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Joint Mobilization Tips

Mobilisation and Manipulation Use And Contraindications In Physiotherapy!

Physiotherapist, Howrah
Mobilisation and Manipulation Use And Contraindications In Physiotherapy!

What is manipulation?
Mobilisation and manipulation is same meaning. This is passive, skilled manual therapy techniques applied to joint.

Type of mobilization

  • Self mobilization or (auto mobilization)
  • Mobilisation with movement
  • Physiological movement
  • Accessories movement

Thrust - this is high velocity, short amplitude motion such as pt can't prevent it

Manipulation under anesthesia- this is medical procedures 

Benifit of mobilization - improve range of motion, reduce pain, improve the mechanics of joint to help with things such as lifting your arm, bending your spine and walk 

Note- mobilization can't change a disease process/ inflammation process but it can minimise pain, maintained joint play and reduce mechanical limitations

Indications of mobilization: pain muscles guarding and spasms

  • Reversible jt hypomobility
  • Positional fault and sublaxtion
  • Progressive limitations
  • Functional immobility
  • Contraindications for mobilization: inflammatory arthritic
  • Malignancy
  • Tuberculosis
  • Osteoporosis
  • Ligamentum rupture
  • Herniated disk with nerve compression 
  • Bone disease
  • Neurological involvement 
  • Bone fracture
  • Congenital bone deformity
  • Vascular disorders 
  • Joint effusion.
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AVN Hip - Its Causes, Diagnosis And Treatment!

M. Ch. (Orthopedic), MS - Orthopaedics, Diploma In Orthopaedics (D. Ortho), MBBS
Orthopedic Doctor, Gurgaon
AVN Hip - Its Causes, Diagnosis And Treatment!

AVN is the acronym for avascular necrosis, which mostly affects the hip bone. This complication develops when there is a loss of blood flow to the bones. Being a living tissue, bones require a continuous supply of blood, and if there is an interruption to this supply for a long time, bones suffer from avascular necrosis. The longer duration of this condition may cause bone death. Apart from the hips, AVN may also affect other sites like knees, shoulder, ankles, etc.

Symptoms -

Usually, there are no symptoms in the early stages. However, as the disease progresses, it begins to hurt as you sit down or put pressure on the hip bones. As the disease progresses unabated, the pain may refuse to go away. Progressively, the hip bone collapses along with its surrounding joint tissue. Pain becomes severe and begins to interfere with your daily activities. However, it may take several months and even a year for the bone and the surrounding tissue to collapse.

Causes -

Causes of avascular necrosis may include:

  • Dislocation of thigh bone affecting the blood supply to the bone. About 20% of people suffering from hip dislocation or fracture may suffer from AVN Hip.

  • Chronic use of corticosteroids. About 35% of patients undergoing chronic corticosteroid use may develop AVN Hip. It is considered that these drugs may interfere with the ability of the body to break down fat.

  • Alcohol abuse too may lead to avascular necrosis much in the same way as corticosteroids.

  • Blood clots, arterial damage, and inflammation may also contribute to blocking the flow of blood to bones and precipitate AVN Hip.

Treatment -

The objective of treating avascular necrosis is to improve the functioning of joints, reducing pain, and stopping bone damage. In the case of early diagnosis, treatment can be done by taking pain-relieving medicines and by limiting regular use of your hips. Taking crutches to limit weight bearing by the hips may help to relieve pain and limiting damage to the bone. You may also need to perform various range-of-motion exercises in order to ensure continued mobility of the joints.

Treatment Outcome -

Needless to say, that the damage already done cannot be reversed. This is why the earlier the problem is diagnosed, the better it is for the patients. The best outcome of treatment depends on:

  • Age of the patient

  • Stage of progression of the disease

  • Location of bone damage and its spread

  • Removing the cause of avascular necrosis, if possible, which means stopping alcohol and drug abuse, taking precautionary steps after femoral dislocations and fractures, stopping the use of corticosteroids, etc.

Take Away -

The symptoms are not visible in the early stage of the condition. This is why a consultation is advisable if a person experiences any of the above symptoms.

