raise the upper body.

8. Do use a lumbar corset especially during traveling.

9. Avoid prolonged use of a corset as it makes your back muscles weak and decondition them.

10. Avoid continuance of same posture for prolonged periods of time.

LOW BACK PAIN

Low Back pain is a musculoskeletal problem encountered by most of the adults at some time in their life. It’s a most common medical problem. There can be variety of causes of low back pain ranging from minor ligamentous sprain to spinal tumour or fracture.
Etiology of low back pain can be categorized as follows-
1. Mechanical Low Backache
• Ligamentous Sprain
• Muscle Strain
2. Degenerative
• Lumbar Spondylosis
• Disc prolapse / slip disc
• Spondylolisthesis
• Spinal stenosis
3. Inflammatory
• Ankylosing spondylitis
• Rheumatoid arthritis
• Osteomyelitis
4. Neoplastic
• Tumors
5. Metabolic
• Osteoporosis
• Osteomalacia
The diagnosis of Low back pain is based on medical history, physical examination including range of motion of back and hip, tests of neurological involvement, muscle strength testing and diagnostic tests like X ray and MRI.
The treatment options depend on the nature of the pain, whether acute or chronic and cause of the pain and accordingly may vary from conservative to surgical. Our focus here is on conservative treatment which includes-
• Analgesics and anti-inflammatory drugs/NSAIDS
• Muscle relaxants
• Various electrotherapeutic modalities like SWD (short wave diathermy), MWD (microwave diathermy), Ultrasound, IFT (interferential therapy), TENS (transcutaneous electrical nerve stimulation).
• Moist heat- Hot packs.
• Lumbar corsets.
• Spinal manipulation
• Exercises to strengthen stretch and condition the back muscles- It is generally recommended in chronic cases. Usually exercise is not performed in acute cases of low back pain. Commonly performed exercises include-
Spinal extension exercises, pelvic tilts, abdominal curls, back rotation exercises.

CERVICAL HEADACHE

Headache is a very common symptom experienced by 90% of the population at least once in their lifetime. There can be many causes of headache, out of which cervical headache is the one. Cervical headache originates in the neck or suboccipital region and radiates upwards in the head, more commonly in frontal, temporal and retro orbital region. It can be unilateral or bilateral and can be accompanied by nausea or lightheadedness. In benign cases, there are intermittent bouts of headache with painfree periods in between. It relates more commonly to sustained neck posture, postural stresses, degenerative joint disease or trauma. Accurate diagnosis of cervical headache is a must; it must be differentiated from tension headache and migraine. Often many treatment modalities have been recommended for its cure, physiotherapy is one such treatment for the same.

Gaining full range of painfree motion in the cervical region, with tonically active cervical muscles, deep neck flexors and scapular muscles is the goal of the physiotherapy treatment program. Postural correction is an important component of this program aimed at efficient recruitment of the postural stabilizers and decreasing the activity in other muscles like levator scapulae.

HEALTHY 10 FACTS ABOUT EATING

.

1. About 55% of our total calorie intake per day should come from carbohydrates and
   1gm of carbohydrate gives 4
   calories.
2. Complex carbohydrates
   i.e. starchy food helps in staving off hunger pangs. They include Breads,
   cereals, oatmeal, noodles, rice, millet, pasta and crackers
   etc.
3. Fibre is a detox ingredient,
   curbs craving for snacks, decreases risk of blood sugar and cancer, decreases
   cholesterol levels and keeps gut
   healthy.
4. Increase fiber intake
   with fluids to let them pass the gut more
   easily.
5. High fibre food-At least
   6gms fibre/100gms.
6. Take at least
   2-5 servings of fruit per day.
7. For weight loss, decrease intake of starchy vegetables and
   vice-versa.
8. Cheese and peanuts
   decrease acid on out teeth’s. Acid levels are increased by
   raisins/toffees/caramels.
9. Milk
   and cheese provides protection against
   caries.
10. Lemon, oranges and lime
    contribute to erosion of teeth enamel.
    

PRENATAL EXERCISES

Regular exercise (at least three times per week) during pregnancy is extremely beneficial as exercise leads to potentially easier pregnancy and labour, improves cardiovascular fitness, decrease risk of gestational diabetes and promotes faster recovery from labour. It also helps in prevention of low back pain during pregnancy and weight gain. It also counteracts the post partum depression.
But certain precautions are to be taken care of while doing exercise in pregnancy like-

1. Avoid any vigorous exercise in hot and humid weather or during a period of febrile illness.
2. Avoid jerky, bouncy motions.
3. Exercise should be done on a wooden floor or tightly carpeted surface to reduce shock and provide a sure footing.
4. Exercise should include a five minute warm up period of muscle warm up and should follow a cool down period at the end of exercise session.
5. Maintain adequate hydration levels during exercise.
6. Ensure proper body mechanics of posture and lifting.
7. After first trimester of pregnancy, avoid exercise in supine or back lying position.
8. Women with a history of sedentary lifestyle should begin with low intensity exercises and progress gradually.
   
   RECOMMENDED EXERCISES
   
   · Leg sliding exercises.
   · Pelvic tilts
   Postural exercises
   · Stretching at various joints of the body.
   · Modified upper and lower limb strengthening exercises.
   Pelvic floor exercises
   · Kegel exercises
   · Pelvic clock exercises
   Breathing exercises
   · Diaphragmatic and abdominal breathing.
   
   Before starting any exercise program it’s important to get permission from your doctor to rule out any CONTRAINDICATIONS
   
   WARNIG SIGNS to stop exercise-
   · Shortness of breath
   · Dizziness
   · Headache
   · Calf swelling
   · Chest pain
   · Bleeding/Amniotic fluid leakage.
   · Unusual abdominal, back or pubic pain