ABOUT THE CONDITION
ABOUT THE CONDITION
ABOUT THE CONDITIONThe ACL is composed of densely organized, fibrous collagenous connective tissue that attaches the femur to the tibia.
ABOUT THE CONDITION
ABOUT THE CONDITION
ABOUT THE CONDITION
ABOUT THE CONDITION
Ergonomics is the study of efficiency of people in their working environment. The tools and machines used in the workplace should be designed according to the physical demands of the people working there. Thus Ergonomics aims to improve workspaces and environments to minimise the risk of injury in the workers.
Muscles, tendons, joints and nerves are susceptible to injury when stressed or traumatised repeatedly, or over an extended period of time. Regardless of the nature of the work, a large proportion of the working population’s time is spent engaged in repetitive movements and maintaining postures for extended periods of time. The reported incidence of work-related back and neck pain, and carpal tunnel syndrome, is between 15-60%, indicating that a high proportion of the working population is at risk of developing one or more work-related musculoskeletal disorders. The parts of the body that are most commonly affected are the lower back, neck and shoulder girdle, and upper limbs.
We perform a detailed ergonomic assessment of your work place, evaluate your posture when at work, assess your strengths required to perform your job/task, co-relate it with your pain and plan a rehabilitation programme which includes posture correction exercises that will allow you to do your job pain free and with a better efficiency thus giving better results.
ABOUT THE CONDITION
Plantar fascia is a thick band of tissue that runs across the bottom of your foot and connects your heel bone to your toes. Earlier the condition was coined as plantar fasciitis because it was believed that there is inflammation predominantly in plantar fascia. Since the recent evidence suggests that the inflammation and degeneration of the plantar fascia and the structures surrounding it occur simultaneously, the term plantar fasciopathy was coined.
The probable causes of the same can be abnormal pressure on the foot due to erratic loading, tightness of structures surrounding the foot, especially calf or altered biomechanics of the lower limb or the entire kinetic chain leading to increased pressure on the foot and ankle.
4-35% in runners and military population.
ABOUT THE CONDITION
Shin splints is the commonest term used for MTSS, the pain along the inner side of lower 2/3rd of the leg.
Causes can be high impact or repetitive loading activities like jumping or running.
It is a syndrome which includes multiple causative factors like weak or tight hip and calf muscles, tight lumbar paraspinals, weak lower abdominals and hip flexors. All these changes leads to altered biomechanics loading the bone there by leading to a stress reaction leading to stress fracture.
The main symptom is dull pain at distal 2/3rd of the leg. It is generally activity dependent. Pain on palpation is typically present following activity for few days.
The most common complication following MTSS is stress fracture of tibia due to continuous micro trauma on bone caused by loading activities.
MRI or Ultrasonography can be used to rule out stress fracture.
The prevalence of lumbar canal stenosis has been suggested as ranging from 1.7 to 13.1%. The prevalence of acquired LSS increases with age with women getting affected more than men.
ABOUT THE CONDITION
Lumbar spinal stenosis is the narrowing of the spinal canal and compression of spinal cord and its nerves producing symptoms like pain , tingling numbness and weakness.
The most common cause of it being degeneration, it can also be caused due to other reasons including congenital, post-traumatic, spondylolisthetic, tumour-compressing.
Symptoms initially start with bouts of Low back and radiating pain. The classical complaint in lumbar stenosis is neurogenic (or spinal) claudication. These symptoms include radiating pain, tingling and weakness of leg. Usually has bilateral leg complaints and distribution of pain is dependent on the area of stenosis(compression). Additional symptoms in the legs may be fatigue, heaviness, leg cramps, as well as bladder issues.
Prolonged standing and walking , back bending becomes difficult or aggravate the symptoms. Forward bending, sitting, stooping or lying helps relieve the symptoms.
At Replay Physio physiotherapy and rehabilitation center, we assist you in avoiding the pain of the injury and help you get fitter faster.
Physical therapy would include:
1% to 3% with the highest prevalence among people aged 30 to 50 years, with a male to female ratio of 2:1.In individuals aged 25 to 55 years, about 95% of herniated discs occur at the lower lumbar spine (L4/5 and L5/S1 level); disc herniation above this level is more common in people aged over 55 years.
ABOUT THE CONDITION
PIVD is a condition in which disc between the two vertebrae bulges/protrudes out leading to compression of spinal cord or nerve.
The human spine is made up of alternating vertebrae and intervertebral discs extending from the neck to the tail bone. The intervertebral discs are the ‘shock absorbers’ of the body and are composed of an outer strong fibrous membrane and an inner ‘jelly-like’ nucleus giving both strength and elasticity. A disc prolapse occurs when there is weakening in the outer membrane which leads to a protrusion of the inner nucleus. This protrusion usually heads towards the spinal canal thus compressing them giving rise to the symptoms.
