Lybrate.com has a number of highly qualified Physiotherapists in India. You will find Physiotherapists with more than 36 years of experience on Lybrate.com. You can find Physiotherapists online in Gurgaon and from across India. View the profile of medical specialists and their reviews from other patients to make an informed decision.
Book Clinic Appointment with Dr. Gaurav Yadav
Spinal Surgery Disorders
Treatment of Neurological Problems
Treatment of Nerve And Muscle Disorders
Treatment of Hip Disorders
Neuro Physiotherapy Treatment
Treatment of Knee Injury
Pregnancy Exercise Therapy
Treatment of Sports Injuries
Treatment of Splinting
Treatment of Spondylosis
Arthritis And Pain Management Treatment
Heat Therapy Treatment
Post Pregnancy Classes
Orthopedic Physical Therapy
Treatment of Shin Splints
Submit a review for Dr. Gaurav YadavYour feedback matters!
I have pain in my left stomach and left back pain near kidney area since last 1 year. 2 times checked sonography n 1 time X ray. But didn't find anything abnormal. I. Have constantly pain in left back area and left stomach area. Please suggest me best solution. Thank you.
The back of my legs have been hurting for 2 days now and the pain in both legs Started yesterday and I didn't fall or anything. Yesterday it was hurting for me to walk. I don't know what's going on.
Arthritis is inflammation of one or more of your joints. Pain, swelling, and stiffness are the primary symptoms of arthritis. Any joint in the body may be affected by the disease, but it is particularly common in the knee.
Knee arthritis can make it hard to do many everyday activities, such as walking or climbing stairs. It is a major cause of lost work time and a serious disability for many people. There are 2 types of arthritis the knee joint in the human body can get afflicted with. They are:
Osteoarthritis: The form of arthritis which, with increasing pain, slowly wears down the joint cartilages is called osteoarthritis. This form of arthritis usually affects people after the age 40. The symptoms of osteoarthritis include:
severe pain in the knee joints
pain after walking up the stairs and it subsiding once you are on rest
severe pain after the movement of joints for a long time
pain that becomes worse in rainy days
joints becoming stiff after waking up in the morning but they improve in the latter part of the day
pain which also occurs in the thighs and the genital regions coupled with joints swelling and joints getting stiff after rest.
Rheumatoid Arthritis: Rheumatoid arthritis is a chronic form of arthritis caused because of the knee joint inflammations. This form of arthritis can occur at any age. Being an auto-immune disease, its symptoms include, but are not limited to:
severe pain in the morning
mild fever accompanying the pain
joints suddenly becoming swollen, red and warm causing, immense pain
sudden stiffness of the joints
pain that increases in cold weather
mild fever, extreme tiredness and weakening of the muscles
Doctors are still doubtful about what exactly causes the disease; but the deformation of the immune system might cause the damage of the joints, causing people who are already suffering from obesity, smokers, and women, in general, more prone to this disease.
When the knee pain is diagnosed as a form of arthritis, the following treatments are suggested:
If you are overweight or obese, losing some of those extra pounds can go a long way in reducing the pain.
Muscle-stretching exercises are effective in keeping the knee joints flexible.
Acupuncture and devices such as knee braces and knee caps can relieve the pain.
Prescribed dosage of anti-inflammatory drugs such as Tylenol, Motrin, and Advil or injections of hyaluronic acid might relieve your pain.
- If regular treatments do not work, you might opt for knee-replacement surgery and osteotomy (the process of cutting a bone with the help of surgery) which might better the alignment of the knee by transforming the bone shapes.
Physiotherapy For Knee Arthritis-
Physiotherapy treatment is aimed at improving the symptoms of the disease (i.e. knee pain, swelling, stiffness), and you should begin to notice a positive difference within one or a few physiotherapy sessions.
The main goals of physiotherapy for your knee arthritis are:
- Reduce your knee pain and inflammation.
- Normalise your knee joint range of motion.
- Strengthen your knee: esp quadriceps (esp VMO) and hamstrings.
- Strengthen your lower limb: calves, hip and pelvis muscles.
- Improve your patellofemoral (knee cap) alignment and function.
- Normalise your muscle lengths.
- Improve your proprioception, agility and balance.
- Improve your technique and function eg walking, squatting. If you wish to discuss about any specific problem, you can consult a Physiotherapist.
Spondylitis includes swelling of the vertebra. It happens because of wear and tear of the ligament and bones found in your cervical spine, which is in your neck. While it is to a great extent because of age, it can be brought on by other reasons too. Side effects incorporate pain and stiffness starting from the neck to the lower back. The spine's bones (vertebrae) get fused, bringing about an unbending spine. These changes might be mellow or extreme, and may prompt a stooped-over posture. Some of the non-surgical methods to treat spondylitis are as follows-
Exercise based recovery/physiotherapy: your specialist may send you to a physiotherapist for treatment. Non-intrusive treatment helps you extend your neck and shoulder muscles. This makes them more grounded and at last, relieves pain. You may neck traction, which includes using weights to build the space between the cervical joints and decreasing pressure on the cervical disc and nerve roots.
