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Dr. Bharath

MBBS

Radiologist, Chennai

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Dr. Bharath MBBS Radiologist, Chennai
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I pride myself in attending local and statewide seminars to stay current with the latest techniques, and treatment planning....more
I pride myself in attending local and statewide seminars to stay current with the latest techniques, and treatment planning.
More about Dr. Bharath
Dr. Bharath is an experienced Radiologist in Tambaram, Chennai. Doctor is a qualified MBBS . You can visit him/her at Gajanan Hospital in Tambaram, Chennai. Save your time and book an appointment online with Dr. Bharath on Lybrate.com.

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Gajanan Hospital

#29, Kakkan Street West, Tambaram, Tamilnadu, Landmark: Near AG Clinics & Near To Vidhya Theater.Chennai Get Directions
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I am having problem in l4 and I5. This problem is from around 3 years. But the condition is improved now. Can you please suggest some exercises?

PG Diploma in Emergency Medicine Services (PGDEMS), Bachelor of Ayurveda, Medicine and Surgery (BAMS), MD - Alternate Medicine
Ayurveda, Ghaziabad
Hi Apply pranacharya restopain oil or prasarini oil on your affected part then give hot fomentation. Take maha rasnadi kwath 2-2 tsf twice a day. And agni tundi vati and maha yograj guggul 1-1 tab twice a day..
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Types and Diagnosis of Uterine Fibroids

Fellowship In Minimal Access Surgery, MS - Obstetrics and Gynaecology, MBBS
Gynaecologist, Hyderabad
Types and Diagnosis of Uterine Fibroids

Noncancerous growths of the muscle tissue surrounding the uterus are known as uterine fibroids. This is a common disease which about 70 to 80% of women contract by the time they are 50 years of age. The uterine fibroids can sometimes be very big and cause heavy periods as well as severe abdominal pain while at other times, uterine fibroids give no signs or symptoms whatsoever and go away on their own. This is why it is crucial to know what type of uterine fibroids you have and how to diagnose them. Here are the types of uterine fibroids and how to diagnose them;

Types
There are three main types of uterine fibroids. They are;

1. Intramural fibroids
The most common type of uterine fibroids are intramural fibroids. They typically appear in the endometrium and may grow larger which results in your womb getting stretched.

2. Subserosal fibroids
Subserosal fibroids are called so because they form on the serosa. The serosa is the outside of your uterus. Sometimes, Subserosal fibroids may grow so large that your uterus appears bigger on one side.

3. Pedunculated fibroids
Pedunculated fibroids tumors are basically Subserosal fibroids with a stem. A base which supports the tumor is called the stem.

Diagnosis
There are a number of tests done to diagnose uterine fibroids. They are;

1. Pelvic exam
A pelvic exam is a thorough inspection of a woman pelvic area. The organs which are in the pelvic area include the cervix, ovaries, uterus and vagina. Normally, this and the next test in this article are enough to diagnose uterine fibroids.

2. Medical history
The history of your periods as well as the other symptoms you have will often be enough to diagnose the uterine fibroids. If your medical history is not enough, then you might need to undergo a pelvic exam.

3. Pelvic ultrasound
An ultrasound is when high-intensity sound waves are used to produce images of the pelvic area. This is only done when a pelvic exam and your medical history are not enough to diagnose uterine fibroids. If you wish to discuss about any specific problem, you can consult a Gynaecologist.

2876 people found this helpful

Sir I have a problem of slipped disc in cervical spine. I am a dance choreographer so I should do my profession or I should stop it.

Fellowship in Shoulder and Upper Limb, Fellowship in Joint Replacement, MS - Orthopaedics, MBBS
Orthopedist, Mumbai
If the problem is recent and correctly diagnosed you should take rest for a couple of weeks and then start gradually with neck physio. Once your neck muscles are strong then you can gradually restart your dance activity.
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I am 27 year boy I have back pain l4 and l5 disk light move. I there any full relief treatment means contact me sir. Back pain person do sex fully or not. After two month marriage fixed so im tired.

BPTh/BPT
Physiotherapist, Delhi
I am 27 year boy I have back pain l4 and l5 disk light move. I there any full relief treatment means contact me sir. ...
Start with physiotherapy treatment. Learn spinal exercise. Don't sit on floor. Don't lift heavy things. Share your x ray report for further discussion.
1 person found this helpful
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I am 22 year running. I am suffering from slip disc problem since last 1 & half year. My pain is increasing day by day. Its start with lower back and now its come in my left leg. I am done many things for it but still I am suffering for with this. What can I do I cant understood.