Disc herniation can occur in any disc of the spine, but the two most common site are lumbar disc herniation and cervical disc herniation
As we grow older, our intervertebral discs begin to lose water content. However, several other factors may encourage or exacerbate prolapsed discs in both the young and the elderly, such as:
Symptoms include mild to severe back pain which can be caused by muscle spasm and may radiate to leg due to nerve irritation. In case of cervical disc herniation in can radiate to the hand. There may be pins like sensations, tingling, numbness, burning , pully like sensation and weakness in the affected area. In severe cases there may be bladder and bowel incontinence and weakness/paralysis of the muscle supplied by that particular nerve root.
Physical assessment along with an MRI scan can confirm the diagnosis.
Medical treatment would include muscle relaxants, anti-inflammatory , analgesics(pain-killers), tricyclics for nerve pain.
Physiotherapy management would include :
ABOUT THE CONDITION
Golfers elbow also known as medial epicondylgia is an overuse injury causing pain on the inside of the elbow joint.
Risk factors in athletes includes
Posterior Cruciate Ligament (PCL) is a ligament within the knee joint. It is similar to the Anterior Cruciate Ligament (ACL), connecting the thigh bone (femur) to the shin bone (tibia). The PCL keeps the tibia from translating/moving back. An injury to the PCL typically requires a powerful force:
Baker’s Cyst, also known as a popliteal or parameniscal cyst, is a fluid-filled sac that forms in the posterior(behind) aspect of the knee. In adults, Baker's Cysts tend to form in association with degenerative conditions of the knee, for example, secondary degenerative meniscal tears, rheumatoid arthritis, osteoarthritis. In younger generation, it is mostly because of overuse or injury to the knee.
The lateral and medial menisci are crescent-shaped fibrocartilaginous structures that collectively cover approximately 70% of the articular surface of the tibial plateau, and primarily function in load transmission and shock absorption through the tibiofemoral joint. A torn meniscus occurs because of trauma caused by forceful twisting or hyper-flexing of the knee joint. Relatively less force is required to create tears in those with degenerative changes of the menisci, typically seen in adults over the age of 40y, often with concomitant osteoarthritis (OA).
Medial meniscal tears are more common than lateral meniscal tears. Tears that are contained within the outer 1/3 vascular zone of the menisci are "red-red" tears, whereas those with central margins extending into the inner 2/3 avascular zone are "red-white" tears. Tears contained within the inner 2/3 avascular zone are "white-white" tears. Tears located within the red zone have the highest potential for either spontaneous healing with conservative management or successful outcome following meniscal repair.
Epidemiology: Injuries to the menisci are the second most common injury to the knee, with an incidence of 12% to 14% and a prevalence of 61 cases per 100,000 persons. Women are more likely to get meniscus injury than men.
Evidence shows that non-operative treatment can be successful especially in the short term and in the presence of osteoarthritis. Partial meniscectomy can preserve some of the function of the meniscus and is beneficial for tears within the avascular white zone. Meniscal repair should be considered for all repairable tears, provided the patient follows-up with the post-surgery rehabilitation approach.
Osteoarthritis is the most common form of arthritis, affecting millions of people worldwide. It occurs when the protective cartilage on the ends of your bones wears down over time. Although osteoarthritis can damage any joint in your body, the disorder most commonly affects joints in your hands, knees, hips and spine. Risk factors for developing OA include age, female gender, obesity, anatomical factors, muscle weakness, and joint injury (occupation/sports activities).
Classically, OA presents with joint pain and loss of function; however, the disease is clinically very variable and can present merely as an asymptomatic incidental finding to a devastating and permanently disabling disorder. The presentation and progression of OA vary greatly from person to person. The triad of symptoms of OA is joint pain, stiffness, and locomotor restriction.
Patients can also present with:
There is no cure for osteoarthritis, but the ill-effects of the process can be managed and slowed down by following a good rehabilitation program. The surrounding structures of a joint such as the muscles, tendons and ligaments that can be strengthened, support the joints and take off excessive loads too.
The sciatic nerve runs just adjacent to the piriformis muscle, which functions as an external rotator of the hip. Hence, whenever the piriformis muscle is irritated or inflamed, it also affects the sciatic nerve, which then results in sciatica-like pain. The sciatic nerve is a thick and long nerve in the body. It passes alongside or goes through the piriformis muscle, goes down the back of the leg, and eventually branches off into smaller nerves that end in the feet.
The diagnosis of piriformis syndrome is not easy and is based on the clinical history and presentation. Other conditions that can also mimic the symptoms of piriformis syndrome include lumbar canal stenosis, disc inflammation, or pelvic causes.
