Plantar fasciitis is the inflammation of a tissue underneath the ankle bone, which causes intermittent pain and discomfort. It affects a whopping 10 million people in India every year. Those aged 40 and above are at a higher risk of being affected by the condition.

Causes Of Plantar Fasciitis-
Plantar fascia is the soft tissue under the ankle bone, which connects the ankle bone to the toes and facilitates movement. If the fascia gets inflamed, the condition is known as Plantar fasciitis. If the tissue undergoes too much pressure, small tears are likely to take place. With repeated stretching and tearing of the tissue, inflammation and pain may develop.

However, in most cases, the exact cause of the condition is not well understood. Although, it is possible that sprinters or sportsmen are more likely to develop the Plantar fasciitis. Furthermore, obese people have a tendency to develop the condition, as do pregnant women during the later stages of pregnancy.

Symptoms
Here are some common symptoms associated with the Plantar fasciitis-

Pain is the most common symptom related to the condition, although the exact location may vary. Some people experience discomfort on the heels, while others may experience pain at the bottom mid-foot area.
The intensity of the pain also differs, as some may experience a dull pain, while others undergo a sharp pain while moving.
The pain is common when you take your first steps in the morning after getting out of bed. It is also common for the pain to return when you get up after spending a prolonged period of time sitting down.
Treatment For The Condition
Treatment is broadly divided into home remedies and conventional medication. Home remedies involve the usage of ice packs on the heels, at least three to four times a day. Ample rest for your legs may also be enough to cure the condition. Additionally, the use of comfortable shoes along with stretching exercises may also cure the condition.

However, if none of the home remedies seems to work, over the counter nonsteroidal anti-inflammatory medications may be used. The doctor may even inject a steroidal medication into the affected region. In such cases, the medical treatments must be used in conjunction with physical therapy.

Plantar Fasciitis - What Are The Causes, Symptoms, And Treatment?

Tennis Elbow is involved with the muscles and tendons of one s forearm. It leads to inflammation of the tendons which join the forearm muscles on the outside of the elbow.

Physiotherapy treatment can be of great help. The primary goal of this treatment is to improve the strength as well as the flexibility of one&#39;s forearm muscles. Now, before we take a look at the tips regarding physiotherapy treatment, let us briefly discuss its symptoms and causes.

Symptoms

If a person suffers from the problem of tennis elbow, then it s sure to cause pain and tenderness on the outside of one s elbow. The pain is at its peak when the elbow is kept still, while there might be variations in the pain when it is in use.

There are other symptoms, which include:

Trying to lift the arm can cause discomfort as it results in pain.
One can also feel the pain while writing or even when anyone tries to grip small objects.
People can even encounter stiffness accompanied by pain when they try to extend his or her arm at full length.

Causes

There are a number of causes behind the occurrence of Tennis Elbow. They include:

Incorrect movements of the arm on a repeated basis, which can result in the tendons getting torn.
Those who play sports like badminton, tennis and squash that require excessive movement of racquets.
Any manual work that requires regular lifting of the wrist.
Sports activities that involve an extensive amount of throwing.

Tips Regarding Physiotherapy Treatment For Tennis Elbow


Consult a physiotherapist to undergo physiotherapy treatment for tennis elbow, the therapist would help to provide strength and flexibility of forearm muscles. The following are some of the tips regarding Physiotherapy treatment to treat tennis elbow:

A physiotherapist can offer the modern technique of dry needling the wrist extensions in order to improve the range of motion among patients.
Modern physiotherapy treatment for tennis elbow also includes the use of Kinesiology Tape, which can relieve pressure, relax associated muscles and also increase blood circulation.
Cupping is another mode of physiotherapy treatment, which can help increase blood flow to the affected tissue and improve the length to rest muscles
Physiotherapy can include a patient wearing an elbow strap, which wraps around his or her upper forearm in such a way that the pressure gets relieved on the tendon attachment.
A physical therapist might even apply ice and electrical stimulation to ease out the pain and improve the healing process of the tendon.
Physical Therapy sessions can also include iontophoresis, which makes use of mild electric current to insert anti-inflammatory medicine.
Once the pain subsides, a physical therapist provides inputs on different exercises like Wrist Extensor Flex, Elbow Bend, Wrist Turn, Wrist Lift and Palm Up, Towel Twist etc.

Physiotherapy Treatment In Tennis Elbow!

Facial paralysis is when there is a loss of voluntary movement of the face on one or both sides. The following are the most common causes of facial paralysis.