MBBS, MS - Orthopaedics
Orthopedist, Delhi
Sleep on a hard bed with soft bedding on it. Use no pillow under the head. Kindly take biod3 max 1 tab dailyx10 paracetamol 250mg od & sos x5days do back (spine)/shoulder/knee exercises make sure you are not allergic to any of the medicines you are going to take do not ignore it. It may have to be further investigated. It could be beginning of a serious problem. If no relief in 4_5 days, then contact me again. Contact your family doctor or nearest hospital for emergency help.
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Can Arteries plaque and ECG level changes can be cleaned naturally with foods only and how much time it will take. Any natural food to advise.

MD - Homeopathy, BHMS
Homeopath, Vadodara
No... It is not possible... And even not by a single medicine... You will need Treatment Yoga and . exercise...
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Can disc stenosis be cured permanently? And can the compressed disc become as it was earlier with Pranayam?

Occupational Therapy (OT)
Occupational Therapist, Jaipur
It's treatable and relieved from disability or pain with life style changes through Occupational therapy with work site and home modifications.
1 person found this helpful
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Breast Cancer

MBBS, DGO, DNB - Obstetrics and Gynecology
Gynaecologist, Delhi
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Symptoms, causes and treatment for Breast Cancer Patients

Hello friends. My name is Dr. Gayatri Juneja. I’m a practicing gynecologist in Model Town for the last 20 years. I’m a visiting consultant in Apollo Cradle Hospital Moti Nagar, and Fortis Hospital Shalimar Bagh, and Sunder Lal Hospital Ashok Nagar. It’s a great pleasure for me to talk to you about certain problems which I think is becoming very important for all of us to know. I am going to talk about Breast Cancer.

Unfortunately, even in India, cancer breast is becoming very common. And it is not that it is a cancer which we cannot pick up at time. The only thing we need is to be aware of it. Only if we know what is happening with our body, is only then we can do what is normal, only then we can see what is not normal, right? It is one of the breast cancer is one of the easiest cancers to pick up. How? My body is my own. I should know what’s happening to me. So minimum a lady can do is do a self examination. Teach your daughters how to do a self examination for the breast. If you find any lump, any time, if you feel there is some pain, which was not there, if you see the nipple is not in the normal position, it is retracted inside, if you see there is skin changes on your breast, if you see any size difference. See minor size difference will be there. That is a natural thing. But if you see there is drastic change, and if you are not comfortable with something, do not neglect it. It’s not at all a normal thing. Go, see a gynaecologist.

It is a confidential thing between you and your doctor. Let her examine you. Let her guide you. You give her a proper history, if you have taken any contraceptive pills, even I-pill is very dangerous. I’ll come to it later how. The thing is…your doctor has examined you, then she will guide you what has to be done. There are various ways of diagnosing cancer of breast. First step is, you do a self examination. First step is over. You find the lump, you go to a doctor. Your doctor will ask for a sonography, that is ultrasound of the breast. And another part of it is an x-ray of the breast. Sometimes in younger age group the breast is very dense, and you cannot diagnose anything on mammogram.

You still are suspecting something, then your doctor might ask for an MRI. MRI is very effective in diagnosing, but we do not suggest it as first line treatment, first line of diagnosis. Once it is confirmed that yes, there is a lump, then what we do is, we ask for a biopsy. Now biopsy can be in 2 forms. It can be taken through the needle, which we call FNAC – Fine Needle Aspiration Cytology, and other is open biopsy, where we remove the whole lump, and send it for testing. If the test comes negative, good, fine, everything is fine. If it comes positive, then further treatment depends upon the type. Then they will do a special CT scan for you, where the will diagnose if any lymph nodes are involved.

Depending on preliminary staging, your doctor will ask for a surgery. Now the surgery will…it is better that the whole breast gets removed. Or what has to be done will be diagnosed, because it is not a single person specialty, it is going to be a multi-specialty treatment then. Now let’s come down to who are the people who are at higher risk. Why should I consider that I am at higher risk? What…who are those people? First, specially after menopause, obesity. If your lifestyle is not at all healthy, your food habits you eat lot of non-veg and processed food, like pizzas and burgers and frozen food, yes you are at risk. Then comes genetics.