2087 people found this helpful

All About Bankart's Lesion

Dr.P. Sharat Kumar 88% (122ratings)
FFSEM, MFSEM, DIP - SEM GB & I, MCh - Orthopaedics, MS - Orthopaedics, MBBS
Orthopedic Doctor, Hyderabad
All About Bankart's Lesion

Bankart's lesion is condition of the shoulder joint, which is characterized by the tearing of the labrum (cartilage) from the shoulder socket called the glenoid fossa. In order to understand this, you need to understand the anatomy of the shoulder joint.

The glenohumeral joint is the portion of the shoulder where the tip of the upper arm (humerus) attaches itself to the scapula. The specific area of the scapula where the humerus is attached is known as the glenoid cavity. The labrum is a soft tissue that runs along the glenoid, its function being to stabilize the ball of the joint in the shoulder socket. It facilitates movement of the arm by ensuring congruence between the glenoid and the humerus bone.

The symptoms of Bankart's lesion are:

  1. You may experience popping or clicking sounds in the shoulder joint
  2. Any overhead movement may cause pain
  3. You may experience sudden pain during the night
  4. Decreases range of motions, leading to impaired functioning of the arm
  5. Unstable shoulders
  6. The shoulders may become weak

The causes which may lead to a Bankart's lesion:

  1. If your arms are outstretched during a fall
  2. In case you experience a direct blow on your shoulder
  3. Lifting heavy objects or a sudden pull
  4. Performing overhead activities repetitively such as fast bowling with a straight arm action in cricket

Treatment for Bankart's lesion: 
The condition is treated after the doctor performs a thorough diagnosis of the symptoms. Once the symptoms are diagnosed, anti-inflammatory medications are prescribed for pain relief. Hot or cold compresses may also be applied on the affected area to ease the pain. In severe cases, arthroscopic surgery is done to treat the condition.

Rehabilitation involves performing various external rotation exercises to strengthen the rotator cuff joint. Various stretches may be prescribed as well to improve the mobility and flexibility of the shoulder joint. In case you have a concern or query you can always consult an expert & get answers to your questions!

5318 people found this helpful

Spine And Joint Pain Due To Aging Or Lifestyle Issues!

Bachelor of Ayurveda, Medicine and Surgery (BAMS), Certificate In Panchakarma
Ayurvedic Doctor, Bangalore
Spine And Joint Pain Due To Aging Or Lifestyle Issues!

By the time you turn 30, your bone density starts to decline irrespective of your gender. However, in women specially, the loss of bone density accelerates after menopause. As a result, your bones become brittle and fragile. As you age, your bones tend to break easily when you face a traumatic injury.30608

What effects does ageing have on your joints and the spine?
In old age, most of the people experience aching or mild soreness when they climb stairs or stand for a long time. Any changes in the connective tissues or the cartilage affect your joints. The cartilage becomes thinner and the proteoglycans become altered. Consequently, the joints lose their flexibility and become more susceptible to damage. This condition leads to osteoarthritis in many people.

Osteoarthritis- It is a degenerative disorder and the second most common type of arthritis. Osteoarthritis is more common in women than in men. The Center for Disease Control and Prevention states that nearly 45% of women are affected by osteoarthritis by the age of 55-60.

Normally, the cartilage acts as a cushion to the joints while the synovial fluid lubricates your synovial joints and helps them move more smoothly. Wear and tear of the cartilage lead to inflammation and swelling of the synovium. Moreover, your body reacts to the inflammation by discharging enzymes. These errantly destroy the bone and cartilage, leading to severe joint pain. The most commonly affected areas are the joints of your knees, shoulders, elbows and ankles.

Your spine also gets affected due to a number of factors- everyday stress, constant wear and tear of its structure. As you age, the discs acting as cushions between the vertebrae start to shrink and the moisture content gradually erodes away. As a result of this, the vertebral bones rub against each other, potentially causing stiffness and back pain. The most common form of spinal injury in the elderly is spondylolisthesis.

