Millennium Scan Centre in Kurla Nursing Home

Stroke survivors often suffer from medical complications such as chronic pain. Medical literature estimates that an average of 30-40 percent patients suffer from chronic pain after 4-6 months of the stroke, while an estimated 10-20 percent of patients suffer chronic pain after 12-16 months of the stroke. Shoulder pain is believed to affect almost 72 percent of post-stroke survivors. While there could be a lot of reasons for chronic pain, the best course of action is to rightly identify the underlying cause of the pain and get treated for the same. 

Understanding the different type of pains post stroke surgery. 

 

 

1. Central post-stroke pain: Central post-stroke pain or CPSP was once believed to be triggered by thalamic injury. The perception has now changed in the medical community. It is now believed that CPSP is the result of a lesion in the pathway of spino-thalamo-cortex. An approximate 8 percent of stroke patients get affected by this type of pain. The pain is often intense in nature and can affect an entire side of the body with a burning sensation.
2. Complex regional pain syndrome: Complex regional pain syndrome or CRPS is a kind of pain that is neuropathic in nature. It is estimated that an average of 12-30 percent of all stroke patient experience this pain within 1-5 months of the stroke. Limited range of motion, spasticity is believed to be the cause of CRPS. In terms of pain intensity, CRPS can be divided into 3 phases: 
   • Stage 1 of the pain can last for 1-6 months with possible implications of hypersensitivity, edema, intense pain and hyperhidrosis. 
   • Stage 2 of the pain is characterized by a decreased flow of blood into the limb. 
   • Stage 3 is the last stage where a patient can witness a loss of function. The treatment can be frustrating as it requires a multi-dimensional approach. Anticonvulsants and gabapentin are frequently prescribed by doctors to deal with this pain.
3. Hemiplegic shoulder pain: This is the pain that can crop up due to the biochemical changes in the upper extremity of the body. Causes of shoulder pain post-stroke include adhesive capsulitis, rotator cuff injury, glen humeral subluxation, etc. While exercise proves to be most effective to treat this condition, for stroke patients it becomes a liability. Electrical stimulation has shown promise of treating this condition.
4. Femur fracture: A stroke survivor has an increased risk of suffering from femur fracture due to the significant decrease in bone mass. Since the bone mass decreases, the weight-bearing capacity of the limbs decreases, thereby increasing the chance of a fall. Femur fracture can lead to intense pain, weakness, tenderness, shortening of the limb, etc. It requires routine fracture and pain management medication along with supporting bandages to recover from this condition.

If oral medications are not proving helpful in managing pain for injuries related to the spinal cord, then one must try for pain management therapies as nowadays, they are highly recommended by the doctors. There are three different types of therapies that can reduce pain without the intervention of a surgery

• Spinal cord stimulation
• Pain pumps
• Peripheral nerve stimulation

These therapies are provided on a trial basis and if a person responds to any of the trials, then long-term treatment plan is decided by a physiotherapist along with a neurologist. While implantable pain management might not work for everyone, if it does, a person might experience a significant reduction in pain.

Peripheral nerve stimulation and spinal cord stimulation to counter the pain:
Both Peripheral nerve stimulation and spinal cord stimulation are types of electrical stimulation that can be deployed to treat chronic pain. This is a method wherein, insulated wires that have electrical contacts are inserted near the spinal cord. In case of the peripheral nerve stimulation therapy, the wires are placed beneath the skin. An implanted generator is attached to a wire, in order to send electrical pulses around the affected area of the spinal cord.

During the process of implantation, a patient is awakened, so as to understand whether the pulse is being directed to the right spot or not and also if there is any relief from pain or not. In some cases, patients may need both peripheral nerve field therapy and spinal cord stimulation at the same time. Stimulation does not necessarily eliminate the pain altogether, it, however, can reduce the pain to half, thereby leading to drastic improvement in performing daily activities.

