Physio-Be-Fit

Frozen shoulder is characterized by progressive pain and stiffness of the shoulder which usually resolves spontaneously after about 18 months. 

There are three phases that the condition will pass through; 
A freezing phase where the joint tightens up, a stiff phase where the movement in the shoulder is significantly reduced and a thawing phase where the pain gradually reduces and mobility increases.

Clinical features

• Age - 40 - 60 yrs
• History of trauma, often trivial followed by aching in the arm and shoulder.
• Tenderness
• Stiffness
• Wasting

Cardinal features: stubborn lack of active and passive movements of shoulder in all directions.

Treatment: 

• One should seek proffessional advise before attempting any frozen shoulder rehab.
• Treatment is divided into two modes: conservative. And surgical.
• Conservative treatment: physiotherapy plays an important role in the prevention as well as resolution of this condition. It aims to releive pain and prevent further stiffening with:
• Rest
• Non steroidal anti inflammatory drugs
• Electrotherapy - ultrasound, tens & laser treatment may also help reduce pain and inflammation.

Therapeutic exercises

1 Pendulum exercise

2 Wand exercises

3 Therapist assisted mobilizations

4 Stretches - 

• Shoulder flexion stretch
• External rotation stretch
• Chest stretch
• Posterior shoulder stretch

 
5 Strengthening exercises

• Isometrics shoulder exercises
• Postural exercises - scapular squeezes

6 Taping

• Surgery 
• Surgery is the last resort if normal treatment has failed.

The core muscles, mainly concentrated around the abdomen, hips, lower back, trunk, and glutes, are indeed a powerhouse that gets you going. The stronger the core muscles, the fitter you stay. Without a proper core strength, a lot of the day to day activities including lifting or bending gets affected. Certain health conditions can weaken the core muscles. But how to know if the core muscles are weak? There are many signs and symptoms associated with weak core muscles.

Mentioned below are some important signs that may be an indication of weak core muscles.

1. For your posture to be correct, the spine and pelvis need to be stable: The muscles of the lower back and the abdomen does exactly that, ensuring a steady and correct posture. However, when the core muscles weaken, they are unable to provide stability to the spine and the pelvis resulting in a poor posture. Left unattended, poor posture, in turn, can trigger a myriad of complications and discomfort.
2. The body loses its balance: As already mentioned, the core muscles go a long way in stabilizing the body and helping you to maintain the body balance. You can perform a small test to know if your balance is affected. Close your eyes and stand on one foot. Repeat the procedure with the other foot as well. If you have a developed core, you will be able to hold the position for at least 10 seconds, if not more (both the legs).
3. A pain concentrated to the lower back: Do not ignore a lower back pain. It could be an indication of your core muscles not being strong enough, especially the ones adjacent to the spine. The weak muscles fail to provide the necessary support to the discs and the vertebrae resulting in pain (mild to severe depending on the severity of the condition) and discomfort. Timely medical intervention may help improve the condition.
4. Weakness throughout the body: The strong core muscles are an indication of a healthy and fit body. When the muscles start to lose its strength, the entire body gets affected. A person finds it difficult to even lift things. Doing even a small and regular work leaves a person weak and tired.
5. You can also perform the Hollowing Test to check your core strength: Sit in a comfortable position. Starting breathing in and out. As you breathe out or exhale, try to pull your stomach inwards towards the spine for at least 10 seconds. Unable to pass this test (can't hold the position for 10 seconds) indicates weak core muscles.
6. You can also try the plank test: Get yourself in a push-up position with the entire body resting on your elbows, arms, and toes. The hip should be level and steady. Failing to stay in this position for 50 seconds is indicative of weak core muscles

Dislocation refers to an injury, which causes the bones to abnormally separate from each other in the joint, which is the meeting place of the bones. Dislocation causes intense pain and is most common in the fingers, shoulders and the elbows. Although a timely diagnosis can make your pain go away, any future injury in the tendons or the ligaments might bring back the injury. 