Bell s palsy, the most common cause of facial paralysis
Stroke is another major cause of facial paralysis, could be combined with right side arm/leg paralysis
Tumours, affecting the facial region can exert pressure on the nerves and lead to paralysis
Infections such as herpes zoster infections cause paralysis
Symptoms:

Difficulty in speech, eating and drinking
Closing eyelids, movement, and expressions become difficult
Loss of sensation, which may be temporary or permanent
Ayurveda believes in not just correcting the paralysis but improving overall health so that there is no recurrence and other areas are also prevented from being affected. According to it, increased vata causes paralysis and so treatment includes correction of it plus prevention of vata accumulation through diet and lifestyle changes.

Dietary and lifestyle changes:

Avoid cold and sour foods like curd, buttermilk, ice creams, cold foods like cucumber, banana, watermelons, etc.
Avoid fermented foods as they aggravate Vata
Reduce or avoid pulses like dal as they can worsen gas accumulation
Substitute rice with wheat
Substitute cow s milk with buffalo milk
Avoid smoking and alcohol completely
Diet must be easily digestible and simple with lot of green leafy vegetables
Avoid foods which can cause constipation
Ayurvedic remedies:

Beejband or country mallow: This has nerve stimulating properties and so useful in paralysis of any sort
Kali Mirch or black pepper: Used as a water gargle, it is beneficial in correcting paralysis
Lavanga or cloves: People with Bell s palsy were given water to which some drops of clove oil were added, and they showed remarkable benefits.
Mulethi or licorice: This is proven to be effective in stopping the progression of paralysis. People with Bell s palsy, in whom there was involuntary tearing, had a stoppage of the symptom.
Ashwagandha capsules: They treat paralysis and also reduce anxiety and stress and depression. It helps by calming and rejuvenating the entire nervous system. It also helps control muscle and joint pains and reduces stiffness. It also helps control insomnia and allows for improved blood pressure.
Curcumin: This is very beneficial in Bell's palsy patients. With its rich antioxidant content, it reduces free radical release and helps control inflammation and reduces oxidative stress.
Nirgundi oil: It also cures the imbalance between Vata and Kapha in the body. Massaging with this oil heals injured facial muscles and nerves and improves paralysis. It also eliminates toxins and prevents greying of hair. Its anti-inflammatory properties provide relief from inflammation and pain.
Pranayam, meditation is sure useful in this condition. Do start asanas, slowly begin with surynamaskar. Along with this, one can take Shastrokta medicine, that are-- 1. Ekangvir Ras vati 1 or 2 bd + Maharasnadi kashay ghan vati 2+2 during the day.

Paralyses - Can Ayurveda Treat It?

Spinal trauma, also referred to as spinal cord injury, occurs when a section of your spinal cord or the nerves at the edge of your spinal canal is damaged. The spinal cord acts as a messenger between the brain and other parts of your body. If the spine sustains an injury, all or some of these impulses may not get through. This may result in complete loss of mobility and sensation below the site of injury. An injury closer to the neck can cause paralysis throughout a larger part of the body than in the lower back region.

How do such injuries occur?

Often, spinal trauma or injury results from a violent event or an unpredictable accident. The following may severely damage your spinal cord-

  A violent attack (a gunshot or a stabbing)
  A motor vehicle accident that may cause trauma to the neck, back or head
  Falling from a great height
  Spinal or head injuries during some sports activity
  Electrical accidents

What are the signs of a spinal cord injury?

The followings signs and symptoms can be observed after an injury to the spinal cord-

  Difficulty walking
  Restricted movement of the legs and arms
  Stiffness, pressure and intense pain in the neck/back
  Loss of sensation
  Muscle spasms
  Loss of bowel or bladder control
  A twisted neck or back
  Lack of coordination, weakness or paralysis in any of the body part

When should you see a doctor?

If you experience significant trauma to the neck or head, accompanied by the above symptoms, then visit a doctor immediately. Spinal trauma or injuries is a debilitating condition and can deteriorate further if you do not seek medical intervention. In fact, if such an injury is not detected on time, you may have to face more severe complications. For instance, paralysis or numbness may develop immediately or gradually as blood clots and swelling occur in the surrounding region of the spine.

The doctor can detect spinal injuries using any of the following methods-

  CT Scan
  MRI
  X-ray

What is the treatment for spinal trauma?

An orthopaedic will recommend the correct treatment for spinal trauma or spinal cord injuries, depending on the severity of the condition.