Spondylolisthesis- This refers to the condition which affects your spinal bones and lower vertebrae. Due to this condition, one of the lower vertebrae slips forward onto the bone directly beneath it. Older people with spondylolisthesis find it difficult to perform routine activities and often encounter symptoms like persistent pain in the lower back and pelvic region, muscle stiffness, etc.

What effects does poor lifestyle have on your spine and joints?
Musculoskeletal disorders in elderly also result from various lifestyle issues. Some of them being-

  1. Poor diet- Both trans fats and saturated fats can increase your cholesterol levels and cause inflammation. Since joint pains are usually triggered by inflammation, the symptoms of osteoarthritis can aggravate if you consume fried foods, white flour, sugar and dairy products. Alcohol consumption and smoking can also lead to joint inflammation. Switch to a healthy diet; include fishes that are rich in omega-3 fatty acids, citrus fruits, green tea. This also helps you keep your weight in check.
  2. Inactive lifestyle- While extreme physical exhaustion can lead to sudden injury and pain, an inactive lifestyle can also adversely affect your joints and muscles. They gradually lose their resilience and become stiff and thus immobile. Practice low-key exercises to keep yourself active.

Role of Ayurveda in treating musculoskeletal disorders-
Ayurveda plays a significant role in treating musculoskeletal pain in old age. Ayurvedic Panchakarma is an Ayurvedic treatment program that is used to boost your immune system, detoxify your body and restore balance. Panchakarma uses particular techniques to heal spinal and joint pain effectively in older people- Abhyanga, Upanaha, Kati Vasti, Pindasweda etc.

  1. Abhyanga- Warm, medicated oil is massaged on your body gently to infiltrate the underlying tissues. This lubricates the joint muscles and helps in toning.
  2. Upanaha- Herbal medicines are applied on the affected area and covered with medicinal leaves. This helps relieve pain, swelling and improves joint mobility.
  3. Kati Vasti- For this procedure, a ring of thick dough-like paste filled with medicated oil is placed on your back and left for some time. This helps strengthen your lower back and also lubricates your spine.
  4. Pindasweda- A hot cotton bag containing rice, herbs, sand or medicinal powder, is used to massage your body. This therapy generates perspiration in your body and allows the heat to penetrate within. This is an effective treatment for arthritis.

Ayurveda uses natural herbs and spices to prepare medicinal oil for therapy. Ayurvedic therapies are safe and a preferred choice of treatment, especially for older people. In case you have a concern or query you can always consult an expert & get answers to your questions!

4832 people found this helpful

Ways To Ensure Bone And Joint Health!

MBBS, MS - Orthopaedics
Orthopedic Doctor, Chennai
Ways To Ensure Bone And Joint Health!

Staying healthy involves a wholesome state of being where the mind and body are in perfect sync. A less than properly functioning body can leave you in a state of potential depression after a certain point of time, while a depressive mind can leave you feeling less than stellar where you end up imagining and experiencing pain. The health of your bones and joints is one such area that requires even more care as you start growing older. Wear and tear is just one of the reasons for degeneration while fractures and injuries can lead to a sudden halt of normal functioning of the bones and joints too.

So how can you ensure bone and joint health in the long run? Follow our tips!

  1. Eating Right: Pick calcium rich food like dairy products that have a low fat content, including milk and yogurt. Also, have a daily dose of green, leafy vegetables and plenty of citrus fruit and juices for your fill of calcium. Further, food like eggs and soybeans which have lots of vitamin D can also help in retaining good bone and joint health. Vitamin C rich fruit like watermelon, oranges, squash and tomatoes also help in natural tissue and cartilage repair. And finally, get plenty of vitamin K to retain good bone density for a prolonged period with ingredients like leafy green vegetables, eggs and cheese.
  2. Exercise: This is the key to good bone and joint health. Much like machinery and tools, the bones and joints of your body can also wither with disuse and prolonged inactivity. Make sure that you indulge in exercises like long walks and muscle strengthening exercises which will give your joints and bones good amount of strength as well. Remember to speak with your doctor before you start a new exercise regime so that you avoid anything that may be harmful in case you have any other ailment. Low impact exercises will strengthen the spine, while fat burning and weight loss exercises will ensure that there is less pressure on the knees and lumbar area. Swimming and resistance building exercises can also be practised for these purposes.
  3. Abstinence: A major factor in promoting better bone and joint health is abstinence from all those things that can create problems in the long run, like smoking, drinking excessively and even too much consumption of caffeine and fatty food. All these things can create depletion of the natural bone mass. Also, switching to a lower heel for everyday wear footwear and changing your position during your time at your workstation are a few things that will go a long way.