If you have a family history of cancer in your nani, dadi, your bua, maasi, cousin, ya sister ya brother, or even cancer of ovaries, you are at high risk. But that doesn’t mean who all have had the history of cancer will also develop this. You are at higher risk, but it is better only to be careful. Then comes very tall ladies it has been seen they are also prone for diabetes. Obesity, and people who have had hormonal replacement therapy with…and once you’re diagnosed don’t get scared. It is a curable cancer, and life expectancy with variable modalities these days is quite good.The quality of life is also good.

So my suggestion would be, to conclude, that please be aware of what is happening with you, and take good care of yourself. If you are healthy, only then you can look after your family. Thank you so much.

3914 people found this helpful

Uterine Prolapse - 8 Causes Behind It

MS - Obstetrics and Gynaecology, MBBS
IVF Specialist, Dibrugarh
Uterine Prolapse - 8 Causes Behind It

The uterus is a muscular structure held in place inside your pelvis with the help of muscles, ligaments, and tissues. These muscles weaken in women due to pregnancy, childbirth or delivery complications and can lead to severe complications. One such complication is a uterine prolapse. Uterine prolapse occurs when the uterus sags or slips from its normal position into the vaginal canal.

The causes of uterine prolapse are varied and include:

- Delivering a large baby
- Pregnancy
- Difficulty in labor and delivery
- Reduction in estrogen levels post menopause
- Traumatic childbirth
- Loss or weakening of the pelvic muscle
- Conditions which lead to increased pressure in the abdominal area such as a chronic cough, straining, pelvic tumors or accumulation of fluid in the abdomen
- Loss of external support due to major surgery in pelvic area

Uterine prolapse can be complete or incomplete depending on how far the uterus sags into the vagina. Women who have minor uterine prolapse may not have any visible symptoms. However, if the condition worsens, it manifests itself in visible signs.

Symptoms of moderate or severe prolapse are:

1. A feeling of fullness or pressure in your pelvis when you sit
2. Seeing the uterus or cervix coming out of the vagina
3. Vaginal bleeding or increased discharge
4. Painful sexual intercourse
5. Recurrent bladder infections
6. Continuing back pain with difficulty in walking, urinating and moving your bowels

Without proper attention, the condition can cause impairments in the bowel, and can also affect bladder and sexual function. If you wish to discuss about any specific problem, you can consult a gynaecologist.

1957 people found this helpful

Bone Cancer - 4 Signs You are Suffering from it!

MBBS, MD - Oncology, DNB - Super Speciality, Immuno Oncology
Oncologist, Delhi
Bone Cancer - 4 Signs You are Suffering from it!

We have more than 200 bones in our body and each of them is susceptible to bone cancer. However, long bones in the arms and legs are most susceptible to this condition. Bone cancer can be primary or secondary. Primary bone cancer involves uncontrolled and abnormal cell division within the bones while secondary bone cancer refers to cancer that originated somewhere else in the body and later spread to the bones. While children and adults are equally at risk for primary bone cancer, adults and elderly people are more susceptible to secondary bone cancer. If diagnosed early enough, bone cancer can be treated and even cured with surgery, chemotherapy or radiation.

Hence it is essential to recognize the signs and symptoms of bone cancer. Here’s what you should look out for.

  1. Pain in Bones: Pain is one the primary symptoms of bone cancer. As the tumour grows larger, this pain can become more intense. In its early stages, the pain may be experienced as a dull ache inside the bone or the affected part of the body. It may also increase or decrease according to your activity level or may be experienced only at night. However, not all bone pains signify ‘cancer’ as this is also a symptom associated with osteoporosis.
  2. Swelling: In some cases, the abnormal growth of bone cells can result in the formation of a lump of mass that may be felt through the skin. In other cases, the affected area may also show signs of swelling.
  3. Breaking of the Bone: Cancer can weaken the bones and make them more brittle. This may make the bones more susceptible to fractures. A bone breaking in an area that has been painful or sore for a long period of time may be a sign of cancer. This is known as a pathologic fracture.
  4. Reduced Flexibility: If the tumour is located near a joint, it may affect the range of movements possible and make simple actions uncomfortable. For example, a tumour around the knee may make walking and climbing stairs a painful exercise.