Intrathecal Pain Pump
This is a procedure through which medication is directly delivered to the spinal cord by implanting an intrathecal pain pump. The medication is directly sent to the pain receptors, thereby ensuring that the brain doesn’t get the pain reception from the neuron. This helps in easing the perception of pain.

This is a procedure where a person is given a general anesthesia only to insert a thin catheter into the fluid-filled region of the spinal cord known as the intrathecal space. A doctor implants a small pump in the abdomen and the same is attached to a catheter. This is followed by injecting the medicine into the reservoir of the pump. In these cases, strong painkillers such as morphine are injected into the pumps, these are filled with painkillers once in a month. This mode of treatment is helpful owing to the act that the body has round-the-clock medication at its disposal. There is provision to administer multiple medicines in case of serious pain. Doctors try to target the exact location of the delivery so that small dosage of medicine can relieve the pain without side-effects.

Physiotherapy plays a pivotal role in helping a person recover after a hip replacement surgery. It brings back the old flexibility and prevents blood clots in the area where the procedure has taken place. After the surgery team gives its green signal, a physiotherapist starts working with a patient for a full recovery.

Here is a list of some common exercises that a physiotherapist suggests after a hip replacement surgery:

1. Walking: It is important to use the crutches for a time period of 4-5 weeks post the procedure. Until the surgeon or the physiotherapist advises against using the crutches, it makes sense to use it while walking. It makes sense to retain the normal walking posture by using the crutches rather than limping without it. A physiotherapist reviews the pressure exerted by the arm while holding a crutch, before advising the patient to get rid of the crutches.
2. Increasing hip flexibility: This is a basic form of exercise where an individual lies on one side of the body with knees and hips bent. A pillow is placed in between the knees. While doing this, it should be ensured that both the feet is kept together and the back muscle is not twisted. The top knee should be slowly raised like an opening of the calm shell. This position should be maintained for 4-5 seconds.
3. Strengthening the hips: The body should rest on the stomach. The buttocks should be tightened and one leg should be slowly lifted. This position should be maintained for a stretch of 3-5 seconds. The same should be repeated for both the legs.
4. Strengthening the hip and the stomach muscle: The body should rest on the back with a leg bent. The stomach muscle should be tightened and the bent leg should be lifted carefully while ensuring that the bend does not supersede more than 90 degrees. While keeping the stomach muscle tight, the lifted leg should slowly come down to touch the surface. This act should be repeated for 5-6 times.
5. Strengthening the thigh muscle: While sitting in a steady chair, an elastic loop should be wrapped around the ankles. The elastic loop should be stretched with one leg while keeping the other foot firmly rooted to the ground. The lifted foot should slowly come down to the normal position. The same act should be repeated for 4-5 times.
6. Improving balance: An elastic loop should be tied to one leg of a table and the other end of the loop should be tied to one ankle. The table should be held on for maintaining balance. Maintaining an erect position, the tied up ankle should be stretched sideways. The position should be maintained for 3-5 seconds to return back to normal standing position. In case you have a concern or query you can always consult an expert & get answers to your questions!

We all have lost our tail with evolution…but did you ever think that the vestigial (redundant) part of that tail which has been left over in us in the form of tailbone can mess up with our daily activities and torture us to the level of not allowing us to sit!

If you are not able to sit or if you are experiencing pain when sitting right at the tail bone region, you may be having ‘Tailbone Pain or Coccydynia’.

What is Coccydynia?

The coccyx, also referred to as the ‘tailbone’ is the last segment of one’s vertebral column. Coccydynia is referred to a disabling pain that occurs in/around the coccyx. This type of pain usually starts when one sits all of a sudden or rises up from the seat after having been seated over a long period of time. Also known as coccygodynia, this condition can mar one’s quality of life. The pain, often described as ‘stabbing’ or ‘piercing’, can radiate to the buttocks, the lumbar spine, and rarely, to one’s thighs.