Take care of your bones and joints the right way today, for a healthier tomorrow. If you wish to discuss about any specific problem, you can consult an Orthopedist.

5022 people found this helpful

Arthritis - 6 Foods You Must Avoid!

Dr.Rakesh Kumar 91% (144ratings)
MS - Orthopaedics, MBBS
Orthopedic Doctor, Delhi
Arthritis - 6 Foods You Must Avoid!

Arthritis is a painful joint condition that leads to pain and stiffness as well as lack of proper mobility due to inflammation and swelling. Usually, an orthopaedic specialist will prescribe anti-inflammatory and pain relieving medication for this condition, but there are various things that you can do to ensure that this condition does not become a debilitating one in the long run. One of the best ways of doing this is by limiting your diet in certain ways when it comes to inflammation producing food.

Here are a few types of food to avoid if you are suffering from arthritis.

  1. Fried food: Fried and processed food is packed with too much of salt in order to better preserve it so that it has longer shelf life. Also, the use of oil in order to deep fry can have a detrimental effect on the inflammation that is already causing problems for your joints. Therefore, it is best to avoid fried, fatty and processed or packaged food that has been frozen for too long.
  2. AGEs: When we speak of AGEs, we are not talking about the number of birthdays that you have celebrated. AGEs are actually Advanced Glycation End products that are a toxin released by food when it is heated, grilled, fried or pasteurised. These toxins can render damage to the proteins in your body. Once this process starts, the body retaliates by sending forth cytokines which are basically inflammatory messengers. This can lead to inflammation and arthritis.
  3. Sugar: Sugar and other refined carbs also have a large amount of AGEs as discussed above. These types of food should also be avoided by patients suffering from arthritis. Also, artificially sweetened drinks and too many baked goodies should be avoided by these patients.
  4. Dairy products: Owing to a certain kind of protein that most dairy products contain, these kinds of food are considered harmful for patients of arthritis. These proteins can encourage inflammation and irritation of the tissue that surrounds your joints. Switching to a vegan diet is considered helpful for arthritis patients.
  5. Alcohol: Excessive drinking is a major problem that can aggravate your arthritis situation. Smoking and drug abuse also leads to such problems. Drinking excessively can lead to the development of gout.
  6. Corn oil: This kind of oil is a part of most packaged, processed and fried food. It also leads to inflammation. Arthritis patients should switch to omega fatty three oils which can be found in fish.

Taking care of your body is a matter of maintaining a good diet with lots of activity that will be congenial for your condition. This will also help in keeping the painful symptoms of arthritis away. If you wish to discuss about any specific problem, you can consult an Orthopedist.

4507 people found this helpful

All About Knee Replacement

Dr.Rakesh G. Nair Nair 85% (18ratings)
DNB (Orthopedics), Diploma in Orthopaedics, MBBS
Orthopedic Doctor, Mumbai
All About Knee Replacement

Knee replacement is a surgery wherein an artificial joint is used to replace a diseased, damaged or worn out knee. This surgery is common among people who fall in the age group of 60-80, but recent trends seem to suggest that younger people are opting for this surgery as well. The lifetime of the artificial knee joint is around 20 years, provided the knee is well cared for.

Why do you need Knee Replacement?

Most common reason is “high grade osteoarthritis” due to wear and tear of the knee joint. The pre-hospital study of the Knee joint is mandatory and would decide what kind of Replacement is suitable to the patient. If there is diabetes or hypertension associated with this, then it should be controlled well before undergoing surgery. Hemoglobin of at least 10 gm% is required.

If the mobility in your knee joint is reduced leading to impaired functioning of the knee joint, then you might need a knee replacement surgery. You may experience pain while walking, sitting and, in some cases, resting as well.

