 Movement disorders    the term refers to a class of neurological conditions, which lead to either an increased/abnormal movement or a scarcity of involuntary and voluntary movements.

Types of Movement Disorders- 
The most common types of movement disorders are  
  Myalgia   More commonly known as muscle pain, myalgia originates in any part of the body. A person with myalgia will experience achiness and soreness in the muscles, which may range from severe to mild.

Myalgia does not occur from an underlying disease. Rather, the pain develops over time, mostly due to prolonged sitting, lying down, a strenuous physical activity, strains or sprains.

  Muscular dystrophy   This refers to a group of genetic disorders that lead to weakness and loss of muscle mass. The abnormal genes cause muscle degeneration and usually begins in early childhood. Myotonic, Facioscapulohumeral (FSHD), and Limb-girdle are a few forms of muscular dystrophy.

Muscular dystrophy is characterized by symptoms like   difficulty jumping and running, muscle stiffness and pain, walking on toes, waddling gait, trouble swallowing and breathing etc.

  Dystonia   The condition involves continuous involuntary muscle contractions with repetitive, twisting movements. Dystonia may affect either a specific body part (known as focal dystonia) or the full body (known as generalized dystonia).

  Huntington s Disease   This is an inherited, neurodegenerative condition, where the brain s nerve cells break down over time. Huntington s disease usually kicks in, in the 30s or 40s. The disease results in psychiatric and cognitive symptoms   amnesia, confusion, slowness in activity etc.

  Multiple System Atrophy   This is a rare neurological disorder, which affects both the autonomic nervous system   the part of the nervous system that controls involuntary actions like digestion and blood pressure   and movement. Multiple System Atrophy leads to movement disorders like Parkinsonism or ataxia.

Symptoms of this disorder include   double or blurred vision, visual disturbances, unsteady gait, loss of balance etc.

  Tourette Syndrome   This is a disorder of the nervous system, which occurs usually between one s childhood and teenage years. The disorder is associated with vocal sounds (vocal tics) and repetitive movements (motor tics).

Physiotherapy for Movement Disorders-
In most cases, movement disorders cannot be completely cured. However, with physiotherapy, you may be able to manage the symptoms and live a better life.

Physiotherapy is based on a few physical activities or mild exercises that help improve your joint movement and builds muscle strength. This particular treatment approach centres on  

  Exercises based on daily tasks that improve muscle strength
  Activities that improve your balance and reduce the chances of falling
  Exercises to gain control over the uncontrolled movement of legs, arms, and head
  Correct posture while standing or sitting to reduce pain and increase comfort
  Cueing, repetition and movement strategies to reduce the effects of freezing
  Participating in certain functional activities that make it easier for you to move around
  The repetitive movement to trigger pathways to the brain and improve movement accuracy
  Exercise to reduce fatigue and increase stamina
  Hydrotherapy and relaxation therapy to ease muscle stiffness

Neurological disorders affect people in different ways. Physiotherapy for movement disorders is tailored according to the patient s goal and needs so that they are able to achieve maximum physical potential.

Movement Disorders - Its Types, Symptoms & Physiotherapy Treatment!

Knee pain is something that can affect anyone - irrespective of their age. While sometimes it may be of minor importance - and can easily be handled by self-care, often, lingering pain is a manifestation of some other serious underlying problem, such as arthritis. In this case, it is imperative that you consult a doctor and take appropriate measures to combat it.

Causes :

Arthritis: The chief cause of lingering knee pain, arthritis itself can be of a number of types:
 Osteoarthritis, which is a result of deterioration of cartilages due to wear and tear
 Rheumatoid Arthritis, an inflammatory chronic disorder
 Septic Arthritis, causing pain, swelling and redness.
 Gout caused due to the development of uric acid crystals in the joints
Fractures: These are caused by the breaking up of the kneecap due to falls or collisions.
ACL Injuries: Caused due to the tearing of the anterior cruciate ligament (that connects the femur and the shinbone). Especially common in sportspersons such as footballers or basketball players.
Meniscus tears: The meniscus or the rubber-like cartilage (that acts as a shock absorber) can be torn by sudden jerks or excess pressure.

Symptoms:The major symptoms of knee pain include weakness, redness, instability, stiffness or the inability to properly straighten or move the leg. Often, a deformity is also visible, such as a bone sticking out of the leg - in which case it is advisable to consult a doctor immediately.

