Shoulder impingement results from the compression of the rotator cuff muscles under the coracoacromial arch.
Inflammation and pain occurs and is aggravated by the shoulder and arm movements.Pain is felt on antero lateral aspect of shoulder radiating down to mid arm at times.
It can be confirmed with Hawkins-Kennedy impingement test and Neer's impingement test.
ETIOLOGY of shoulder impingement syndrome is multifactorial-
1. Acute trauma: fall on to the shoulder or direct blow on the shoulder.
2. Chronic injury from:
a) Repeated overhead activity like throwing, lifting and catching.
b) Improper postural habits leading to muscle imbalances between deltoid and infraspinatus, teres minor, subscapularis or between supraspinatus and gravity. As a result one group of muscles become tight and other gets stretched and become weak.Loss of rotator cuff strength causes superior migration of humerus resulting in impingement.
3.Outlet impingement due to subacromial osteophytes, hooked or beaked acromion shape, thickened or calcified coracoacromial ligament.
TREATMENT GOALS
1-Decrease the inflammation
*Cryotherapy-Use ice packs for a maximum of 15 minutes, 3 times a day
*Anti inflammatory medication
*Relative rest-Avoiding aggravating and loading activities like overhead reaching and lifting heavy weights in order to prevent further injury to the rotator cuff.
2-Improve posture and shoulder ROM
*Gentle stretching exercises and ROM
-Downward and backward pulling of both the arms with the hands clasped behind the back
-Scapular retraction exercises
-Codman pendular exercises
-Horizontal adduction stretch
-Triceps stretching
-Corner stretch-to stretch the front of the shoulder and the pectorals muscles by pushing against a wall in the corner of the room.
-Biceps stretch
* Sit with back fully supported and work with shoulders being close to the body.
3-Strengthen the rotator cuff muscles and scapular stabilizers.
*Bilateral shoulder extension exercises in prone or standing position.
*Resisted shoulder external and internal rotation in the gravity eliminated plane.
*Supraspinatus strenthening by resisting shoulder abduction in empty can position of the hand.
*Bilateral shoulder abduction in prone
*Supine press
*Biceps curls
Tuesday
Peripheral Neuropathy and Physiotherapy
Peripheral neuropathy is a disorder of the peripheral nervous system due to damage to the peripheral nerves resulting from a variety of causes like trauma,
infections, autoimmune disorders, systemic infections,inherited disorders, metabolic or endocrine disorders, toxic causes and vitamin deficiency especially vitamin B12.
Peripheral Neuropathy is of four types mainly-
1.Sensory neuropathy, in which part of the sensory system is damaged causing pain, tingling, numbness, or loss of sensation. It usually progress from distal to proximal i.e. it first starts in fingers or toes.
2.Motor neuropathy is characterized by damage to the motor nerves resulting in motor weakness and atrophy. Also symptoms of tiredness, heaviness,cramps, tremor, muscle twitch (fasciculations) and gait abnormalities are present.
3.Autonomic neuropathy is characterized by damage to the autonomic nervous system which affects blood pressure, heart rate, sweating, digestion, and bowel and bladder function.Symptoms may include urinary incontinence, constipation, diarrhea, dizziness and fainting.
4.Mixed neuropathy, in which two or more of the above mentioned types are present.
The objectives of Physiotherapy management for peripheral neuropathy includes-
(a)Pain Relief-TENS, Transcutaneous Electrical Nerve Stimulation therapy has shown to be effective and safe in the treatment of diabetic peripheral neuropathy
(b)Flexiblity or stretching exercises-They are important for improving muscle mobility, function and blood circulation in the affected area.It also helps in
maintaining range of motion.
(c)Strengthening of muscles-It improves muscle strength and reduces the feeling of numbness and tingling.It can be done by using weights or strengthening bands to target the necessary muscle.
(d)Braces or splints- To improve balance and posture.It can be used for compression neuropathies like carpal tunnel syndrome.
(e)Practicing functional activities are also important.
(f)Treatment through vibrations or ultrasound.
(g)Balance training to improve gait and posture.
Safety is an important consideration for patients with peripheral neuropathy.Muscle weakness and loss of sensation increase the risk of falls.It can be prevented by following measures
* Testing water temperature before bathing
* Avoiding open toes or high heels and not to walk barefoot.
