Dr Sadia Physiotherapist

08/06/2023

Sleeping postures.
*(A)* Sleeping on the stomach allows the lumbar curve to collapse into increased lordosis.
*(B)* Placing a small pillow under the abdomen can support the lumbar curve.
*(C)* Sleeping on the side often causes the “upper” thigh to fall toward the other thigh and bed, placing a torque into the sacroiliac joint.
*(D)* Placing a pillow between the thighs supports the upper thigh.
*(E)* When sleeping on the back, tight hip flexor musculature can anteriorly tilt the pelvis, thereby increasing the lumbar lordosis.
*(F)* Placing a roll under the knees relieves the tension from the hip flexor musculature.Sleeping postures.
*(A)* Sleeping on the stomach allows the lumbar curve to collapse into increased lordosis.
*(B)* Placing a small pillow under the abdomen can support the lumbar curve.
*(C)* Sleeping on the side often causes the “upper” thigh to fall toward the other thigh and bed, placing a torque into the sacroiliac joint.
*(D)* Placing a pillow between the thighs supports the upper thigh.
*(E)* When sleeping on the back, tight hip flexor musculature can anteriorly tilt the pelvis, thereby increasing the lumbar lordosis.
*(F)* Placing a roll under the knees relieves the tension from the hip flexor musculature.

07/06/2023

DEFINITION
Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by stiffness and pain in your shoulder joint. Signs and symptoms typically begin gradually, worsen over time and then resolve, usually within one to three years.

Your risk of developing Frozen shoulder increases if you're recovering from a medical condition or procedure that prevents you from moving your arm — such as a Stroke or a mastectomy.

Treatment for Frozen shoulder involves range-of-motion exercises and, sometimes, corticosteroids and numbing medications injected into the joint capsule. In a small percentage of cases, arthroscopic surgery may be indicated to loosen the joint capsule so that it can move more freely.

It's unusual for Frozen shoulder to recur in the same shoulder, but some people can develop it in the opposite shoulder.

SYMPTOMS
Frozen shoulder typically develops slowly, and in three stages. Each stage can last a number of months.

Freezing stage. Any movement of your shoulder causes pain, and your shoulder's range of motion starts to become limited.
Frozen stage. Pain may begin to diminish during this stage. However, your shoulder becomes stiffer, and using it becomes more difficult.
Thawing stage. The range of motion in your shoulder begins to improve.
For some people, the pain worsens at night, sometimes disrupting sleep.

CAUSES
The bones, ligaments and tendons that make up your shoulder joint are encased in a capsule of connective tissue. Frozen shoulder occurs when this capsule thickens and tightens around the shoulder joint, restricting its movement.

Doctors aren't sure why this happens to some people, although it's more likely to occur in people who have Diabetes or those who recently had to immobilize their shoulder for a long period, such as after surgery or an arm fracture.

RISK FACTORS
Certain factors may increase your risk of developing Frozen shoulder.

Age and s*x
People 40 and older, particularly women, are more likely to have Frozen shoulder.

Immobility or reduced mobility
People who've had prolonged immobility or reduced mobility of the shoulder are at higher risk of developing Frozen shoulder. Immobility may be the result of many factors, including:

Rotator cuff injury
Broken arm
Stroke
Recovery from surgery
Systemic diseases
People who have certain diseases appear more likely to develop Frozen shoulder. Diseases that might increase risk include:

Diabetes
Overactive thyroid (Hyperthyroidism)
Underactive thyroid (Hypothyroidism)
Cardiovascular disease
Tuberculosis
Parkinson's disease
PREPARING FOR YOUR APPOINTMENT
While you might first consult your family physician, he or she may refer you to a doctor who specializes in orthopedic medicine.

What you can do
Before your appointment, you may want to write down:

Detailed descriptions of your symptoms
Information about medical problems you've had
Information about the medical problems of your parents or siblings
All the medications and dietary supplements you take
Questions to ask the doctor
What to expect from your doctor
Your doctor may ask some of the following questions:

When did your symptoms begin?
Are there activities that worsen your symptoms?
Have you ever injured that shoulder? If so, how?
Do you have Diabetes?
Have you had any recent surgeries or periods of restricted shoulder motion?
TESTS AND DIAGNOSIS
During the physical exam, your doctor may ask you to move in certain ways to check for pain and evaluate your range of motion (active range of motion). Your doctor might then ask you to relax your muscles while he or she moves your arm (passive range of motion). Frozen shoulder affects both active and passive range of motion.

In some cases, your doctor might inject your shoulder with a numbing medicine (anesthetic) to determine your passive and active range of motion.