Other symptoms to look out for are sudden and drastic weight loss, tiredness, excessive sweating at night, fever and difficulty breathing in case cancer has spread to other organs. Since many of these symptoms are common to other medical disorders, you should consult a doctor immediately if you notice any of them. A physical examination and a couple of tests along with a biopsy will be required to confirm a diagnosis of bone cancer.

3348 people found this helpful

sciatica

BPTh/BPT
Physiotherapist, Pune
Prolapsed Disc
Also known as slipped disc, herniated disc or sciatica. The discs are the shock absorbers of your spine. When they are injured the inner soft part of the disc can protrude out through a tear in the outer lining of the disc. This disc material can press on the nerves in the spinal column, injuring them through direct pressure and causing inflammation.
The most common age to develop a disc prolapse is between the ages of 30-50 years., twice as many men as women are affected. Prolpased discs occur mainly in the low back (lumbar) spine. Less than I in 20 cases of back pain are due to a disc prolapse, most are due to mechanical back pain. (see section back pain).
Symptoms
A slipped disc is characterised by sudden, severe back pain that is often made worse by movement and which can usually be eased by lying down flat.
Nerve root pain (sciatica) can also occur because a nerve is trapped or irritated by a prolapsed disc. Although the problem is in the back, patients experience pain along the course of the nerve, for example, down a leg to the calf or foot.
With a prolapsed disc, the sciatic nerve is most commonly affected. The sciatic nerve is a large nerve that is made up from several smaller nerves that come out from the spinal cord in the lower back and travels down each leg. The irritation or pressure on the nerve may also cause pins and needles, numbness or weakness in part of a buttock, leg or foot.
In rare cases, cauda equina syndrome can occur. This is a disorder where the nerves at the very bottom of the spinal cord are trapped. It can cause low back pain as well as problems with bowel and bladder function and weakness in one or both legs. These symptoms need urgent medical treatment to prevent permanent damage to the nerves that supply the bladder and bowel.
A large number of people can have a prolapsed disc without any symptoms if it doesn’t trap or irritate the nerve.
Investigation
A doctor will normally be able to diagnose a prolapsed disc from the symptoms and by examining the patient.
In most cases, no tests are needed, as the symptoms often settle within a few weeks.
Tests such as x-rays or scans may be advised if symptoms persist. In particular, an MRI scan can show the site and size of a prolapsed disc. This information is needed if surgery is being considered
12 people found this helpful

Adults With Brain Injury - Know How Occupational Therapy Can Help You!

Master of Occupational Therapy (MOT), Bachelor of Occupational Therapy (BOT)
Occupational Therapist, Delhi
Adults With Brain Injury - Know How Occupational Therapy Can Help You!

Brain injury can happen as a result of trauma, infection or degeneration with old age. Whatever be the reason, injury on the head can result into brain dysfunction and should be given required medical diagnosis. In these cases, occupational therapy can be a major help.

It helps in improving health, providing rehabilitation and educational service to enable people to participate in things they are interested in and manage their daily activities. Occupational therapy can be used to manage issues relating to memory, organization and attention span, behavior and emotion control, safety issues and issues which contribute to society. Depending on expectations, different therapies can be sought. Read on to know a little more about how occupational therapy can help adults with brain injury.

  1. The person's skills and what they want to do are to be assessed and accordingly a daily plan that can be easily followed is made. Where possible, use technology like smart phone or voice recorder to manage this plan. The therapist can train the person to use these tools, review progress and make changes as necessary.
  2. The therapist will also teach ways to do things on their own like cooking and small shopping, so they become independent and are therefore less frustrated.
  3. Patients in need of anger management, the therapist will help them to identify what induces anger or frustration and support in managing those before it turns into actual anger. This will help the person relax and be more positive.
  4. This could also be done using small roleplays, wherein they are taught ways to respond and be more relaxed and calm.
  5. If you are keen on participating in social events or volunteering opportunities, then the therapist can recommend options for you based on your areas of interest. The therapist can also work with the identified organization (school, NGO, or workplace) to inform them of the kind of support required by you. Work behavior and social behavior can be taught to help the affected person succeed.
  6. If the affected person happens to be alone, then they need to be assessed for ability to judge (e.g., self-awareness, impulsivity, and reliability), even while doing daily activities like bathing and dressing. Driving is permissible only if cleared for it by the therapist.
  7. The home needs to be assessed for safety. You may have to make some safety modifications, for instance replace power tools with hand tools. Else, shared housing options, where independence and having someone close by is possible, should be evaluated.