* Take care while cooking by using heat resistant ladles and pot holders
* Inspect your feet regularly for any cut,bruise or blister
* Wear socks and gloves when needed
* keep the skin moisturised.
* Make environment safe by removing obstacles in home, use adequate light at night, use handrails while ascending or descending stairs,Use non slip bath mats in bathroom.
infections, autoimmune disorders, systemic infections,inherited disorders, metabolic or endocrine disorders, toxic causes and vitamin deficiency especially vitamin B12.
Peripheral Neuropathy is of four types mainly-
1.Sensory neuropathy, in which part of the sensory system is damaged causing pain, tingling, numbness, or loss of sensation. It usually progress from distal to proximal i.e. it first starts in fingers or toes.
2.Motor neuropathy is characterized by damage to the motor nerves resulting in motor weakness and atrophy. Also symptoms of tiredness, heaviness,cramps, tremor, muscle twitch (fasciculations) and gait abnormalities are present.
3.Autonomic neuropathy is characterized by damage to the autonomic nervous system which affects blood pressure, heart rate, sweating, digestion, and bowel and bladder function.Symptoms may include urinary incontinence, constipation, diarrhea, dizziness and fainting.
4.Mixed neuropathy, in which two or more of the above mentioned types are present.
The objectives of Physiotherapy management for peripheral neuropathy includes-
(a)Pain Relief-TENS, Transcutaneous Electrical Nerve Stimulation therapy has shown to be effective and safe in the treatment of diabetic peripheral neuropathy
(b)Flexiblity or stretching exercises-They are important for improving muscle mobility, function and blood circulation in the affected area.It also helps in
maintaining range of motion.
(c)Strengthening of muscles-It improves muscle strength and reduces the feeling of numbness and tingling.It can be done by using weights or strengthening bands to target the necessary muscle.
(d)Braces or splints- To improve balance and posture.It can be used for compression neuropathies like carpal tunnel syndrome.
(e)Practicing functional activities are also important.
(f)Treatment through vibrations or ultrasound.
(g)Balance training to improve gait and posture.
Safety is an important consideration for patients with peripheral neuropathy.Muscle weakness and loss of sensation increase the risk of falls.It can be prevented by following measures
* Testing water temperature before bathing
* Avoiding open toes or high heels and not to walk barefoot.
* Take care while cooking by using heat resistant ladles and pot holders
* Inspect your feet regularly for any cut,bruise or blister
* Wear socks and gloves when needed
* keep the skin moisturised.
* Make environment safe by removing obstacles in home, use adequate light at night, use handrails while ascending or descending stairs,Use non slip bath mats in bathroom.
Thursday
Physical Therapy and Parkinson's disease
Parkinson's disease is a chronic progressive neurological disorder resulting from deficiency of dopamine in the brain.It manifest with the triad of-
1. Rigidity or stiffness in the body
2. Bradykinesia or slowness of the movements
3. Resting tremors and postural instability.
Other manifestations include- Intellectual impairment in form of dementia, communication problems due to dysarthria and hypophonia, dysphagia and silorrhea, muscuoskeletal problems due to disuse and inactivity and festinating gait pattern.
Physical therapy management of Parkinson's disease include-
1.Increasing activity levels-Increase overall mobility, do some stretching exercises to elongate muscles and involve patient in a regular walking program.
2.Decreasing rigidity and bradykinesia-Incorporate PNF patterns(specially D2F for upper extremity and D1E for lower extremity) with emphasis on trunk rotation patterns and rhythmic initiation technique.Relaxation exercises in form of gentle rocking can be used to reduce muscle tension.Deep breathing exercises can also be used.Daily stretching and ROM exercises are important.
3.Improving gait pattern-Emphasize high stepping, broad based gait with arm swing and contralateral trunk rotation.Toe wedge can be used to counteract festination.
4.Improving balance-Weight shifts in standing,stepping movements forward and backward, walking and marching in place can be helpful.
5.Improve strength-Focus on lower extremity strengthening in order to improve gait and posture.Trunk extension exercises are also important.
6.Walking aids in form of canes can be used to improve gait and balance
1. Rigidity or stiffness in the body
2. Bradykinesia or slowness of the movements
3. Resting tremors and postural instability.
Other manifestations include- Intellectual impairment in form of dementia, communication problems due to dysarthria and hypophonia, dysphagia and silorrhea, muscuoskeletal problems due to disuse and inactivity and festinating gait pattern.
