Recovery Spine & Joints Clinic

14/02/2026

🔹 Hip Mobility & Piriformis Release
For Sciatic Pain Relief

Tight hips especially the piriformis muscle can irritate the sciatic nerve, leading to pain that travels from your lower back down your leg.

The goal of these exercises:
👉 Reduce hip tightness
👉 Relieve pressure on the sciatic nerve
👉 Help pain move from the leg back toward the hip (a good sign of improvement)

✅ Exercises to Improve Hip Mobility

1️⃣ Figure-4 Stretch (Supine)
Lie on your back
Cross one ankle over the opposite knee
Pull the bottom leg toward your chest
Hold 20–30 seconds per side
Targets: Piriformis & deep hip rotators

2️⃣ Seated Piriformis Stretch
Sit upright in a chair
Cross one ankle over the opposite knee
Gently lean forward with a straight back
Hold 20–30 seconds per side
Targets: Glutes & piriformis

3️⃣ Half-Kneeling Hip Flexor Stretch
Kneel on one knee, other foot forward
Gently shift hips forward
Keep chest tall and core engaged
Hold 20–30 seconds per side
Targets: Hip flexors (tight hip flexors can worsen sciatic symptoms)

4️⃣ 90/90 Hip Rotation
Sit with both knees bent at 90°
Rotate knees side to side in control
Move slowly and stay tall
Targets: Hip internal & external rotation mobility

⚠️ Important:

Stop immediately if you feel:
🔥Sharp pain
🔥Increased numbness
🔥Tingling that worsens
🔥Mild stretching discomfort is okay nerve pain

14/02/2026

Rough estimate of Healing time of various injuries.

14/02/2026

The human body is composed of approximately 60% water, forming the foundation of cells, blood, and bodily fluids.
Proteins make up about 16–20%, building muscles, organs, skin, enzymes, and structural tissues.
Fats account for roughly 10–25%, serving as stored energy, insulation, and key components of cell membranes.
Minerals contribute around 4–6%, primarily strengthening bones and teeth while supporting essential physiological functions.
Carbohydrates (~1%) and nucleic acids with other trace molecules (

14/02/2026

Love Your Spine This Valentine’s 💝

This Valentine’s Day, show your spine a little love.

Whether you are celebrating with someone special or taking time for yourself, your spinal health matters too.

Today could be a good moment to:

🧡 Do some gentle movements that feel safe and supportive
🧡 Rest without guilt when your body asks for it
🧡 Acknowledge the strength it takes to manage your condition every single day

Your spine carries you through life. It deserves care, patience and kindness.

13/02/2026

13/02/2026

ARTERIAL BLOOD GASES

1️⃣ What Are ABGs?
ABGs measure:
Acid–base balance
Ventilation (CO₂ removal)
Oxygenation

They tell you:
Is the patient ventilating properly?
Is the patient oxygenating properly?
Is the body compensating?
ABGs are drawn from an artery (radial most common).

2️⃣ Normal ABG Values
| Parameter | Normal Range | What It Reflects
pH 7.35–7.45 Acid–base status
PaCO₂ 35–45 mmHg Respiratory (lungs)
HCO₃⁻ 22–26 mEq/L Metabolic (kidneys)
PaO₂ 80–100 mmHg Oxygenation
SaO₂ 95–100% Oxygen saturation

CO₂ = Acid. HCO₃⁻ = Base

3️⃣ ABG Interpretation
1: Look at pH
The pH tells you if the blood is acidic or alkaline.
Normal pH:
7.35 – 7.45
Think of it like a number line:
7.35 ← NORMAL → 7.45
If pH is Less Than 7.35:
The patient is in ACIDOSIS
That means the blood is too acidic.
Example:
pH = 7.28 → Acidosis
pH = 7.30 → Acidosis
If pH is Greater Than 7.45:
The patient is in ALKALOSIS
That means the blood is too alkaline (basic).
Example:
pH = 7.50 → Alkalosis
pH = 7.48 → Alkalosis

2: Look at PaCO₂ (Respiratory)
High CO₂ (>45) → Respiratory acidosis
Low CO₂ (

13/02/2026

Children are not born with fully developed kneecaps.
Instead, their kneecaps are made of soft cartilage that does not show up on X-rays.
Around the age of three to five, this cartilage slowly begins to harden into bone through a process called ossification.
The kneecap continues developing throughout childhood and adolescence.
By the late teenage years, it becomes fully formed and strong.