Some of the common reasons why you may opt for this particular surgery are:

  1. Gout, where, small crystals are formed inside the joint.
  2. Rheumatoid Arthritis, an autoimmune disorder, wherein the immune system of the body attacks the body’s healthy tissues.
  3. Hemophilia, wherein, the blood ceases to clot normally.
  4. Injuries to the knee
  5. Disorders that cause unusual bone growth (bone dysplasias)
  6. Death of bone in the knee joint following blood supply problems (avascular necrosis)
  7. Knee deformity with pain and loss of cartilage
  8. Unusual growth of bones in the knee joint

Knee replacement surgery is classified into:

1. Partial Knee Replacement: In this surgery, only one part of the joint is replaced.

2. Total Knee Replacement: Total knee replacement surgery involves replacement of both sides of the knee joint.

The usual hospital stay period is around 2-3 days after the surgery is completed. Initially, you will require the help of crutches to walk for at least 2 months. You may also be asked to do gentle knee strengthening exercises. It may take up to two years to recover completely from a knee replacement surgery. If you wish to discuss about any specific problem, you can consult a orthopedist.

4076 people found this helpful

Lower Back Pain - Do I Need Physical Therapy?

Pain Management Specialist, Kolkata
Lower Back Pain - Do I Need Physical Therapy?

Lower back pain is fast becoming an epidemic not just among elderly, but across all age groups. Primary causes of back pain are quite a few including lumbar hernia, disc degenerative disease (DDD), spondylosis etc., but the symptoms are usually the same excruciating pain in the lower region of the spine, followed by stiffness. Since back pain is caused due to a number of spinal problems, it manifests differently in different patients. The pain may be dull, burning or sharp. It could also be felt at a single point or over a broad area and could be accompanied by muscle spasms or stiffness or even shooting pain in one or both legs.

Back pain can also be differentiated according to time period:

  1. Acute: Pain lasts for less than three months.
  2. Recurrent: Acute symptoms reoccur over time.
  3. Chronic: Pain lasts longer than three months.

Sometimes symptoms resolve on their own, but in many cases conservative treatment, such as physiotherapy, which often work better than surgery, becomes essential. Alternate therapies like surgery, acupressure, acupuncture as well as yoga and Ayurveda also help.

Physiotherapy - Exercises that work
Since the reason for low back pain is not always same, a patient’s treatment too should be tailored for his specific symptoms and condition. This is what the physiotherapist will do design an exercise plan based on the patient’s specific problem and its cause.

Physiotherapy treatments may include:

  1. Manual therapy, which includes direct spinal manipulation aimed at improving the mobility of joints and soft tissues
  2. Strengthening and flexibility exercises
  3. Education about what do and what not to do
  4. Training for proper sleeping positions, lifting, bending, and sitting as well as for working at home and at work
  5. Use of heat/cold treatments or electrical stimulation to help relieve pain

Physiotherapy exercises help support the back and strengthen muscles so that the spine is cushioned properly. This is why physiotherapy is relevant as a treatment for backache. Treatments like traction help in lengthening the spine and relieving compression of nerves that cause sciatica, radiating pain into legs largely due to lumbar herniation. If back pain is extreme, a patient will require physical therapy along with medication, which will help in managing pain and bringing inflammation down. But in the long term, being physically active, going for walks, sitting properly and maintaining a good posture will help the most. If you wish to discuss about any specific problem, you can consult a physiotherapist.

3812 people found this helpful

Everything You Need To Know About Shoulder Arthritis Treatment

MBBS, MS - Orthopaedics, Fellowship in Arthroscopy & Arthroplasty Shoulder & Knee
Orthopedic Doctor, Gurgaon
Everything You Need To Know About Shoulder Arthritis Treatment

The shoulders are the most mobile joints in your body. Shoulder joints undergo wear and a tear over time and hence become unstable. Shoulder arthritis is one of the painful conditions affecting the shoulder joints. Arthritis not only takes a toll on the tendons and muscles, but also affects the ligaments and joints too. They usually cause symptoms such as joint pain, resulting in limited mobility.