What can cause a dislocation?
The causes of dislocation are as follows:

1. A body joint can get dislocated if you have suffered a fall.
2. If you are into any form of sports that requires strenuous physical activity and intense exertion on certain body parts like gymnastics, football or volleyball you have a chance of suffering from dislocated body joints.
3. Automobile accidents can also cause dislocation of joints.
4. Some People who are with a loose ligament and are more likely to get a dislocated joint than other people. This may happen without the influence of a major physical trauma or stress.

Understanding the signs and symptoms

In the majority of the cases, a dislocation of the joint is easily detectable as it induces inflammation along with redness and deformation of the affected area. Some of the other symptoms that might occur as a result of the dislocation of the body joints could be: 

1. You might experience severe pain while moving the dislocated joint.
2. There will be a lack of sensation near the dislocated portion.
3. There might be a stinging sensation in the dislocated area.
4. In certain areas you may not be able to move the joint at all

If you have a dislocated joint, the doctors can easily relocate them. Depending on the amount of swelling and pain you are experiencing, the doctor might administer local anesthesia during the process. If the joint dislocation is too severe or has multiple instances of dislocation, then you may have to undergo surgery. Surgery may also be suggested if the adjoined ligaments or tendons are severely affected along with the joints.

Back pain is a common source of pain, which can be acute, subacute or chronic in nature. Back pain is classified along the segments of the spine and can be divided into neck pain, middle back pain, lower back pain or tailbone pain.

Joint Replacement Surgery is a procedure where the damaged surface of the advanced arthritic joints are removed and replaced with artificial joints, such as metallic, plastic and ceramic joints. These surfaces closely replicate the original anatomy.

When do you need a knee replacement?
When you suffer from severe pain or deformity in the joint (knee in this case), the pain or stiffness and deformity makes it difficult to perform simple tasks. Severe grade IV osteoarthritic knees of  people over 50 years when have pain, swellingand deformity fail to respond to medicines, physiotherapy, injections and rest.

Aim of the surgery

1. Correct the deformity: Relieve the pain and give near full movements almost immediately after the procedure. Details including techniques and safety, it is a safe, rewarding surgery with a success rate of as high as 99.5% when done by an able and experienced professional.
2. Anaesthesia: Usually it is the spinal cord epidural where one is rendered numb for 3 to 4 hours waist down. Sometimes a general anaesthesia is given. A 4 to 5 inches cut is made in front of the knee and all the damaged cartilages, bones, loose bodies are removed from the lower end of the thigh, upper end of the tibia (usually of few millimetres) and the surface re-crafted to match the size and shape of the artificial joint (it is usually imported). They are fixed with bone cement. The ligaments and muscles are reattached and the parts closed.

Aftercare tips for joint replacement patients:

1. Recovery: Stand up and walk a few steps with a walker the day after the procedure i.e. in 24 hours. Physiotherapy in hospital for 5 to 7 days and/or walking, progressively longer walks and exercises over the following 15 days. Stitches are removed in 15 days. The patient can return back to normal activity in 4 to 8 weeks after the surgery.
2. Activities: Normal walks of 3 to 5 km per day, climbing stairs, cycling, swimming and driving can be performed with the new implant(s) now.
3. Avoid: Squatting/kneeling, playing sports like football, cricket, tennis, jumping, adventure sports,

The longevity of joints will vary between 15-35 years depending on the material used by the doctor.

Gridhrasi is what Sciatica is known as in Ayurveda. It is the disorder that causes mild to agonizing pain in the sciatic nerve or neuralgia. These nerves, emerging from the pelvis, run along the hamstring and may cause intense pain in one or both the legs when a person suffers from Sciatica. Sciatic pains fill your life with misery as the simplest of daily activities cause sudden and excruciating pain. There are two types of sciatia i.e. true sciatica and pseudo sciatica. Sciatica may be caused due to bulging disc or herniated disc, degenerative disc disease, piriformis syndrome, pregnancy or trauma etc. 

