Dr Madhu Phophalia's Physical medicine and Rehabilitation clinic

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07/03/2024

Backache is the second most common ailment after common cold. Taking medicine for immediate relief is not a permanent solution. Expert advice and tailor made treatment is highly recommended. However following basic measures can be beneficial-for most of backaches.

* Practicing proper back care during daily activities is essential for treating back issues. Back education is very crucial, as it teaches basic body mechanics such as correct posture while standing, sitting, and carrying objects. Consulting an occupational therapist or physical therapist can provide education on proper behaviors when experiencing back pain, while sitting at work, bending forward to lift anything and also in lying down position.

* Additional recommendations include:
a) Avoiding activities that exacerbate pain.
b) Taking intermittent rest breaks.
c) Avoiding bending from back and bending from knees with straight back to pickup objects from floor instead of.
d) Avoiding pushing and pulling activities until pain subsides.
e) Limiting prolonged sitting and standing.
f) Avoiding sitting or sleeping on the floor.

Using anti-inflammatory analgesics like ibuprofen, along with other pain relievers and muscle relaxants when spasms associated.
* Applying local analgesic gels, sprays, or ointments.
* Using hot fomentation to alleviate pain.
* Consider electrotherapy options such as transcutaneous electrical nerve stimulation (TENS), along with other methods like ice packs, heating pads, electrical stimulation, phonophoresis, iontophoresis, relaxation techniques, and biofeedback.

* Engaging in supervised physiotherapy exercises, which may include ROM exercises , stretching & strengthening exercises. Swimming/ hydrotherapy exercises tailored to alleviate back pain.
* Using a lumbosacral corset, support, or brace.
* If overweight or obese, consider weight reduction for long-term benefits.
* Considering epidural steroid injections for pain relief not attainable by routine conservative treatment.
* Surgery is typically considered a last resort when all conservative measures fail even after an adequate trial.
You can also incorporate following specific exercises into your daily routine for treatment and prevention recurrences of backache.

* Knee-to-chest stretch. Lie on your back with your knees bent and your feet flat on the floor.
* Lower back rotational stretch.
* Lower back flexibility exercise.
* Bridge exercise.
* Cat stretch.
* Seated lower back rotational strech.

Consultation with specialists such as physiatrist,orthopedists, physical therapist may provide additional guidance and treatment options tailored to your needs.

Sharing some pictures to show how to take Care of joints in activities of daily living. Please modify your way of Doing ...
31/01/2022

Sharing some pictures to show how to take Care of joints in activities of daily living. Please modify your way of Doing daily chores accordingly so your joints are used in a proper way if you have any kind of arthritis / musculoskeletal disease causing pain, discomfort or difficulty.

13/01/2022

Back Pain : Mystry solved !!

Most low back pain will resolve with a simple, conservative, self-directed program. Some people will require additional treatment, as do many patients with chronic or recurrent pain. A physical therapy rehabilitation program can be very helpful. It typically involves an exercise program to improve posture, body mechanics, flexibility, and strength, and it may add modalities such as heat or cold treatments and ultrasound.

If physical therapy doesn't do the trick, selected patients can be helped by injecting steroids into the painful area. The back exercises, posture tips, and achieving optimal body weight helps in the long term. Careful studies show that the best plan for back pain management is to return to normal activities as soon as one can. Gentle activity can help to walk away from pain. Avoid prolonged sitting, heavy lifting, and repetitive bending and twisting motions. Be as active as your pain will allow, but don't push too hard. When you rest, lie on a firm surface such as a good mattress, a mattress with a bedboard under it. When you sit, select a chair with good low back support.

Yoga, Tai Chi can help in some cases and need supervision. Swimming too is helpful for a significant number of people. It is done in a reduced gravity environment which places much less stress on our lower spine compared to other physical activities. There is a lot of emphasis on core and back muscle strengthening and stretching of the spine in yoga and that helps overcome the symptoms.

Conservative management is the gold standard including physiotherapy, stabilization belts, nerve stimulation, pharmacological treatment, acupuncture, massage, relaxation, posture training.


Your symptoms can be due to;

1) Herniated/degenerated disc in back

2) Lumbar spondylosis; bone spurs in the back vertebrae pressing on the nerves.

The following investigations would be required, for the confirmation of the diagnosis;
1) X-ray of the lower back
2) MRI of the spine
3) Nerve conduction velocity (NCV) study
4) Electromyography (EMG).

The following measures would be helpful;

1) Backcare in the activities of daily living, which is an integral component of the treatment of back problems. Back education is one of the most important things which teaches the basic body mechanics, like correct posture for standing, standing at a desk or drawing board, sitting, brushing teeth, washing the face, pushing and pulling a weight, lifting a weight, getting in and out of bed, sleeping, getting into and sitting in a car. The training for these routine activities helps in preventing the spasm of the muscles. One needs to consult an occupational therapist or physical therapist which can educate about the proper and improper behaviors when the back is painful in case they have to sit, bend forward, lie down, walk, cough, or sneeze.

You need to practice postural hygiene by avoiding bending your back forward. If you have to pick anything from the floor you should bend your knees while keeping the back straight.
You should also avoid sitting for long periods as intradiscal pressure, that is the pressure inside the disc is maximum during sitting posture and that can aggravate your symptoms. If you have to sit, you must take regular breaks every 15 to 20 minutes even if for a couple of minutes. When sitting, try using a footstep to support your feet so that the thigh body angle remains 90 degrees or less than that for most of the time.