  Medications - Intravenous medications can help reduce the pain and symptoms of acute spinal cord injury
  Immobilization - Braces, corsets, or neck collar can help realign and stabilize the spine
  Surgery - Surgery may be performed to remove bone fragments, herniated disks, foreign objects, or fractured vertebrae that are compressing the spine. Surgery also prevents deformity and pain in the long run.

Recovery starts typically within a week after the treatment. If you undergo surgery, you will have to wait a little longer to get back to your day-to-day activities. It is advisable that you follow up with your doctor and carry on physiotherapy for the first six months at least.

Spinal Trauma - When Should You Consult A Doctor?

Exercises to cure long hours of sitting
Most of us are used to sitting throughout the day, willingly or unwillingly due to work or otherwise. We spend more hours sitting, and most of our work is done in this position. The downsides of this are many, one of them being a stiff back which not only causes a lot of pain but also initiates many other health problems.
Train yourselves on these highly effective exercises which minimise the pain and keep your muscles active.

1. Back press: put towel on your back and press the towel with the back. Hold that position for 10 sec. Repeat 10 times. Do not hold your breath while applying pressure at the back.
2. Bridges: lie on the floor, bend your knees and secure your feet on the ground. Raise your hips upwards so that your body forms a straight line from your shoulders to your knees. Release and go back to previous position.
3. Knee to chest exercise: just lie down on an exercise mat, bend your one knee while lying and try to touch that knee to the stomach. Hold it for 10 seconds. Repeat this with the other leg. Alternate the legs each time.
4. Bilateral knee to chest: bend both the knees while lying on bed. With support of your hands try bringing both bent knees to touch the stomach. Hold that position for 10 seconds. Repeat 5 times.
5. Static abdominal exercise: lying on your back, try to contract your stomach without holding your breath. Hold it for 10 seconds. Repeat the exercise for 7 or 10 times.
6. Knee to opposite chest: lying on your back, bend your knees. Try bringing one knee to opposite side of the chest and hold that position for 7 sec. Do this for 7 times and repeat the same for the other leg too.
7: leg swings: these are easy and fun. Stand by the wall, hold on to a rod or something similar to keep balance. Now with the leg that is not towards the wall, swing. Swing your leg from front to back, left to right. Do not be too quick, do this at a mediocre pace. Repeat with the other leg.
8: static glutei: lying on the stomach, squeeze your buttock and hold it for 10 seconds. Repeat 10 times.

General precautions:
1. Avoid bending instantly after or during the exercises. Incase you have to bend, first bend your knee then bend your back to pick up anything from ground.
2. While getting up from bed first turn to one side while lying, sideways then get up from bed slowly.
3. Apply hot pack in back whenever there is pain.
4. Try to sleep in hard part of mattress not in soft mattress.



Long Hours Of Sitting? Try This Permanent Relief From Back Pain

As life expectancy is increasing so is the incidence of vertebral body (VB) fractures now being the commonest fracture of the body. PVP is an established interventional technique in which bone cement is injected under local anaesthesia via a needle into a fractured VB with imaging guidance providing instant pain relief, increased bone strength, stability, decreasing analgesic medicines, increased mobility with improved quality of life and early return to work in days.

In this era of minimally access surgery replacing open surgeries, PVP is a novel procedure & should be in the first line of management in place of conservatism or major spine surgery for painful uncomplicated compression fracture spine.

Morbidity & consequences of spinal fracture:

Traumatic VB is a painful condition requiring bed rest restricting daily activities markedly
Left untreated it can cause DVT, increase osteoporosis, loss of VB height, respiratory & GI disturbances, emotional & social problems secondary to unremitting pain, loss of independence with high cost of rehabilitation.
High risk of primary or consequential damage to neural, bony or disc element
Increased wedging, deformity & increase incidence of adjacent VB
Chronic pain of altered spine mechanics
Uncomfortable braces & sleep disturbance because of pain & discomfort with its sequels.
Cost of surgery and hospital treatment
Cost of implants
Phobia of surgery
Prolonged recovery period & Extensive rehabilitation
Changed spinal mechanics & transition syndrome
Major surgery & anesthesia with its own complications
Results / Outcome

PVP is a novel procedure with high benefit to risk ratio, which is highly underutilized in relation to the high prevalence of the vertebral.
Different studies show an immediate pain relief in (85   90)% of patients with low complication rate ranging from (1-5)% depending upon the type of lesion.
PVP does augment height of VB but ideal would be kyphoplasty
Patient is either off medicine or on reduced doses.
Patient feels so well that he almost forgets if he had VB

Percutaneous Vertebroplasty (PVP) is an emerging interventional technique in which surgical polymethyl methacrylate bone cement is injected under local anaesthesia via a large bore needle into a vertebral body (VB) under imaging guidance providing increased bone strength, stability, pain relief, decreased analgesics, increased mobility with improved QOL and early return to work. Started in 1984 by Galibert PVP is done in host of indications.