So, with a brain injury, not all is lost. Occupational Therapy can definitely help restore function to a large extent, so use it to reap maximum benefits. If you wish to discuss about any specific problem, you can ask a free question.

4833 people found this helpful

Breast Cancer - Signs That Help You Spot It!

MBBS, DNB - Surgery, Fellowship in Breast Surgical Oncology
Oncologist, Gurgaon
Breast Cancer - Signs That Help You Spot It!

Breast cancer is an abnormal growth of cells in the tissues of the breast. Mainly it occurs in females but less than 1% of all the breast cancer cases develop in males. The majority of breast cancers start in the milk ducts. A small number start in the milk sacs or lobules. It can spread to the lymph nodes and to the other parts of the body such as bones, liver, lungs and to the brain.

With more reliable early detection methods as well as the trend towards less invasive surgery, there is hope that even more women with breast cancer will be treated successfully and will go on to resume their normal lives.

Signs & Symptoms 
It is painless, especially, during the early stage. Watch out for the following changes in the breast:

  1. A persistent lump or thickening in the breast or in the axilla. 
  2. A change in the size or shape of the breast. 
  3. A change in the colour or appearance of the skin of the breast such as redness, puckering or dimpling. 
  4. Bloody discharge from the nipple. 
  5. A change in the nipple or areola such as scaliness, persistent rash or nipple retraction (nipple pulled into the breast).

Consult a doctor immediately if you notice any of these changes.

Risk Factors 
Being a woman puts you at risk of getting breast cancer. There are certain factors that increase the risk of breast cancer. Some of them have been listed below:

  1. The risk increases with age; most cases of breast cancer develop after the age of 50 
  2. Genetic alterations in certain genes such as BRCA1 and BRCA2 
  3. Family history of breast cancer 
  4. Being overweight 
  5. Early menarche (onset of menstruation before the age of 12) 
  6. Late menopause (after the age of 55) 
  7. Never had children 
  8. Late childbearing 
  9. No breast feeding 
  10. Excessive consumption of alcohol 
  11. Use of hormonal replacement therapy (HRT) for a long period of time

However, most women who have breast cancer have none of the above risk factors. Likewise, not having any of these risk factors does not mean that you will not get breast cancer.

Early Detection and Screening

More treatment options are available when breast cancer is diagnosed at an early stage and hence the chances of recovery is also higher. So regular breast screening is important for early detection even if there are no symptoms. Following are the ways of screening:

  1. Breast Self-Examination (BSE): Perform BSE once a month about a week after your menses are over. If you no longer menstruate, choose a date each month which is easy to remember e.g. your date of birth or anniversary.
  2. Clinical Breast Examination: Get a breast specialist to examine your breast once a year if you are 40 years and above.
  3. Mammogram: Go for a screening mammogram once a year if you are 40 to 49 years old and once every two years if you are 50 years and above even if you do not have any symptom. It is not recommended for younger women (less than 40 years of age) as they have dense breasts, making it difficult for small changes to be detected on a mammogram. So ultrasonography of the breasts is advisable to them.

Types of Breast cancer

  1. Non-Invasive Breast cancer: These are confined to the ducts within the breasts. They are known as Ductal carcinoma in-situ (DCIS).
  2. Invasive Breast cancer: It occurs when cancer cells spread beyond the ducts or lobules. Cancer cells first spread to the surrounding breast tissue and subsequently to the lymph nodes in the armpit (Axillary lymph nodes). These cells can also travel to the other parts of the body such as bones, liver, lungs or brain and hence known as metastatic breast cancer.

Making A Diagnosis 

If you notice any unusual changes in your breasts, you should see a doctor immediately. He will examine you clinically and may ask you to undergo some tests so that a definitive diagnosis can be made. Further, the staging work up is done to find out the stage of the disease and management accordingly.

Treatment options 
Treatment of breast cancer may include various methods such as surgery with or without breast reconstruction, chemotherapy, radiation therapy, hormonal therapy and targeted therapy. Treatment options offered, depend upon the number of factors such as the stage of cancer and likelihood of cure, your general health and your preference. If you wish to discuss about any specific problem, you can consult an oncologist.