Anatomy

The coccyx is the final part of one’s vertebral column. The vertebral units are fused together. The frontal portion of the coccyx is the fusion site of the muscles and ligaments which control the functions of the pelvic floor. The coccyx also supports the anus’s position. The gluteus maximus is attached to the posterior part of the coccyx. Ligament or muscle damage, or muscle weakness can cause the coccyx to assume an abnormal position, thus causing pain.

Common Causes:

1. Sitting for extended periods of time, especially on hard surfaces

2. Effect of a direct trauma, such as a fall

3. Giving birth

4. Bone fracture, tumors or an infection can also cause this condition

How do you know whether it’s Coccydynia?

1. You will experience pain while sitting, especially on hard surfaces

2. Localized pain in or around the tailbone that worsens with touch or any pressure applied on it

3. The pain will become severe when you stand from a seating position after considerable amount of time

4. The pain might also start during sexual intercourse

5. The pain increases in women during their menstrual cycles

Diagnosis

1. Local Coccydynia

   • Traumatic

   • Idiopathic

2. Radiated or referred Coccydynia

3. Psychogenic Coccydynia

4. Chronic proctalgia

Physiotherapy Approach For Treating Coccydynia

Patients diagnosed with Coccydynia are advised to avoid factors which might provoke the pain. The initial line of treatment will include making certain adjustments such as applying gel cushion when one is sitting for extended periods of time. This helps reduce localized pressure and improve his posture. Other modes include:

1. Mobilizations: This can help realign the posture of the coccyx. Initially, there might be tenderness; hence, it is advised to start with rotational mobilization. To start with, either side should be mobilized first.

2. Manipulation: This can be done intra-rectal and when the patient is lying in a lateral position. The coccyx is repeatedly extended and flexed with the help of the index finger. However, care must be taken so as to not hurt the rectal mucosa.

3. Massage: Massaging the coccygeus muscles has also been proven to relieve pain. Biofeedback can also be integrated with it in order to avoid incidences of muscle pull on the coccyx.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Paralysis can be concluded as the state when the muscles lose functioning in any part of the body. Any kind of disruption in our nerve system can be responsible enough to cause paralysis. Our central nervous system and peripheral nervous system communicate and control our senses of movement. But interruption in nerve impulses can cause weakness in muscles which leads to muscle paralysis.

Symptoms
A paralysed patient will encounter symptoms like:

1. Decreasing the motor power
2. Decreasing vasomotor control
3. Loss of sensation
4. Decreasing bowel and bladder control
5. Losing the ability of sexual function.

When it comes to treating a paralysis patient, physiotherapy is proven to be the best remedy. Physiotherapy has thoroughly helped patients with paralysis in getting to feel confident and independent. Physiotherapy includes various exercises and techniques which are developed with time in order to provide a complete rehabilitation to the patients.

Types of paralysis:
There are mainly four types of paralysis

1. Monoplegia: when one limb gets paralysed
2. Hemiplegia: when arm and leg of a single side get paralysed
3. Paraplegia: when legs get paralysed
4. Quadriplegia: when both sides get paralysed

Treating paralysis with physiotherapy

1. Physiotherapy is advised to patients with any type of paralysis. It should be started soon in order to improve blood circulation in the muscles. It also helps in relaxing the stiff muscles. This treatment improves the overall health condition of the patient.
2. Physiotherapy is also responsible for reducing any kind of swelling which takes place due to external brain injury.
3. Physiotherapy is helpful in making the patient stable and independent.
4. It also helps in maintaining the blood pressure.
5. It helps to improve the respiratory system.
6. Physiotherapy maintains the affected muscles and nerves. It provides strength to the affected muscles and works to prevent the limbs from getting deformed.
7. One major symptom of paralysis is a loss of bladder and bowel function. Physiotherapy helps in managing the paralysed bowel and bladder.
8. Physiotherapy involves different techniques which can be learnt from a physiotherapist in order to transfer a paralysed patient.
9. Othorsis, canes, braces, splints are the equipment that are advised to the patient by a professional physiotherapist.
10. Physiotherapy helps in resolving problems such as anxiety, anger, depression, denial which takes place after post-paralysis mental trauma.
11. Physiotherapist provides safeguarding tips to the patient and his or her family in order to avoid accidents.
12. Physiotherapy has a big role in creating the motivation in patient's mind.