- Medications: your specialist may prescribe you certain medicines if over-the-counter medications do not work. These include:
- Muscle relaxants, for example, cyclobenzaprine, to treat muscle fits
- Opiates, for example, hydrocodone, for pain relief
- Epileptic medications, for example, gabapentin, to ease pain created by nerve damage
- Steroid infusions, for example, prednisone, to decrease tissue irritation and diminish pain
- Home treatment: in case your condition is less severe, you can attempt a couple of things at home to treat it:
- Take an over-the-ounter pain reliever, for example, acetaminophen or a calming medication, for example, advil or aleve.
- Use a warming cushion or an ice pack on your neck to give pain alleviation to sore muscles.
- Exercise routinely to help you recover quickly.
- Wear a delicate neck prop or neckline to get transitory help. In any case, you shouldn't wear a neck brace for temporary pain relief.
- Acupuncture: acupuncture is a highly effective treatment used to mitigate back and neck pain. Little needles, about the extent of a human hair, are embedded into particular points on the back. Every needle might be whirled electrically or warmed to improve the impact of the treatment. Acupuncture works by prompting the body to deliver chemicals that decrease pain.
- Bed rest: severe instances of spondylitis may require bed rest for close to 1-3 days. Long-term bed rest is avoided as it puts the patient at danger for profound vein thrombosis (dvt, blood clots in the legs).
- Support/brace use: temporary bracing (1 week) may help get rid of the symptoms, however, long-term use is not encouraged. Supports worn for a long time weaken the spinal muscles and can increase pain if not continually worn. Exercise based recovery is more beneficial as it reinforces the muscles.
- Lifestyle: losing weight and eating nutritious food with consistent workouts can help. Quitting smoking is essential healthy habits to help the spine function properly at any age.
Once the conservative treatment fails:
Early aggressive treatment plan of back leg pain has to be implemented to prevent peripherally induced cns changes that may intensify or prolong pain making it a complex pain syndrome. Only approx 5% of total lbp patients would need surgery approx 20% of discal rupture or herniation with neurologically impending damage like cauda equina syndrome would need surgery. Nonoperative treatment is sufficient in most of the patients, although patient selection is important even then. Depending upon the diagnosis one can perform combine properly selected percutaneous fluoroscopic guided procedures with time spacing depending upon patient`s pathology response to treatment. Using precision diagnostic therapeutic blocks in chronic lbp, isolated facet joint pain in 40%, discogenic pain in 25% (95% in l4-5 l5-s1), segmental dural or nerve root pain in 14% sacroiliac joint pain in 15% of the patients. This article describes successful interventions of these common causes of lbp after conservative treatment has failed.
Need for non-surgical options: outcome studies of lumber disc surgeries documents, a success rate between 49% to 95% and re-operation after lumber disc surgeries ranging from 4% to 15%, have been noted. “in case of surgery, the chance of recurrence of pain is nearly 15%. In fbss or failed back surgery the subsequent open surgeries are unlikely to succeed. Reasons for the failures of conventional surgeries are:
- Dural fibrosis
- Arachnoidal adhesions
- Muscles and fascial fibrosis
- Mechanical instability resulting from the partial removal of bony ligamentous structures required for surgical exposure decompression
- Presence of neuropathy.
- Multifactorial aetiologies of back leg pain, some left unaddressed surgically.
Epidural adenolysis or percutaneous decompressive neuroplasty is done for epidural fibrosis or adhesions in failed back surgery syndromes (fbss). A catheter is inserted in epidural space via caudal/ interlaminar/ transforaminal approach. After epidurography testing volumetric irrigation with normal saline/ l. A./ hyalase/ steroids/ hypertonic saline in different combinations is then performed along with mechanical adenolysis with spring loaded or stellated catheters or under direct vision with epiduroscope sciatica gets complicated by pivd with disco-radicular conflict causing radicular pain sometimes disabling. In this era of minimally invasive surgery lot many interventional techniques have evolved to address the disc pathology. We are still working for the ideal, safe effective technique to tackle disco- radicular interphase. Here now we have devised a mechanical neuroplasty or foraminoplasty technique using an inflatable balloon tip catheter with guide wire via targeted transforaminal or interlaminar route aided by drugs instillation. Selected patients are procedured fluoroscopic guided with local anesthesia under prescribed sedation aseptically via preselected route depending upon location type of pivd causing root insult. First a suitable size needle is placed at desired site confirming with radiolucent dye through which hyaluronidase with saline or la was injected. A flexible guide wire is passed at selected location direction on which the inflatable balloon is threaded to the area of interest.