Senile osteoporotic compression remains the commonest Indication. Other indications are Metastatic VB, Multiple myeloma VB, VB haemangioma, Vertebral osteonecrosis & for strengthening VB before major spinal surgery. The benefit has been extended to the traumatic stable uncomplicated VB compression (VCF) which is commoner in younger age group with active life profile and prime of their career where strict bed rest and acute or chronic pain are unacceptable and they are more demanding for proactive treatment approach so as to be back to work ASAP.

Discovering the fact that VB is the commonest of body, its incidence >the hip, it becomes imperative to take it more seriously. With increasing life-span there is more of aged osteoporotic population, more so due to sedentary indoor lifestyle and post menopausal osteoporosis. Diabetics, smokers & alcoholics are at higher risk of developing osteoporosis. I have seen such alcoholic patient developing six spine fractures in just three months time from a single fracture being on complete bed rest.

Quick fix of fracture spine makes patient walk back same day instead of bed rest of months together avoiding morbidity & mortality of prolonged bed rest, making bedridden patient walk, in a way bringing patient back to normal life.

In this era of MAS replacing open surgeries, PVP is a novel procedure & should be in the first line of management in place of conservatism or major spine surgery for painful uncomplicated compression.

Morbidity & consequenses of spinal 

Traumatic VB is a painful condition requiring bed rest restricting daily activities markedly.
Left untreated it can cause DVT, increase osteoporosis, loss of VB height, respiratory &
GI disturbances, emotional & social problems secondary to unremitting pain, loss of independence with high cost of rehabilitation.
High risk of primary or consequential damage to neural, bony or disc elements.
Increased wedging, deformity & increase incidence of adjacent VB
Chronic pain of altered spine mechanics.
Uncomfortable braces & sleep disturbance because of pain & discomfort with its sequels.
Morbidity and complication of spinal surgery 

Cost of surgery and hospital treatment
Cost of implants
Phobia of surgery
Prolonged recovery period & Extensive rehabilitation
Changed spinal mechanics & transition syndrome
Major surgery & anesthesia with its own complications
Preparation & Procedure:
X-ray spine in a/p & lat view. CT is more informative of bone & morphology. MRI is good for soft tissue injuries. Ask for pedicle size in all dimensions and construct a 3D image aiming needle placement and cement filling in scan room itself as rehearsal of PVP. This reduces operative time & gives better results. Conventionally PVP is done by hammering the vertebroplasty needle through the bone. Here we use light weight drill to bore through the vertebra. It is important to set the needle at exact entry site & side with right trajectory aiming the defects.

In lateral view needle should go through middle of the pedicle going up to anterior 1/3 of VB. In P/A view the needle can be in midline or paramedian depending upon & if uni/bipedicular approach is planned. Approach varies as per location of vertebra, anterolateral in cervical, costotransverse/parapedicular in thoracic & transpedicular in lumbar vertebra.

Do bone biopsy if there is any doubt about lession. Do dye test (vertebral venography). Make cement more radiopaque by adding barium /or tungsten. Inject cement with 1or2 ml luerlock syringes strictly under fluoroscope in lateral view & cross checking in P/A view. Stop injecting either there is adequate filling or at the first sight of ectopic cement leak. Keep sample cement to see for hardening. Remove needle with rotational movement before cement hardens.

Pain relief is by virtue of different mechanisms postulated :

Cementing of fragments.
Thermal neurolysis of VB nerve ending due to heat of polymerization.
Washing away of nociceptor chemicals.
Neurolytic action of liquid monomer.
By allowing early ambulation decreasing pains of immobility & bed rest.
Complications 

PVP is generally safe with low risk.
Ectopic cement leak is frequent but generally inconsequential.
Outcome 

PVP is a novel procedure with high benefit to risk ratio, which is highly underutilized in relation to the high prevalence of the vertebral
Different studies show an immediate pain relief in (85   90)% of patients with low complication rate ranging from (1-5)% depending upon the type of lesion.
PVP does augment height of VB but ideal would be kyphoplasty.
Patient is either off medicine or on reduced doses.
Patient feels so well that he almost forgets if he had VB

Vertebroplasty (PVP) / Kyphoplasty - Approach To Management Of Vertebral Body Fractures!

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