Physical therapy management of Parkinson's disease include-
1.Increasing activity levels-Increase overall mobility, do some stretching exercises to elongate muscles and involve patient in a regular walking program.
2.Decreasing rigidity and bradykinesia-Incorporate PNF patterns(specially D2F for upper extremity and D1E for lower extremity) with emphasis on trunk rotation patterns and rhythmic initiation technique.Relaxation exercises in form of gentle rocking can be used to reduce muscle tension.Deep breathing exercises can also be used.Daily stretching and ROM exercises are important.
3.Improving gait pattern-Emphasize high stepping, broad based gait with arm swing and contralateral trunk rotation.Toe wedge can be used to counteract festination.
4.Improving balance-Weight shifts in standing,stepping movements forward and backward, walking and marching in place can be helpful.
5.Improve strength-Focus on lower extremity strengthening in order to improve gait and posture.Trunk extension exercises are also important.
6.Walking aids in form of canes can be used to improve gait and balance
Friday
POST NATAL EXERCISES
Post Natal exercises focus on strengthening of weak muscles which mainly includes
1. Pelvic floor muscles
2. Abdominals
Pelvic floor muscles
Strengthening of pelvic floor muscles is extremely important in the post partum phase as these muscles becomes lax and weak due to stretching with vaginal delievery.Their weakness can lead to leakage of urine with coughing or frequent urge to pass urine.
Kegel Exercises can be done for these muscles by squeezing the pelvic muscles as if trying to stop urine flow.The feeling is one of ‘squeeze and lift’. Hold it for 10seconds, release, rest for a few seconds and repeat 10 times. Practice it 3-5 times a day.
Avoid pulling in your tummy, squeezing your legs together, tightening your buttocks or holding your breath while doing kegel exercises.
Abdominals
Abdominal muscles like Rectus abdominis, Transverse abdominis and Obliques (External and Internal) also become lax after delivery. These needs to be strengthened for toning them up.
Following exercises can be one for this purpose.
1. Posterior Pelvic tilts- In crook lying position i. e. lying down with hip and knee flexed to 45 degrees and feet flat on the bed—Draw in your tummy and press lower part of your back into the bed to flatten your back. Hold this position for 5 -10 seconds, release and repeat 10 times.
2. Abdominal Curls- In crook lying position,lift your head and shoulders just to clear shoulder blades off the bed trying to reach towards your knees. Hold this position for 10 seconds, release and repeat 10 times.
3. Sit ups- This exercise can be done in advanced stages of strengthening.
4. Working for obliques- In crook lying position, lift your head and shoulders to reach with one hand towards opposite ankle. Repeat this with both sides.
5. One leg SLR( Straight Leg raising)-Raise between 30- 45 degrees for lower abdominals workout with other leg being flexed at hip and knee.
Note- Progression of these exercises must be guided by a Physical therapist depending on the the progress you have made.
Other important aspects-
1. Maintaining good posture is very important- keep your back straight, stand tall with tummy tucked in and relaxed knees. Use good body mechanics while bending and getting out of bed so as not to stress your back.
2. Continue with prenatal breathing exercises and foot and ankle movements to improve your circulation.
3. Hip adductors isometrics is also a good exercise.
Precautions
1.Consult with your doctor before starting any post natal exercise program. Every post natal exercise program vary depending on whether you have delivered vaginally or by C- section and how much you have recovered post delivery.
2.Stop exercise if it hurts, pains or if you are tired or unwell.
3.Keep yourself hydrated.
1. Pelvic floor muscles
2. Abdominals
Pelvic floor muscles
Strengthening of pelvic floor muscles is extremely important in the post partum phase as these muscles becomes lax and weak due to stretching with vaginal delievery.Their weakness can lead to leakage of urine with coughing or frequent urge to pass urine.
Kegel Exercises can be done for these muscles by squeezing the pelvic muscles as if trying to stop urine flow.The feeling is one of ‘squeeze and lift’. Hold it for 10seconds, release, rest for a few seconds and repeat 10 times. Practice it 3-5 times a day.