Adhesiolysis is achieved mechanically with inflating balloon for 10 seconds at a time location. We inflated the balloon with contrast agent to have visualization of adhesiolysis opening up of adhesions or root route. Here the balloon pressure time has to be kept in minimum to avoid neurological damage, for which we inflate balloon for 10 seconds at a time. Close observation is made to balloon shape, pressure patient`s response. Once dilatation is done the drug mixture of steroid with la or hynidase/ hypertonic saline is instilled over nerve in epidural space. We have logically used same approach for our balloon neuroplasty foraminoplasty as it is safe targets exactly the area of disco-radicular interphase or conflict. We can manage to address both the exiting and traversing nerve roots with single entry just by manipulating our guide wire to the place of offence. The procedure can be done via transforaminal route at level or level above or below, especially via s1 foramen. Now we are employing this technique for fresh cases coupling with intradiscal decompression aided by instant disc retrieval by epidural balloon inflation with good results. The idd is done by coblation/ laser/ dekompressor or rf biacuplasty. There is scope of coupling this technique with endoscopic spine surgery. By adding “balloon neuroplasty” to the armamentarium of the interventional pain management many patients can be benefited relieved of previously interventionally unmanageable disco-radicular pain including fbss sufferers.
Provocative discography: coupled with ct a diagnostic procedure prognostic indicator for surgical outcome is necessary in the evaluation of patients with suspected discogenic pain, its ability to reproduce pain (even with normal radiological finding), to determine type of disc herniation /tear, finding surgical options in assessing previously operated spines.
Percutaneous disc decompression (pdd): after diagnosing the level of painful offending disc various percutaneous intradiscal procedures can be employed.
Ozone-chemoneucleoplasty: ozone discectomy a least invasive safe effective alternative to spine surgery is the treatment of choice for prolapsed disc (pivd) done under local anaesthesia in a day care setting. This procedure is ideally suited for cervical and lumbar disc herniation with radiculopathy. Total cost of the procedure is much less than that of surgical discectomy. All these facts have made this procedure very popular at european countries. It is also gaining popularity in our country due to high success rate, less invasiveness, fewer chances of recurrences, remarkably fewer side effects meaning high safety profile, short hospital stay, no post operative discomfort or morbidity and low cost. If despite the ozone therapy the symptoms persist, percutaneous intradiscal decompression can be done via transforaminal route with drill discectomy/ laser or coblation nucleoplasty/ biacuplasty/ disc-fx / endoscopic discectomy are good alternatives before opting for open surgerical discectomy; which has to be contemplated in those true emergencies, as mentioned above as the first choice. In biacuplasty radiofrequency energy is used in bipolar manner heating shrinking the disc making it harder as well for weight bearing. It also seals the annular defect ablates annular nerves relievingback pain. In laser or coblation nucleoplasty energy is used to evaporate the disc thereby debulking it to create space for disc to remodel itself assisted by exercises.
Dekompressor: a mechanical percutaneous nucleotome cuts drills out the disc material somewhat like morcirator debulking the disc reducing nerve compression. A mechanical device cuts drills out the disc material debulking the disc reducing nerve compression curing sciatica brachialgia. It comes in needle size of 17g for lumbar discs 19 g for cervical discs. In lumbar region postero-lateral approach is used in cervical discs anterolateral approach is used.
Disc-fx : endoscopic discectomy: in this novel technique a wide bore needle is inserted placed sub-annular in post disc just under the disc protrusion. Disc is then mechanically extracted with biopsy forceps to empty the annular defect. This painful sensitive annular defect supplied be sinuvertebral nerve is thermo-ablated with radiofrequency which also seals the defect to prevent decrease recurrences. Next higher procedure, endoscopic discectomy is done with endoscope put through sheath inserted via posterolateral transforaminal or posterior interlaminar approach. Mostly done under local anaesthesia its fast becoming standard of care for disc protrusion extrusions causing spinal canal stenosis with root or cord compression with leg pain.
Laser discectomy done for closed bulging discs is an outpatient procedure with one-step insertion of a needle into the disc space. Disc material is not removed; instead, nucleus pulposus is debulked by evaporating it by the laser energy. Laser discectomy is minimally invasive, cost-effective, and free of postoperative pain syndromes, and it is starting to be more widely used at various centers.
Seld: epiduroscopic laser neural decompression is considered an effective treatment alternative for chronic refractory low back and/or lower extremity pain, including lumbar disc herniation, lumbar spinal stenosis, failed back surgery syndrome with morbid adhesion neuritis that cannot be alleviated with existing noninvasive conservative treatment. This procedure is done under vision via an epiduroscope inserted via caudal canal or transforaminally employing front or side firing laser fibers /or fine instruments. If you wish to discuss about any specific problem, you can consult a pain management specialist.