These are the benefits of physiotherapy which help the paralyzed limbs getting stronger and better. But it is always advised to be done under a professional physiotherapist. In case you have a concern or query you can always consult an expert & get answers to your questions!

The point of doing a work out is to put your body through the motions and phases before you hit an intense spot of persistent action before cooling down. This helps in giving your body a well-balanced work out. But what many of us do not know is that a good workout schedule will also involve well-paced warm up sessions with exercises that will warm up the body and its various areas as well as the muscles so that the intensity does not hit the body suddenly and result in some sort of injury or undue fatigue.

So get it right with these eight warm up exercises that you aren't doing, but totally should!

1. Dynamic: Follow a dynamic routine and mix it up a little with various kinds of movements that will work the different areas of the body. Start with squats and move on to lunges before you do a few skips to warm up!
2. Jump: Try the jumping rope the next time you hit the gym and watch your heart rate go up just enough to get you all warm and loose, ready for that heavy duty work out. You can start with five minutes of this motion before moving on to your first set.
3. Dance: Did you know that switching on your favourite music and shuffling your feet before you start to gyrate a little can actually get you in the right frame of mind for a work out? So next time, warm up with a little dancing!
4. Balance: Warm up with a balancing act or two. Stand on one leg and do deadlifts with a dumb bell. Repeat the same motion for both arms. This helps in imitating the actual work out that you will be indulging in, which helps in warming up the relevant areas.
5. Stretches: Try doing stretches and jumping jacks for stability and to work your core strength before you hit the gym equipment. This will bring about better blood circulation and help you get your heart ready for the work out.
6. Swing: Use swinging movements with your arms and legs with circles and marches to help loosen up the muscles.
7. Walk: Do the animal walk with crab walks, frog jumps, bunny hops, inch worm motions and much more to unleash your energy.
8. Medicine Balls: Grab some medicine balls and do a few moves like the rotational twist, the front body push, the reverse eight and many more to get your body pumped up.

Warming up is an important part of working out, so remember to get your warm up routine right!

In case you have a concern or query you can always consult an expert & get answers to your questions!

Frozen shoulder is a condition when somebody encounters continuous shoulder stiffness and pain. It could last for weeks. It is likely to occur when swelling increases around the shoulder which reduces inability to move or stretch properly. This ordinarily happens when somebody is recovering from an injury. Frozen shoulder at times happens when somebody is wearing a sling or a cast. It also occurs, if someone is recovering from surgery, experiencing joint pain or facing restraint of movement for other reasons.

A frozen shoulder can go on from a couple of months to as much as 3 years and the precise cause is unknown. Physiotherapy is often to treat this condition. It has been found that posture plays a huge part in your recovery from a frozen shoulder. The urgent goal is to get the shoulder join moving once again. The sooner this is done, the better are the odds of a quick recovery. Anti-inflammatory medicines, heat application and delicate stretching activities are performed with the assistance of a physiotherapist.

Physiotherapy is very crucial for a frozen shoulder since it is very difficult to get movement in the stiff joint without any exercise, stretching or other methods used by a physiotherapist. It is mostly crucial to get physiotherapy to:

1. To reduce pain in the shoulder
2. To increase the flexibility and strength of the shoulder
3. To enhance movement of the shoulder.
4. To increase endurance of the muscles

Physiotherapy treatment for a frozen shoulder depends on the stage you are on and is customized according to the needs of your condition. Physiotherapy treatments for a frozen shoulder include:

1. Pain relief: Pain diminishing techniques including gentle shoulder movement exercises, muscle releases, needle therapy, dry needling and kinesiology taping for pain can help during the painful swelling phase.
2. Defrosting: Shoulder mobilization and stretching are the best in order to achieve a full shoulder recovery. As your scope of movement increases, your physiotherapist will then be able to give you muscle strengthening exercises to control and keep up your recently found range of movement.
3. Warm Up: Before beginning shoulder exercises for a frozen shoulder, try to warm up your shoulder keeping in mind the end goal. That is to help blood supply in the affected area and avoid future injuries. The best approach is to extend and warm up the shoulder by applying heat for 10 to 15 minutes, scrubbing down or showering with Epsom salt.