Causes of piriformis syndrome include the following:
Patients with piriformis syndrome will present with the following:
Short-term symptoms can be reversed within a few days at our chronic pain management clinic. Longstanding symptoms may take a few weeks to address the biomechanical and muscle habits that have predisposed you to the injury.
Frozen shoulder/ Adhesive capsulitis (AC), is an insidious painful condition of the shoulder persisting more than 3 months. This inflammatory condition that causes fibrosis of the glenohumeral joint capsule is accompanied by gradually progressive stiffness and significant restriction of range of motion (typically external rotation). However, the patients may develop symptoms suddenly and have a slow recovery phase.
It is characterized by stiffness, pain and limited range of movement in your shoulder due to inflammation and subsequent scarring around the shoulder joint.
Mostly seen in patients with age > 40, peak at the age of 56. Incidence is 2% to 5% of the general population. Female: Male ratio 2:1, In general, bilateral shoulder involvement is rarely simultaneous and instead occurs sequentially.
Patients with Diabetes Mellitus (5 times more likely to develop) 11%, stroke, hyperthyroidism, hypothyroidism, heart diseases, Parkinson’s disease are more prone to developing frozen shoulder.
Frozen shoulder occurs in three phases along with the following symptoms:
1. Acute (painful freezing phase)10-36 weeks
- Pain even at rest
- Nagging constant pain and worse at night with no response to usual anti-inflammatory and steroids.
- Motions are limited in all directions only in end range.
2. Adhesive stage (frozen) 4-12 months
-Pain gradually subsides but stiffness remains
-Pain only at end ranges of movement.
-Gross reduction of Glenohumeral (arm) movement with near total loss of external rotation.
-Atrophy of deltoid, rotator cuff, biceps, triceps
3. Resolution phase(thawing) 12-42 months
-Spontaneous improvement in ROM
-Significant capsular restrictions from adhesions.
Prognosis:The duration of Adhesive capsulitis is from 1 to 3.5 years with a mean of 30 months. In about 15% of patients, the contra-lateral shoulder becomes affected within 5 years.
Thoracic outlet syndrome (TOS) is a group of disorders that occur when blood vessels or nerves in the space between your collarbone and your first rib (thoracic outlet) are compressed. TOS usually occurs in patients who have a cervical rib (extra rib) that directly attaches to C7 vertebra which causes further compression.
TOS affects approximately 8% of the population. It is 3-4 times more frequent in women as compared to men, between the age of 20 and 50 years. Females have less-developed muscles, a greater tendency for drooping shoulders owing to additional breast tissue, a narrowed thoracic outlet and an anatomical lower sternum, these factors change the angle between the scalene muscles and consequently cause a higher prevalence in women.
The mean age of people affected with TOS is 30s-40s; it is rarely seen in children. Almost all cases of TOS (95-98%) affect the brachial plexus; the other 2-5% affecting vascular structures, such as the subclavian artery and vein. This can cause pain in your shoulders and neck and numbness in your fingers.
Thoracic outlet syndrome (TOS) is composed of three types: neurogenic, venous, and arterial.
Signs and symptoms of neurological thoracic outlet syndrome include:
Signs and symptoms of vascular thoracic outlet syndrome can include:
The term spondylosis is used to define a generalized natural ageing process. Cervical and lumbar spondylosis results from the process of degeneration of the intervertebral discs and facet joints of the cervical and lumbar spine. Biomechanically, the disc and the facets are the connecting structures between the vertebrae for the transmission of external forces. They also facilitate cervical spine mobility.
On radiological finding, 90% of men older than 50 years and 90% of women older than 60 years have evidence of degenerative changes in spine. 70% Of individuals may show bad changes on X- ray but are asymptomatic. Sex ratio reports have been variable but are essentially equal.
Mechanical low back pain refers to back pain that arises intrinsically from the spine, intervertebral discs, or surrounding soft tissues. This includes lumbosacral muscle strain, disk herniation, lumbar spondylosis, spondylolisthesis, spondylolysis, vertebral compression fractures, and acute or chronic traumatic injury.
Low back pain (LBP) is the fifth most common reason for physician visits, which affects nearly 60-80% of people throughout their lifetime. The lifetime prevalence of low back pain is reported to be as high as 84%, and the prevalence of chronic low back pain is about 23%, with 11-12% of the population being disabled by low back pain. In the 2010 Global Burden of Disease study the global age-standardized point prevalence of LBP (from 0 to 100 years of age) was estimated to be 9.4%.
Patients generally present with a history of an inciting event that produced immediate low back pain. The most commonly reported histories include the following:
Typical physical findings are nonspecific, including restricted range of motion of the spine, tight hamstring muscles, paravertebral muscle spasms, muscular trigger points, tenderness and aggravation of symptoms on flexion or extension and straight leg raising tests.
The incidence of hip impingement in patients with groin pain is 0.44% in the entire population.