Possible risks :Factors which include the odds of being inflicted by knee pain and cause serious complications include :
Being overweight: This exponentially increases the stress or pressure that is applied on the knee joints - even in doing mundane tasks like walking up and down stairs.
Excessive physical activity: Some activities, such as sports apply excess stress on the knees as compared to other tasks.
Loss of muscle flexibility: Tightness or weakness in muscles causes increasing number of problems in the knees.

All About Knee Pain

Your knee is a very complex structure consisting of bones, ligaments, cartilage, tendons, muscles and meniscus. Most people encounter knee pain at some point in their lives. If your knee pain is chronic in nature, then it may last for a prolonged period.

Many causes may be responsible for your knee pain. Some of the causes are stated as follows:
1. Your knee is very much prone to injuries. Knee injuries may happen due to accidents, falling down carelessly or while playing sports. The most common knee injuries that may be the cause for your knee pain are mentioned as follows: 
a) Fractures may cause you to feel pain in the areas of your knee bones.
b) Anterior Cruciate Ligament injury (ligament injury caused by twisting and a sudden motion) or Medial Collateral Ligament injury (injury to the tissue in the insides of your knee) is very common to sportspersons and may be the reason for severe knee pain.
c) Sometimes your knee bones may get dislocated from their usual alignment. This can also make you experience severe knee pain.
d) Ligament injuries, meniscus tear or tendon tear can also be responsible for your knee pain.

2. Sometimes pain in your buttock or foot region can also result in mild knee pain.

3. At times chronic problems like osteoarthritis that affects the cartilage can cause the problem of knee pain. Other chronic problems like Gout, rheumatoid arthritis can also cause severe knee pain.

4. Being overweight can also result in knee pain.
The symptoms of knee pain may be different in each case. The most common symptoms are mentioned below:
a) Stiffness of knee
b) Swelling of your knee
c) You may also feel unstable
d) Difficulty in walking or bending of your knee.
e) You may notice redness in your knee area.

Knee pain must not be ignored. It is highly recommended for you to seek advice from an orthopedic as soon as you encounter any of the above mentioned symptoms.

Suffering from Knee Pain - Know What Causes it? 

Knee pain is referred to as a condition when the knee joints (which are responsible for walking, running, sitting and standing along with bearing the maximum body weight for most forms of physical activities) are significantly inflamed, giving rise to a severe pain in particular areas or the entire knee joint. There might also be severe stiffness around the knee joint which might make it very difficult to function.

Knee pain might occur due to obesity, old age, different forms of arthritis, severe injury in the knee or the associated ligament or bones, knee cap dislocation, overuse of the knee joint and infections of the knee joint.

Homeopathic Treatment For Knee Pain:

Homeopathy is one of the most popular holistic systems of medicine. The selection of remedy is based upon the theory of individualization and symptoms similarity by using holistic approach. This is the only way through which a state of complete health can be regained by removing all the sign and symptoms from which the patient is suffering. The aim of homoeopathy is not only to remove the symptom of knee pain but to cure its underlying cause. As far as therapeutic medication is concerned, several well-proved medicines are available for knee pain that can be selected on the basis of cause, location, sensation, modalities and extension of the knee pain. For individualized remedy selection and treatment, the patient should consult a qualified homeopathic doctor in person. The effective homeopathic remedies for knee pain are as follows :

Bryonia Alba   This homeopathic preparation is effective in curing knee pain with the symptoms of severe pain in the knee joints during walking. Pain stops when you stop walking or moving and you may also have an abnormal growth in the knee joints. If the knee pain is caused due to osteoarthritis, Bryonia Alba can prove to be a useful remedy as well.

RhusTox   If the knee pain comes with the symptoms of severe pain in damp weather, intense pain after initial movement which tends to gets better in continuous motion, a prescribed dosage of RhusTox might help in the elimination of the pain.

Colchium   The medicine is useful in treating knee pain which worsens due to movement and subsequently improves in warm weather or after getting appropriate rest.

Silicea   This preparation is useful in curing knee pain which retains the sensation of being tightly bound during all times.

Lachesis   If the knee pain is caused due to rheumatoid arthritis, Lachesis can be an effective treatment. Lachesis can also be prescribed if the pain is accompanied with an abnormal growth around the affected area.