Physiotherapy does not bring out immediate results, but gradually. Flexibility will increase gradually. One should keep in mind, not to stretch their shoulder too quickly at once. This can lead to a ligament tear. The exercises should be tender and gradual. If you wish to discuss about any specific problem, you can consult a Physiotherapist.

A stroke or paralysis can occur when the blood supply to that part of your brain is curtailed or drastically reduced. Due to this, the brain is deprived of the essential oxygen and the nutrients, and within a few minutes the brain cells can undergo severe damage and die. It is often treated as a medical emergency and can cause complications for life if left unattended.

Symptoms:
With regards to a stroke, a quick and an immediate treatment can be the difference between life and death. It is very much mandatory to note the symptoms of stroke and to impart the treatment accordingly. Some of them can include:

1. Trouble with speaking: Your speech pattern gets affected, and you may have trouble talking.
2. Paralysis: When the oxygen is cut off, a part of the body can become numb thus rendering it lifeless.
3. Headache: A severe headache may occur that can make the body go into spasm. Dizziness and unconsciousness can follow it.
4. Walking and mobility: You would be unable to walk on your own, or there can be a huge difference in your walk pattern. Most of the times, you might not be having any control over your legs.

Risk Factors
There are many risk factors associated with stroke and paralysis. The most common one is undoubtedly overweight. Physical inactivity, alcohol abuse, and drug abuse can contribute equally to the occurrence of stroke. Cholesterol levels, high blood pressure and old age may also be risk factors. Paralysis can be the biggest drawback of stroke where one part of your body can be lost to movements. You might also lose control of your face or arm, and this can affect your walking steps. This can be a life changing factor and more than medication sometimes physical therapy heals the person to an extent.

Physiotherapy for Paralysis:
You can feel helpless and frustrated, and this can lead to depression. There are many ways by which physiotherapy can help you. The therapies are made in such a way that you can try to lead a normal life without any hindrance, and this depends on the nature of the paralysis you are undergoing. In most of the cases, a person can get back at least 60% to 70% of his/her mobility back though not completely. Also, current medicines have advanced that there is a possibility to get back the movement in the paralyzed areas.

One of the major challenges you will face is to relax as the physical feeling of helplessness can hamper your thoughts in the long run. Stay relaxed and always remember that you are not alone. Take the help of a family member or a friend. Be relaxed all the time and make a determined effort with physiotherapy exercises. Avoid the lifestyle which you had before and embark on a healthier lifestyle and make sure you watch your diet at all times. Try to indulge in your favorite pass time and over a period start your daily chores without the help of an aid. You can undergo the physiotherapy exercises for life as they can be positive even after the condition subsidies. If you wish to discuss about any specific problem, you can consult a Physiotherapist.

Child care is often one of the crucial aspects that have to be given due consideration during the growth of a child. Children now are susceptible to a variety of impairments, and even though there are medications and treatments to take care of their needs, they would still require a personal touch. This is where pediatric physiotherapists come in. Their primary job is to work with people of different ages from premature babies to young adolescents to ensure that they interact optimally and address their development stages. Like any physiotherapist, they are also concerned with the movements of the child, their postures and their coordination with the outside world. Let us have a look at their profession in depth.