Frozen shoulder can usually be diagnosed from signs and symptoms alone. But your doctor may suggest imaging tests — such as X-rays or an MRI — to rule out other problems.

TREATMENTS AND DRUGS
Most Frozen shoulder treatment involves controlling shoulder pain and preserving as much range of motion in the shoulder as possible.

Medications
Over-the-counter pain relievers, such as aspirin and ibuprofen (Advil, Motrin IB, others), can help reduce pain and inflammation associated with Frozen shoulder. In some cases, your doctor may prescribe stronger pain-relieving and anti-inflammatory drugs.

Therapy
A physical therapist can teach you range-of-motion exercises to help recover as much mobility in your shoulder as possible. Your commitment to doing these exercises is important to optimize recovery of your mobility.

Surgical and other procedures
Most Frozen shoulders get better on their own within 12 to 18 months. For persistent symptoms, your doctor may suggest:

Steroid injections. Injecting corticosteroids into your shoulder joint may help decrease pain and improve shoulder mobility, especially in the early stages of the process.
Joint distension. Injecting sterile water into the joint capsule can help stretch the tissue and make it easier to move the joint.
Shoulder manipulation. In this procedure, you receive a general anesthetic, so you'll be unconscious and feel no pain. Then the doctor moves your shoulder joint in different directions, to help loosen the tightened tissue.
Surgery. Surgery for Frozen shoulder is rare, but if nothing else has helped, your doctor may recommend surgery to remove scar tissue and adhesions from inside your shoulder joint. Doctors usually perform this surgery with lighted, tubular instruments inserted through small incisions around your joint (arthroscopically).
LIFESTYLE AND HOME REMEDIES
One of the most common causes of Frozen shoulder is the immobility that may result during recovery from a shoulder injury, Broken arm or a Stroke. If you've had an injury that makes it difficult to move your shoulder, talk to your doctor about exercises you can do to maintain the range of motion in your shoulder joint.

ALTERNATIVE MEDICINE
Acupuncture
Acupuncture involves inserting extremely fine needles in your skin at specific points on your body. Typically, the needles remain in place for 15 to 40 minutes. During that time they may be moved or manipulated. Because the needles are hair thin and flexible and are generally inserted superficially, most acupuncture treatments are relatively painless.

Transcutaneous electrical nerve stimulation (TENS)
A TENS unit delivers a tiny electrical current to key points on a nerve pathway. The current, delivered through electrodes taped to your skin, isn't painful or harmful. It's not known exactly how TENS works, but it's thought that it might stimulate the release of pain-inhibiting molecules (endorphins) or block pain fibers that carry pain impulses

05/06/2023

Normal Gait Phases.

05/06/2023

05/06/2023

For appointment
Contact # 051-8779111
Islamabad specialized hospital
PD-128, main stadium double road r
Rawalpindi.

29/05/2023

Upper crossed syndrome(UCS) and Lower crossed syndrome(LCS) with their presenting postures.

28/05/2023

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Lordosis is a medical condition characterized by an excessive inward curvature of the lower spine, leading to a pronounced arch in the back. While the spine naturally has a slight inward curve, an exaggerated or abnormal curvature can cause various symptoms and complications.

There are several factors that can contribute to the development of lordosis. One common cause is poor posture, particularly habits like slouching or sitting with an excessive arch in the lower back.

Prolonged periods of poor posture can strain the muscles and ligaments supporting the spine, leading to an abnormal curvature.

In some cases, lordosis may be associated with underlying conditions such as obesity, osteoporosis, or certain neuromuscular disorders.

In these instances, the abnormal curvature is often a secondary symptom of the underlying condition.

The symptoms of lordosis can vary depending on the severity of the curvature.

Mild cases may not cause any noticeable symptoms, while more severe cases can result in lower back pain, muscle stiffness, and difficulty in maintaining a neutral standing or sitting position.

Treatment for lordosis depends on the underlying cause and the severity of the curvature.

It typically involves a combination of interventions, including physical therapy, exercises to strengthen weak muscles and stretch tight ones, pain management techniques, and lifestyle modifications to improve posture and body mechanics.

In severe cases, where conservative measures do not provide relief, surgical intervention may be considered to correct the curvature and alleviate symptoms.

However, surgery is generally reserved for rare cases and is not the first-line treatment option.

24/05/2023

Hyperextended knee.(Genu Recurvatum)
A hyperextended knee is an injury that happens when your knee is bent backward beyond its usual limit. Sports injuries and other traumas apply a lot of force to your knee's connective tissue (the tendons, ligaments and cartilage that hold it in place and help it move).

Symptoms.
Pain.
Swelling.
Trouble moving your knee like you usually can.
Instability or feeling like your knee is weaker than usual.
Bruising or discoloration.