Avoid pulling in your tummy, squeezing your legs together, tightening your buttocks or holding your breath while doing kegel exercises.
Abdominals
Abdominal muscles like Rectus abdominis, Transverse abdominis and Obliques (External and Internal) also become lax after delivery. These needs to be strengthened for toning them up.
Following exercises can be one for this purpose.
1. Posterior Pelvic tilts- In crook lying position i. e. lying down with hip and knee flexed to 45 degrees and feet flat on the bed—Draw in your tummy and press lower part of your back into the bed to flatten your back. Hold this position for 5 -10 seconds, release and repeat 10 times.
2. Abdominal Curls- In crook lying position,lift your head and shoulders just to clear shoulder blades off the bed trying to reach towards your knees. Hold this position for 10 seconds, release and repeat 10 times.
3. Sit ups- This exercise can be done in advanced stages of strengthening.
4. Working for obliques- In crook lying position, lift your head and shoulders to reach with one hand towards opposite ankle. Repeat this with both sides.
5. One leg SLR( Straight Leg raising)-Raise between 30- 45 degrees for lower abdominals workout with other leg being flexed at hip and knee.
Note- Progression of these exercises must be guided by a Physical therapist depending on the the progress you have made.
Other important aspects-
1. Maintaining good posture is very important- keep your back straight, stand tall with tummy tucked in and relaxed knees. Use good body mechanics while bending and getting out of bed so as not to stress your back.
2. Continue with prenatal breathing exercises and foot and ankle movements to improve your circulation.
3. Hip adductors isometrics is also a good exercise.
Precautions
1.Consult with your doctor before starting any post natal exercise program. Every post natal exercise program vary depending on whether you have delivered vaginally or by C- section and how much you have recovered post delivery.
2.Stop exercise if it hurts, pains or if you are tired or unwell.
3.Keep yourself hydrated.
Wednesday
Therapeutic Modalities - ULTRASOUND
Ultrasound(US) is a sound wave that has a frequency greater than 20 KHz.
It is generated by applying an alternate current to a piezoelectric
crystal (found in the transducer in the sound head). This crystal
contracts and expands at the same frequency at which current changes
polarity. The sound field generated by this crystal in turn makes the
molecules in the sound field vibrate and oscillate.
The crystal commonly used in US units is synthetic plumbium
zirconium titanate (PZT), lead zerconate.
Therapeutic ultrasound has a frequency range of 0.75 and 5.0 MHz.
Most modalities have 1 MHz and 3 MHz sound head
Ultrasound energy is absorbed mostly in tissues with high collagen
content (bone, periosteum, cartilage, ligaments, capsules, tendons, fascia,
scar tissue and tissue interface i.e. bursa & synovium).
Physiological effects of Ultrasound:
1. Enhance inflammatory response and tissue repair
2. Heat soft tissue
Common uses for pulsed non-thermal ultrasound
· Facilitate healing in the inflammatory and proliferative phase
following soft tissue injury (tendonitis, bursitis, acute soft tissue
injuries)
· Bone healing
Common use for continuous ultrasound:
· Prior to stretching at tight structure (tendon, capsule, ligaments,
fascia, scar)
· Pain control in chronic pain
· Chronic inflammatory conditions
CONTRAIDICATIONS
· Undiagnosed pain
· Cancer
· Active tuberculosis
· Psoriasis
· Decreased circulation
· Infection
· Pregnancy
· Central nervous system tissue
· Joint cement (cannot use continuous mode, but may use pulsed
mode 50% or less)
· Plastic components
· Pacemakers
· Thrombophlebitis
· Uncontrolled bleeding or blood-thinning medication (coumadin)
· Eyes
· Reproductive organs
· Heart
PRECAUTIONS
· Acute inflammation (use non-thermal settings only)
· Epiphyseal plates (use pulsed, low intensity <0.5w/cm2)>
It is generated by applying an alternate current to a piezoelectric
crystal (found in the transducer in the sound head). This crystal
contracts and expands at the same frequency at which current changes
polarity. The sound field generated by this crystal in turn makes the
molecules in the sound field vibrate and oscillate.
The crystal commonly used in US units is synthetic plumbium
zirconium titanate (PZT), lead zerconate.
Therapeutic ultrasound has a frequency range of 0.75 and 5.0 MHz.