Role of Pediatric physiotherapists
The major role of the pediatric physiotherapist would be to assess the child and make a detailed physiotherapy plan according to his/her needs. They are also required to work in close collaboration with parents, teachers, doctors and other health care professionals. Based on the length and the gravity of the treatment, it can either be done at home or at the designated health care centers. Some of the conditions they address can include:

1. Cerebral palsy
2. Developmental delay
3. Visual handicaps
4. Premature babies
5. Postural problems
6. Respiratory problems such as asthma

They also give across treatments in older children for:

1. Brain injury and spinal injury
2. Neurological diseases
3. Post trauma injuries, such as fractures, sports injuries
4. Burns and plastic surgery
5. Limb deficiency conditions
6. Chronic pain

The Challenges:
Their major focus would be in imparting guidance for the movement that the child might be hampered with. Since children would not be having the necessary control to fight a disease, they can also focus on strength training in a child. They can also slowly groom up your child to let them feel at ease with the physical world. Most of the exercises and session would focus on one critical issue their confidence level. Pediatric physiotherapists would always concentrate on this aspect, apart from the training. They always encourage the children to take part in a wide variety of activities and will also groom them to be independent. Also in older children when they have the capacity to understand, the pediatric physiotherapist should always inform the child about his/her physical nature and that there is nothing wrong with him. The more open they are to the child, the more the child would reciprocate.

There are also many medications and physical treatment plans that can be given when the child is undergoing the therapy. These can include wheelchair assist, walkers or canes. Most of the children who are affected by the conditions may also have a poor development of their vision. The pediatric physiotherapist should liaise with the ophthalmologist to take care of their needs as a sense of right vision can sometimes go a long way in how the child responds to a treatment. They also have an added commitment of making the child respond to a treatment in which he/she is comfortable in. If you wish to discuss about any specific problem, you can consult a Physiotherapist.

A fracture is a complete or incomplete crack, which appears on a bone due to application of intense pressure or force. A fracture results in extreme pain, and the bone becomes immobile. Any kind of movement boosts the pain. Fracture pain occurs in three distinct stages. Acute pain is felt immediately after a fracture while sub acute pain occurs over the weeks that follow after a fracture. The third stage or chronic pain occurs when the fracture and soft tissues around it have healed.

Fracture pain is quite intense in nature and proper precautions should be taken while dealing with them:

1. Development of fracture pain: When a bone undergoes a fracture, the ligaments and tendons are also damaged. While the bone slowly heals, ligaments and tendons fail to heal equally well or completely. Post fracture pain also develops when the outside of the bone does not heal completely. This usually does not appear in an X-ray.
2. Treatment of fracture pain: Modern medications can be utilized to treat a fracture pain. Steroid injections and prescribed anti-inflammatory medicines help in treating a fracture pain. However, these remedies cause side effects, which are harmful for the body. Cortisone shots are utilized for the same purpose as well.
3. Prolotherapy: Prolotherapy is an approach where ligament and tendon strengthening is stimulated along with repairing. This technique ensures complete treatment of the fracture, and the risk of long-term complications like arthritis is absent. In cases of fracture pain, which occurs due to the incomplete healing of the outer part of the bone, Prolotherapy helps in strengthening the fibro-osseous junction at the source of the pain. This will stop the nerve endings from firing. Prolotherapy provides speedy recovery and accounts for making the injured bone stronger than before. This process is often undergone by athletes. The procedure is undertaken only after thorough examinations for detection of the root cause of the pain. Prolotherapy is considered to be the best treatment for repairing tendons and ligaments, which commonly cause fracture pain. The body is simply stimulated and the painful areas are repaired. This is done by the introduction of a mild inflammatory reaction to the area of the weak tendons and cartilages. The results obtained after Prolotherapy are permanent and the fracture pain is unlikely to reoccur.

Other measures:

• Splints are utilized to stop the movement of fractured bone and braces can be used to support the bone. Plaster cast also supports and immobilizes the fractured bone. Traction and surgical implants are other treatment measures.
• Fracture pain occurs not only because of the broken bone, but also because of the weakened ligaments and tendons around the bone. Fracture pain should be handled very carefully, and proper control measures should be applied. If you wish to discuss about any specific problem, you can consult a physiotherapist.