Hip impingement in medical terms is known as Femoroacetabular impingement (FAI), is a condition in which the anatomic abnormalities of the femoral head and/or the acetabulum result in an abnormal contact between the two during hip motion, especially in positions of hip flexion and rotation, leading to cartilage and labral damage and hip pain. This results in increased friction during hip movements that may damage the joint.
Iliotibial band friction syndrome (ITBFS) is the most common injury of the lateral side of the knee in runners, with an incidence estimated to be between 5% and 14%. It has even been reported that ITFBS is responsible for 22% of all lower extremity injuries in general.
Iliotibial band syndrome (ITBS or IT band syndrome) is an overuse injury of the connective tissues that are located on the lateral or outer part of thigh and knee. It causes pain and tenderness in those areas, especially just above the knee joint. Iliotibial band syndrome is the most common cause of lateral knee pain in runners and bicyclists.
Weak hip, adductors and calf muscles, play a larger role in the development of ITB syndrome. If the symptoms are ignored, the inflammation can continue and scarring develops in the bursa, decreasing knee range of motion and causing increasing pain with decreasing activity.
The hamstrings are the three muscles at the back of the thigh. At the top they are attached to the 'sit bone' of the pelvis. The lower ends cross the back of the knee joint and are then attached to the bones of the lower leg:
Hamstring strain injuries remain a challenge for both athletes and clinicians, given the high incidence rate, slow healing, and persistent symptoms. Prevalence ranges from 8 to 25 percent, depending upon the sport. In soccer it is the most frequent injury.
Hamstring strains are common in sports with a dynamic character like sprinting, jumping, where quick eccentric contractions are regular. Besides running, kicking is another activity in which hamstring muscle strain injuries occur frequently.
Hamstring strains are caused by a rapid extensive contraction or a violent stretch of the hamstring muscle group which causes a high mechanical stress. This results in varying degrees of rupture within the fibres of the musculotendinous unit.
Acute or sudden hamstring strains usually happen in two ways, either sprinting related or stretch related. During sprinting the hamstring muscles work extremely hard to decelerate the shin bone just before the foot strikes the ground and it is at this point that the hamstring is most likely to tear. Stretch related injuries usually occur higher at the back of the thigh in the tendon of the semimembranosus muscle. Sprinting related hamstring injuries often feel worse but recover more quickly, whereas stretch related hamstring strains can take longer to heal as the injury is more likely to the tendon where blood flow is lower.
Symptoms of a hamstring strain include:
Timeframes for rehabilitation and return to sport vary depending on the nature and severity of the strain. As a general rule, Grade 1 hamstring strains should be rested from sporting activity for about three weeks and Grade 2 injuries for a minimum of four to eight weeks. In the case of a complete rupture (Grade 3 strain), the muscle may have to be repaired surgically and the rehabilitation to follow will take about three months.
Premature return to sport and inadequate rehabilitation will reduce the impact of sport injury rehabilitation program and increase the chances of re-injury. Full stretch and strength should be achieved in addition to the ability to perform full speed training. Assessment of sport-related activities, such as twisting, jumping and changing direction suddenly should also be evaluated.
The gastrocnemius/calf muscle consists of 2 heads. The medial head originates from the posterior medial femoral condyle while the lateral head arises from the posterior lateral femoral condyle. The gastrocnemius muscle is vulnerable to injury because it crosses 3 joints: knee, ankle and subtalar joint.
Tendo Achilles injury is common in young athletes involved in high impact plyometric sports such as racquet sports, running, basketball, football, and skiing. Calf injuries occur more commonly in men than in women,In the older age group tears usually occur in the fourth to sixth decade of life due to degeneration.
Grade 1 Injury (Mild) :
The patients may feel a sharp pain at the time of injury or pain with activity. They are usually able to continue the activity. There may be no or minimal loss of strength and range of motion. MRI study exposes bright signals on fluid-sensitive sequences with less than 5% feathery appearance of muscle fiber involved. Grade 1 injury indicates less than 10% of muscle fibers disrupted.
Grade 2 Injury (Moderate)
The patient cannot walk at the moment of injury. The patient may complain of weakness during ankle dorsiflexion and plantar flexion. Change in the myotendinous junction due to edema or hemorrhage. Grade 2 injury implies 10% to 50% disruption of muscle fibres.
Grade 3 Injury (Severe)
There may be a palpable defect on the affected calf. The MRI findings include complete disruption of continuity of muscle, wavy tendon morphology and retraction and extensive hemorrhage or edema. Grade 3 injury indicates 50% to 100% disruption of muscle fibres
Treatment- depending upon the grade of injury treatment differs.
Most studies indicate that gastrocnemius strains mostly have a good prognosis. Most patients can have a marked decrease in pain and return to exercise after adequate management.