You should also consider strengthening the core and the back muscles that play an important role in supporting the vertebral column.
Two excellent exercises for strengthening core and back muscles are swimming and yoga, once you are significantly better and these can be done without the pain.

The following more need to be done:

a) Avoid activities that increase pain.
b) Rest intermittently
c) Avoid bending at 90 degrees
d) Pushing and pulling should be avoided until the pain subsides
f) Avoid prolonged sitting and standing
g) Avoid sitting or sleeping on the floor
2) Anti-inflammatory analgesics like ibuprofen, other analgesics, and muscle relaxants
3) Local analgesic gels or sprays/ointment
4) Hot fomentation
5) Electrotherapy like transcutaneous electrical nerve stimulation: done by the physical therapist. Other things are ice packs, heating pads, electrical stimulation, phonophoresis, iontophoresis, relaxation, and biofeedback.
6) Well-supervised physiotherapy: The exercises consist of abdominal bracing, modified sit-ups, double-knee-to-chest or low back stretches, seat lifts, mountain and sag exercises, knee-to-elbow exercises, hamstring stretches, extension exercises, and extension flexibility exercises. Swimming exercises (pool exercises) are best for back pain. Initial stretching and later strengthening exercises are taught.
7) Lumbosacral corset or support or back brace.
8)If obese or overweight, reduce weight for long-term benefits.
9) Epidural steroid shots
10) Surgery is usually the last resort when the above conservative measures fail.

29/07/2020

Patient empowerment; let them be part of their disease management for a perfect experience!

Dr Arun Phophalia M.S.
Professor of Surgery (Modern Medicine) University of Homeopathy, Chairman PhD and Research Committee.

Medical science has taken a huge leap by number of advancements in the last century. All this is due to ongoing research, newer diagnostic and medical imaging armamentarium and decoding human genome. While diagnostics have also grown, we may still lack a definitive treatment protocol for an individual in a lot of circumstances.

The problem is inherited in our research ways. We have since time immemorial published reports on group of people, where data show bunch of patients responding to a treatment protocol in a favorable way, while the other small but significant group may have less response and fraction might not respond at all. We adopt the treatment; just because a statistically significant population has responded favorably to the treatment. But when an individual comes; we do not know, whether he/she would fall in the group, which did not respond to the treatment protocol. This can be an huge disappointment to the patient as well as for the doctor, in that case, due to negative outcome. Thus we need to evolve intelligence where we can gauge the treatment response, in an individual circumstance (instead of group of people), before starting it.

There is an another problem faced by the modern medical practitioners. People come with general symptoms of sense of non well being, lethargy, generalized muscle pain, fatigue etc which may not indicate any definite diagnosis. A very detailed investigative work up could also come up negative for everything. The dilemma is; how to proceed with the treatment, as there are many psychological affections associated with all the chronic medical issues. Physicians in these cases resort to symptomatic treatment, which may give significant side effects. Again the patients and physician are distraught alike, here.

Despite the advancement of the medical science, we are far from a definite answers to many maladies. The question here is how to approach the patients in whom no definite diagnosis are achieved.

Here comes the role of patient empowerment. Let the patient know everything about their medical issues; right from their symptoms, physical exam findings, meaning of their investigative results, possible conclusions drawn, various kinds of treatment available and their pros and cons. This can also be done by asking them to read on the internet, discussions during medical consultation and many other ways. And then let the patient decide on their own therapeutic decision. They can be helped on arrival of a treatment protocol in all of these circumstances, but they need to be actively participating in their own care. Outcome in all these cases is likely to be more favorable than when people are far less informed.

Medical science is a complicated phenomenon which is dictated by various variables like; a) severity of disease or symptoms or their perception by an indvidual, b) duration in hand, c) money / cost (finance), d) insurance, e) previous experience, f) education and g) knowledge, h) individual psyche, I) availability of the facilities, man power, expertise etc.

Thus there is a need to develop a platform which can factor all the variables and provide evidence based, equal standard of immediate care in an affordable manner, assisted by the patient himself after understanding and knowing everything. Medical science is an art of possibilities and probabilities. It is not a perfect science. So let the patients be empowered for the personalized decisions. Results and outcomes are going to be better with good patient experiences.

The more they are informed, the more they are happy!

Dr Arun Phophalia M.S.

Professor of Surgery (Modern Medicine) University of Homeopathy, Chairman PhD and Research Committee.

08/11/2019

Hello and welcome friends.

Prevention of any disease, delaying its onset, decreasing it’s symptoms specially age related musculoskeletal disorders and auto immune joint diseases is our primary aim as a consultant Physiatrist .

And second is to give each patient/ person a tailor made advice according to his/her age, s*x, life style, occupation, previous diseases. Their emotional,intellectual levels, understanding have important role in overall outcome.
Regular follow up and maintinence exercises, care of joints in daily activities and control of associated medical diseases is the key to remain healthy.

What may be the best treatment for you , cannot be same for the other person with similar looking symptoms. So please do not forgo/ linger on your health issues and always take advice of a qualified professional only.

Address

Jaipur

Opening Hours

Monday 9am - 5pm
Tuesday 9am - 5pm
Wednesday 9am - 5pm
Thursday 9am - 5pm
Friday 9am - 5pm
Saturday 9am - 5pm

Telephone

+919828233221

Website

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