1931 people found this helpful

I have cervical small disc bulge and disc protrusion inserting thecal sac. Is there any permanent cure in ayurveda?

MD - Homeopathy, BHMS
Homeopath, Vadodara
I don't know about the ayurvedic but I know homoeopathy can help a lot in such conditions... You may try taking Nux Vomica 1 hourly in the evening..
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Tips to Prevent Herniated Discs

M.Ch. orthopaedics, M.S. (Orth)
Orthopedist, Ludhiana
Tips to Prevent Herniated Discs

Our spinal disk resembles a jelly donut, wherein the softer insides are protected by the hard exterior. Sometimes, as a result of some injury or an accident the jelly slips out, leading to an extremely painful condition which in medical parlance is known as herniated disc. The pain that you are subjected to, during herniated disc, occurs as the nerves nearby are damaged due to the concussion.

Apart from pain, herniated disc is preceded by other symptoms, some of them are:

  1. Pain in the arm or the leg: Depending on which part of the body you have suffered the herniated disc, in the neck or in your lower back, this condition is succeeded by intense pain either near the buttocks or near the shoulders. It goes without saying that this pain increases sharply with movement.
  2. Numbness: That part of the body where the nerves are damaged due to herniated disc often becomes numb and has no sensation whatsoever.
  3. Weakness: Due to herniated disc, the muscles become weak that considerably impairs and curbs mobility.

However, there are various ways by which you can prevent a herniated disc. Some of them are:

  1. Exercise: Exercise in any form and even for a short while yields several benefits. Your body invariably gains momentum and agility. If you exercise daily, your spine becomes more stable and strong, thereby preventing a possible herniated disc.
  2. Maintaining the right and good posture: A lot depends on the way you sit and walk, in fact more than you can imagine. If you sit badly, it exerts a pressure on the spine and the discs. Subsequently, a good posture does the very reverse and curbs chances of a herniated disc in the future.
  3. Keep a tab on the weight: It is always healthy to maintain the right weight, the one that keeps you away from the onset of various diseases. If you are overweight, it puts more pressure on the spine disk, thereby increasing the risk of developing a herniated disc.
3045 people found this helpful

This is my Mri report impression. Disc degeneration and disc bulge is seen at L5/S 1 level indenting the thecal Sac without any nerve root compression. Annulus tear is noted. 2 this r my x ray report impression. Pid L5. S 1.

FRHS, Ph.D Neuro , MPT - Neurology Physiotherapy, D.Sp.Med, DPHM (Health Management ), BPTh/BPT
Physiotherapist, Chennai
This is my Mri report impression. Disc degeneration and disc bulge is seen at L5/S 1 level indenting the thecal Sac w...
Do Take Physiotherapy treatment of IFT and vacuum Therapy Physiotherapy treatment for pain relief for 12 days followed by strengthening exercise from physiotherapist Best wishes.
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Neck Pain - Health Tip

Master of Physical Therapy MPT CARDIO, BPTh/BPT
Physiotherapist, Rajkot
Neck Pain - Health Tip
Herniated disks or bone spurts in the vertebrae of the neck may become the reason behind severe neck pain. They sometimes take too much space and compress the nerves branching out from the spinal cord.
10 people found this helpful

I met accident and my back disk d8 and d12 injured and operted in banglore now i am paraplegia patient from 7 years any treatment to cure it please reply me i went for stem cell in chenni also

MS ORTHOPEDIST, MBBS
Orthopedist, Noida
Its sad to know about your conditions. Stem cell can provide little help on immediate spinal trauma... there r other parameters to evaluate the neurology which is not possible with chatting.. prognosis is not good in long standing cases...
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I am 42 year old female .After slip disc L1toL4 problem, pain in left heel and becomes severe at times. Is it spur in the foot ,slip disc or something else.

FRHS, Ph.D Neuro , MPT - Neurology Physiotherapy, D.Sp.Med, DPHM (Health Management ), BPTh/BPT
Physiotherapist, Chennai
I am 42 year old female .After slip disc L1toL4 problem, pain in left heel and becomes severe at times. Is it spur in...
Do Take IFT and laser Therapy for pain relief for 12 days followed by strengthening exercise from physiotherapist and need to be with Clinical examination.
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