Nonsurgical or Lifestyle treatments:

  1. Take rest or avoid the activities that provoke pain or change the way of your arm movements.
  2. Physical therapy boosts shoulder mobility.
  3. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or aspirin alleviate pain and inflammation.
  4. Corticosteroid injections in the shoulders can also help to ease the pain and inflammation, although temporarily.
  5. Applying moist heat or ice packs over the shoulders for about half an hour at least thrice a day brings relief.
  6. Drugs such as methotrexate can be administered in case one is suffering from rheumatoid arthritis (a chronic disease attacking multiple joints of the body).
  7. Dietary supplements such as chondroitin and glucosamine may help reduce pain.

Surgical treatments (if your pain results in disability and does not lessen with nonsurgical options)

  1. Join replacement surgery or arthroplasty involves replacing the damaged parts of the shoulder with a prosthetic (artificial) joint.
  2. Few mild forms of arthritis may be treated using the Arthroscopic procedure (minimally invasive surgery). It requires a surgeon to ease the joint pain by making small incisions to “clean out” the joint. A tiny camera fitted into the joint guides the surgeon through the surgery.
  3. Resection arthroplasty is a method that involves the surgical removal of the bone from the collar bone and substituting it with a scar tissue to treat arthritis of particular joints. If you wish to discuss about any specific problem, you can consult an orthopedist.
4317 people found this helpful

Types And Treatment of Arthritis

Dr.Poonam Patel Vasani 91% (905ratings)
MBBS, MD - Anaesthesiology, FIPM, Fellowship in palliative medicine, certificate in interventional pain management, Multidisciplinary pain management course
Pain Management Specialist, Pune
Types And Treatment of Arthritis

What are the Different Kinds of Arthritis and How to Treat Them? 

Arthritis is a very common medical condition that affects a lot of adults as they age. It occurs due to inflammation of the joints, which can be caused by a number of factors such as aging, injury or infection. There are over a hundred different kinds of arthritis that cause various sorts of problems to those affected. However, this condition can be broadly classified into two major types, which include the following: 

  1. Osteoarthritis- Also known as degenerative joint disease, osteoarthritis is the most common kind of chronic condition to affect the joints. This occurs when the cartilage that surrounds the joint wears away and allows the ends of bones to rub against each other causing immense pain and is often accompanied by inflammation and swelling. The primary cause of osteoarthritis is aging, obesity and occurs mainly due to pressure on the joints. 
  2. Rheumatoid Arthritis- This is the most common type of arthritis that occurs due to joint inflammation. It is an autoimmune condition, which means that it is caused by a dysfunction of the immune system that leads to inflammation of the joints. Chronic inflammation causes joint deformities and even the development of rheumatoid nodules on the skin around the joint. Two-thirds of patients affected by rheumatoid arthritis are women. 

Depending on the nature of the condition and the age and medical history of the patient, diagnosis and treatment of arthritis varies. Although there is no permanent cure for arthritis, especially the type caused by aging, a number of remedies exist that provide relief from pain.

Some of the common methods of treatment for arthritis are: 

  1. Medication- Some medicines provide relief from the pain of arthritis if it is not too severe. These include painkillers, anti-inflammatory pills, sprays, and ointments, etc. In case of high-intensity pain, codeine is often prescribed.
  2. Stem Cell Therapy or PRP Therapy- This method involves drawing platelets from the patient's own blood and injecting it into the inflamed parts of the joint in order to repair damaged muscles and alleviate pain. This treatment stimulates natural healing process of body and is free from side effects.
  3. Injections- A number of anti-inflammatory substances and lubricants can be injected into the affected joints to decrease pain. Ozone gas injections or hyaluronic acid injections are an example of this. 
  4. Intramuscular Stimulation- Targeted treatment of tender points in muscle help to relieve muscle spasm associated with arthritis and also improves joint mobility and decreases pain. 
  5. Surgery- In extreme cases, surgical procedures are resorted to for treating arthritis. However, successful surgery cannot always be guaranteed and it comes with its own set of risks. If you wish to discuss about any specific problem, you can consult a rheumatologist and ask a free question.
2807 people found this helpful

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