According to Ayurveda, Sciatica is caused due to impairment in Vata i.e. the dosha responsible for the functional ability and movement of the body, and also in some cases due to impairment in the Kapha i.e. the dosha that is responsible for body fluids and lubrication.

Ayurvedic herbs that improve the symptoms of Sciatica are:

1.        Babunah is also known as Bitter Chamomile. Not only is it used to relieve and reduce the pain faced by a sciatica patient, but it is also used for treating problems such as rheumatism due to the advancement of age. Compressed bitter chamomile flowers are prescribed for sciatica.

2.        Guggulu is also known as Indian Bdellium. Since guggulu is well known for its anti-inflammatory properties, it relaxes the sciatic nerves.

3.        Rasna is also known as Vanda Orchid. Intense or agonizing pain due to the sciatic nerve issues can be reduced by this ayurvedic herb due to its anti-inflammatory properties. 

4.        Juniper oil is extremely helpful when massaged onto the thigh muscles with firm strokes or pressure. It is used extensively in massage therapy for treating sciatica since the extent of reduction in sciatic nerve pain is tremendous. 

5.        Jaiphal is also known as Nutmeg. After being mixed with sesame seeds oil, nutmeg is coarsely powdered and then fried till it turns brown. This is then applied to those areas where the sciatic pain is intense for instant relief.

6.        Kumari is also known as Indian Aloe. Properties of Indian Aloe are extremely helpful in treating lower back ailments such as sciatica and lumbago.

7.        Shallaki is also known as Boswellia or Frankincense. Containing anti-inflammatory properties, shallaki is applied externally to get relief from sciatic nerve pain. 

Ayurvedic preparations such as yogaraja guggulu, Vataganjakusha, Saindhavadi taila are also very useful in treating Sciatica. 
 

Knee replacement is a procedure where the weight-carrying surfaces of knee joint are replaced surgically to ease the pain or any disability. People suffering from osteoarthritis, rheumatoid arthritis or psoriatic arthritis undergo knee replacement. All these conditions revolve around stiffness and painful knee. This surgery is usually performed on people aged over 50.

Surgery Types: 
Knee replacement is mainly of two main types:

1. Total knee replacement where both the sides of knee joints are replaced
2. Partial knee replacement where only single side of the joint is replaced

Procedure: In case of partial knee replacement with minimal invasion, a smaller incision, which is 3 to 5 inches, is required. This leads to minimal tissue damage and the surgeon can work between the fibres of the quadriceps muscles. Here, an incision through the tendon is not required. This may result in less pain, recovery time is reduced, and motion is better as scar tissue formation is less.

In total knee replacement, four steps are performed:

1. Removal of damaged cartilage surfaces, which is at the ends of the femur and tibia, with a small quantity of underlying bone.
2. Replacement with metal components, which help as a recreated surface of the joint
3. Incision of knee cap with a resurface made of a plastic button, which is optional based on the case
4. Insertion of a medical grade plastic spacer amid the metal components. This creates an effortless gliding surface.

After general or spinal anaesthesia, an incision of 8-12 inches is made in the front part of the knee. Joint part which is damaged is removed from the surface of the bones. The surfaces are then formed in a way to hold a metal or plastic artificial joint. The thigh bone shin as well as knee cap is attached to the artificial joint with either cement or a special material.

After Effects of the Procedure: After the surgery, patients may stay in a hospital for three to five days. Post surgery, notable improvement can be seen after a month or later. The patient is gradually relieved from pain with the construction of new gliding surface during surgery.

There will be slow progress in the movement. In the beginning, one may walk with a support of parallel bars and then with the help of crutches, walker, or cane. After full recovery in about six weeks, people can enjoy normal activities except running or jumping.

Presently, over 90% of total knee replacements function well even after 15 years of surgery. Hence, knee problem is no problem at all!