Causes.
Most hyperextensions are caused during sports or other physical activities. Traumas like falling can also cause your knee to hyperextend. Anything that forces your knee backward can cause a hyperextended knee.

Test.
Stand in front of a full-length mirror and turn to the side. Take a look at your legs; are both legs straight and even, or does one knee dip back a bit farther than the other? It may be subtle and something you've not noticed before, or it may be more pronounced and something you've been concerned about.

Treatment.
Rest: Avoid the activity that caused your injury. ...
Ice: Apply a cold compress to your knee for 15 minutes at a time, four times a day.
Compression: You can wrap your knee in an elastic bandage to help reduce swelling.

Exercises.
swimming.
gentle hamstring stretches.
stationary bike.
straight leg raises.
wall sits.
lateral step-up.
quad sets — strengthening the quads (thigh muscles) by contracting, holding and releasing the muscles, placing a rolled towel under the knee for support if lying down.

Brace.
managing a hyperextending knee. In the case of quadriceps weakness which will not regain full strength, a specific knee orthosis to prevent hyperextension is a good option.

Surgery.
It's rare to need surgery after a hyperextended knee. However, if the injury that caused your hyperextension damaged tendons like your ACL or PCL, you might need surgery to repair those tears. Most of the time, surgery to repair damage in your knees is an outpatient procedure, which means you can go home the same day

22/05/2023

Office Syndrome

Office Syndrome caused by the use of certain muscles incorrectly according to the body or Using the same muscles repeatedly For a long time continuously, such as tensing the neck, sitting in front of the computer for a long time Lifting things in the same position for a long time, etc.

The cause of office syndrome is when the muscles in the neck, shoulders, and shoulders contract and do not relax. until it becomes a lump (trigger point), causing the blood and oxygen to be unable to circulate easily The patient will begin to have pain or stiffness in the neck, shoulders and shoulders, and if left without proper treatment. The body will begin to create a thick membrane to cover up. As a result, the muscles in that area become inflamed, causing more pain.

If the fascia that attaches to the adhesion begins to spread to squeeze the surrounding nerves Patients will begin to have symptoms of abnormalities in that nerve, for example, they may have pain that spreads up to the ear, jaw, jaw, eye socket, head, or spreads down the arms and chest, causing chest tightness, shortness of breath, and difficulty breathing for unknown reasons.

If not treated properly Office syndrome can develop into Cervical sciatic nerve condition This is because the fascia will begin to hold on and pull back to the cervical vertebra in that area. deformed and to crush nearby nerves This results in pain in the arm, numbness in the arm, and eventually weakness in the arm.

09/05/2023

POPPING AND GRINDING SOUND FROM THE NECK

Crepitus is a medical term used for a popping or grinding sound that sometimes comes from various parts of the body especially the foot and the neck. This grinding sound is caused due to rubbing of two bones against each other. If this grinding sound is heard frequently from the joints then it is a sign of arthritis.

When this grinding, popping or cracking sound is heard from the neck then it is called as Neck Crepitus. This is quite a common phenomenon and is a sign that the person has arthritis. Arthritis of the neck is a medical condition in which there is wearing out of the bones of the neck making them stiff and resulting in pain and popping of the joints.

Neck Crepitus is usually seen in older adults and is a rare phenomenon in youngsters. Neck Crepitus is not a medical condition and is just a symptom of an underlying condition thus treatment is aimed at the underlying cause of Neck Crepitus.

CAUSES

There can be numerous causes for Neck Crepitus or grinding sound from neck. If an individual experiences occasional popping of the neck then it is not a cause for concern as it is a natural thing. Such type of crepitus does not pose any threat to the joints.

The problem starts when Neck Crepitus is associated with pain and restricts movement of the neck which may suggest some underlying issues with the cervical spine. The most common cause for Neck Crepitus or the grinding sound from neck is osteoarthritis of the cervical spine. Osteoarthritis is a medical condition in which the cartilage which acts as cushion between the vertebrae is worn out due to age and stress and strain of everyday use. Hence Neck Crepitus is usually seen in people above the age of 50. Neck Crepitus is normally audible when the individual moves the neck. The patient may also experience pain and have restricted motion of the neck. The neck also becomes stiff.

TREATMENT

Treating Neck Crepitus depends on the cause of it. If the crepitus in the neck or the grinding sound from neck is caused due to arthritis then treatment of arthritis is done but the concerning fact is the restricted range of motion along with pain and stiffness of neck. In case if the patient experiences weakness or other neurologic symptoms in the upper extremities then it might suggest potentially more serious condition in the cervical spine.

If Neck Crepitus is caused due to forceful motion of the neck while lifting something up or due to sudden motion of the neck then it is not a cause of concern and it does not require any sort of treatment.