Most modalities have 1 MHz and 3 MHz sound head
Ultrasound energy is absorbed mostly in tissues with high collagen
content (bone, periosteum, cartilage, ligaments, capsules, tendons, fascia,
scar tissue and tissue interface i.e. bursa & synovium).
Physiological effects of Ultrasound:
1. Enhance inflammatory response and tissue repair
2. Heat soft tissue
Common uses for pulsed non-thermal ultrasound
· Facilitate healing in the inflammatory and proliferative phase
following soft tissue injury (tendonitis, bursitis, acute soft tissue
injuries)
· Bone healing
Common use for continuous ultrasound:
· Prior to stretching at tight structure (tendon, capsule, ligaments,
fascia, scar)
· Pain control in chronic pain
· Chronic inflammatory conditions
CONTRAIDICATIONS
· Undiagnosed pain
· Cancer
· Active tuberculosis
· Psoriasis
· Decreased circulation
· Infection
· Pregnancy
· Central nervous system tissue
· Joint cement (cannot use continuous mode, but may use pulsed
mode 50% or less)
· Plastic components
· Pacemakers
· Thrombophlebitis
· Uncontrolled bleeding or blood-thinning medication (coumadin)
· Eyes
· Reproductive organs
· Heart
PRECAUTIONS
· Acute inflammation (use non-thermal settings only)
· Epiphyseal plates (use pulsed, low intensity <0.5w/cm2)>
EXERCISES FOR TYPE 2 DIABETES MELLITUS
Type 2 diabetes is growing at an alarming rate. With so many prevalent risk factors and morbidity associated with type 2 diabetes, its essential to prevent it and retard its progression.
According to the relevant research done in the field of type 2 diabetes and exercises, its proven that physical activity or exercise is one such modality which can be helpful. The main hypothesis supporting the results is the increased uptake of glucose in muscles as a result of exercise.
Various types of exercises are advocated for the same which can be broadly categorized into two:
1.- Aerobic exercises in the form of walking- 90 minutes of moderate intensity walk per week is sufficient.
2.- Resistance exercises- With moderate amount of resistance involving the major muscle groups of the body.
For example,
-Biceps Curls
-Triceps Curls
-Front and Back lateral pull downs
-Hamstring curls
-Knee extension exercises
-Abdominal curls.
8-10 repetitions of each exercise 3 times per week is sufficient to achieve the desired effect.
The long term benefits of these exercises are as follows-
According to the relevant research done in the field of type 2 diabetes and exercises, its proven that physical activity or exercise is one such modality which can be helpful. The main hypothesis supporting the results is the increased uptake of glucose in muscles as a result of exercise.
Various types of exercises are advocated for the same which can be broadly categorized into two:
1.- Aerobic exercises in the form of walking- 90 minutes of moderate intensity walk per week is sufficient.
2.- Resistance exercises- With moderate amount of resistance involving the major muscle groups of the body.
For example,
-Biceps Curls
-Triceps Curls
-Front and Back lateral pull downs
-Hamstring curls
-Knee extension exercises
-Abdominal curls.
8-10 repetitions of each exercise 3 times per week is sufficient to achieve the desired effect.
The long term benefits of these exercises are as follows-
- Improved glucose tolerance
- Decreased level of fasting blood glucose and HbA1c levels
- Improved quality of life
- Increased muscle strength with resistance exercises
- Improved cardiovascular fitness
- Decreased morbidity associated with Type 2 diabetes
- Improved balance
- Improved lipid profile
- Improved resting blood pressure levels and heart rate
- Improved body composition- more of muscle mass and less of fat with resistance exercise
Precautions for doing exercise.
- Get a resting ECG done
- Take care of fasting blood glucose levels. Avoid exercise if its <70>250mg/dl
- Avoid resistance training if hypertensive.
- Avoid exercising the muscle in which insulin is being injected. Timing of injection and exercise has to be scheduled with help of your physician and physical therapist.
- Avoid hypoglycemia.
- Be aware of the signs and symptoms of hypoglycemia.
- Keep an orange candy or juice handy.
- Take care of your feet. Keep them clean and dry.
- Maintain your hydration levels.
- Incorporate a period of warm up and cool down in your exercise program.
NOTE: Consult your physician before embarking on any exercise program
Subscribe to:
Posts (Atom)