These are just a few of the commonly used Homeopathic remedies and are mentioned only to create awareness about the effectiveness of Homeopathic medicines for Knee Pain. It is not advisable to resort to self-medication for any disease.

Treating Knee Pain With Homeopathy Treatment

Ayurveda is a very old system of medicine, which originated in India. Using herbs found in nature to cure various illnesses, knee pain can also be permanently cured with this method indigenous to India. It reduces knee pain caused by various illnesses including arthritis, inflammation of the cartilage and wearing of the patella among others. Here are some common Ayurvedic remedies, which help reduce knee pain:

1. Alfalfa: Alfalfa is medically known as Medicago Sativa. Alfalfa is excellent for making sure that your joint pain reduces, when taken in liquid form four times a day.

2. Ashwagandha: Ashwagandha is medically known as Withania Somnifera. In the West, Ashwagandha is popularly known as Winter Cherry. Also, it has a lot of therapeutic properties, which include reducing joint pains. 

3. Banyan: The Banyan tree's medical name is Ficus Benghalensis. It has a sap very similar to the form of rubber known as latex is derived from the Banyan tree. The Banyan tree's sap is externally applied over the joints and the pain usually disappears after a few regular applications. 

4. Bishop's weed: The medical name for Bishop's weed is Trachyspermum Ammi. The oil extracted from this herb is usually applied to the knees to reduce the intensity of such knee pains.

5. Celery: The medical name for celery is Apium Graveolens. Celery is not only an effective treatment for rheumatoid arthritis and associated pains in the knees, but it is also helpful in treating gout. It is usually agreed upon that this particular treatment is usually long lasting because of its alkaline nature.

6. Dandelion: Dandelion's biological name is Taraxacum Officinale. It is rich in magnesium and is crucial for the correct mineralization of the bones. This mineralization allows the bones to become stronger and also prevents knee pain.

7.  Garlic: The medical name for garlic is allium sativum. Five to six cloves eaten everyday has proved to reduce knee pains.

8. Ginger: Ginger is biologically called Zingiber Officinale. These can be easily included in your diet and go a long way in curbing knee pain.

Ayurveda and Knee Pain

Knee replacement can be extremely painful. Previously, opioids or narcotics were administered for pain relief. But excessive addition of opioids is not exactly effective for controlling pain. 

Multimodal pain management has become an important part of the perioperative care of patients undergoing total joint replacement. The principle of multimodal therapy is to use interventions that target several different steps of the pain pathway, allowing more effective pain control with fewer side effects. Many different protocols have shown clinical benefit. The goal of this review is to provide a concise overview of the principles and results of multimodal pain management regimens as a practical guide for the management of joint arthroplasty patients.

Multimodal denotes administering two or more than two types of medications that work with different mechanisms. The following are the techniques used:

Pre-operative Femoral Nerve Block: Prior to the surgery, a catheter is placed beside the femoral nerve for blocking it. This nerve is located in the upper thigh. Medication is delivered through the catheter for the nerve to be numbed for 24 hours. Thus, pain signals to the brain are blocked. This method reduces the use of narcotics and the consequent side effects.

Patient Controlled Analgesia (PCA): This method is also known as  Pain Pump . An intravenous pump is used to administer pain relief medications, such as oxymorphone or morphine, after the surgery. The control button of the machine could be pressed, by the patient for 6 to 10 times per hour. The machine is used for two post-operative days.

Oral Medications: The oral medications include Non-Steroidal Anti-Inflammatory drugs or NSAID; such as Celebrex which is similar to aspirin, structurally. Alternatively, acetaminophen, such as Tylenol or its equivalent composition, can also be used.

Acetaminophen: It acts on the Central Prostaglandin Synthesis and relieves the patient of pain through multiple mechanisms.

Epidural Analgesia: It produces lower pain scores and involves less time for achieving physical therapy goals. However, this is subject to side effects such as dizziness, urinary retention and itchiness.

Gabapentinoids: These medications include membrane stabilizers such as Gabapentin and Pregabalin.

The objective of multimodal treatments is to provide quick relief to the patient and immediately so. Earlier the rehabilitation, more successful will be the knee replacement surgery.

Multimodal Pain Relief After Total Knee Replacement

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