In case of pain with Neck Crepitus, gentle massage of the neck is recommended which facilitates neck motion and also decreases tension in the neck muscles.Sometimes a cervical collar or a brace is also quite effective in controlling the symptoms caused by Neck Crepitus or getting rid of grinding sound from neck.

01/05/2023

🔴 Patellofemoral Pain Syndrome

✅ Patellofemoral Pain Syndrome (PFPS) is an umbrella term used for pain arising from the patellofemoral joint itself, or adjacent soft tissues.

✅ PFPS can be due to a patellar trauma, but it is more often a combination of several factors (multifactorial causes) including :
🔹 Overuse and overload of the patellofemoral joint
🔹Anatomical or biomechanical abnormalities
🔹Muscular weakness
🔹 Imbalance or dysfunction

✅ Clinical Presentation
Complain of anterior knee pain that is aggravated by activities that increase patellofemoral compressive forces such as:
🔹Ascending /descending stairs
🔹Sitting with knees bent
🔹 Kneeling &
🔹 Squatting

✅ Diagnostic Procedures
The American Physical Therapy Association made the following criteria for the diagnosis of PFPS

1️⃣ Presence of retropatellar or peripatellar pain.
2️⃣ Reproduction of retropatellar or peripatellar pain during squatting, or other functional activities loading the PFJ in a flexed position.
3️⃣ All other conditions that could cause anterior knee pain, such as tibiofemoral pathologies, should be excluded.

✅Subjective FindingPossible Clinical Reasoning
🔹Insidious Onset - Typical of PFPS
🔹Overload event eg excessive stair climbing, longer distance - Typical of PFPS
🔹Traumatic incident - Unlikely to be PFPS

✅ Patterns of Pain
🔹Pain only during activity - Think biomechanics
🔹Pain only after activity especially much later or next day - Think inflammatory
🔹Pain that improves with exercise - Think tendon/ muscle length

✅ Clinical Signs
Researches suggest following criteria for diagnosis of patellofemoral pain syndrome

1️⃣ Both pain on muscle contraction and pain on squatting are present
2️⃣ 2 out of 3 of the following are present - pain on muscle contraction and/or pain on squatting and/or pain on palpation
3️⃣ 3 out of 3 are present - pain on muscle contraction, pain on squatting and pain on kneeling

🔴Physical Therapy Management🔴

1️⃣ Strengthening of the Quadriceps

▪️ Straight-leg exercise Patient lies on his back, one knee bent at +/- 90° (! pain-free if that knee is affected by PFPS) and foot flat on the ground. The other knee is fully extended. Patient elevates extended leg and holds it for 10secs, before relaxing (concentric contraction and/or eccentric contraction is also possible, which makes it dynamic). Control that Patient keeps a normal lumbar lordosis and does not compensate with his basin.

▪️ Pillow squeeze exercise Patient sits comfortable with his trunk supported. Both knees extended. Place a pillow (or towel) under one knee (that knee might be slightly flexed). Patient tries to push the pillow/towel in the table by extending his or her knee. (Quadriceps contraction).

2️⃣ Closed kinetic chain exercises (CKC) VS Open kinetic chain (OKC) exercises

▪️ Squats; be sure that the patient’s knee doesn’t come farther than his toes. Once his knee passes his toes, the stress on his patellofemoral-joint become too high and might provoke pain. (Exercises should be practiced within this range and pain-free.)

3️⃣ Vastus medialis obliquus
4️⃣ Hip muscles training
5⃣ Proprioceptive training

6⃣ Electrotherapy

🔹In case of neuromuscular disbalance between the VMO and VL, electrical stimulation of the VMO should be considered to complement the conservative (exercises) therapy.

🔹The patient sits with the trunk supported extended legs with slight knee flexion and lower limb muscles completely relaxed. Following parameters were used in research (isometric contraction of the VMO).

▪️ Electrode placing = 1 on the motor point and the other one next to it.
▪️ Asymmetric bipolar current
▪️ Pulse width = 0.5 milliseconds
▪️ Pulse frequency = 50Hz
▪️ Intensity = max. the patient can endure without pain
▪️Time = 7 minutes => 6 repetitions, on for 6 seconds and off for twelve, and progressed to 30 minutes, 11 repetitions, on for 10 seconds and off for 12sec.

7️⃣ Foot Orthoses

▪️ In research prefabricated orthoses were used; made of ethylene-vinyl acetate of medium density (Shore A 55), containing built-in arch supports and 4-varus rearfoot wedging. Prefabricated foot orthoses significantly enhanced functional performance in individuals with PFPS after 12 weeks.