13/02/2026

🧠 Adhesive Capsulitis (Frozen Shoulder): A Clinical & Rehabilitation Perspective

Adhesive Capsulitis is a chronic, self-limiting fibro-inflammatory disorder of the glenohumeral joint capsule, characterized by progressive pain and global restriction of both active and passive range of motion (ROM).

🔬 Pathophysiology

Initial synovial inflammation (synovitis)

Capsular hypervascularity

Fibroblast proliferation

Collagen deposition (Type I & III)

Capsular thickening and contracture (especially rotator interval & inferior capsule)

Reduced capsular volume (normal ≈ 28–35 ml → significantly decreased)

🔎 Histologically resembles Dupuytren’s contracture.

Key structure involved:
✔ Coracohumeral ligament thickening
✔ Rotator interval fibrosis
✔ Inferior glenohumeral ligament contracture

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📊 Epidemiology & Risk Factors

Prevalence: ~2–5% in general population

Up to 20% in diabetic patients

Age: 40–60 years

Female predominance

Strong association with:

Diabetes Mellitus

Thyroid disorders

Prolonged immobilization

Post-trauma

Post-cardiac or neurological events

⚠ Diabetic patients show more severe stiffness and poorer prognosis.

📌 Clinical Presentation

Pain Characteristics:

Insidious onset

Diffuse, poorly localized shoulder pain

Night pain (hallmark feature)

Pain aggravated by end-range movements

ROM Limitation:

Restriction of both active and passive ROM

Capsular Pattern:

External Rotation > Abduction > Internal Rotation

External rotation is typically the earliest and most severely restricted movement.

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🧭 Staging (Neviaser Classification)

1️⃣ Freezing Phase (Painful Phase)

Duration: 2–9 months

Synovitis predominant

Progressive pain

Gradual ROM limitation

2️⃣ Frozen Phase (Adhesive Phase)

Duration: 4–12 months

Pain reduces

Marked stiffness

Capsular fibrosis dominant

3️⃣ Thawing Phase (Resolution Phase)

Duration: 6–24 months

Gradual restoration of mobility

Minimal pain

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🩻 Diagnosis

Primarily clinical.

Imaging:

X-ray: Usually normal (to rule out OA, calcific tendinitis)

MRI: Capsular thickening (>4 mm), reduced axillary recess volume

Ultrasound: Coracohumeral ligament thickening

Differential Diagnosis:

Rotator cuff tear

Glenohumeral osteoarthritis

Subacromial impingement

Cervical radiculopathy

💊 Management Protocol

1️⃣ Pharmacological

NSAIDs

Intra-articular corticosteroid injection (early phase beneficial)

Glycemic control in diabetic patients

Hydrodilatation may be considered in selected cases.

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🏥 Physiotherapy Management (Stage-Specific)

🔹 Painful Stage:

Patient education

Activity modification

Grade I–II joint mobilizations

Pendulum exercises

TENS / IFT

Gentle passive ROM within pain-free range

⚠ Avoid aggressive stretching in acute inflammatory phase.

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🔹 Stiff Stage:

Grade III–IV mobilizations (posterior & inferior glide)

Sustained capsular stretching

End-range mobilization techniques

Wand & pulley exercises

PNF techniques

Scapular mobilization

Evidence supports combined mobilization + stretching for optimal outcomes.

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🔹 Recovery Phase:

Progressive strengthening

Rotator cuff strengthening

Scapular stabilizers (serratus anterior, lower trapezius)

Functional retraining

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📈 Prognosis

Often described as self-limiting, but up to 30–40% may have residual stiffness.

Early intervention improves functional recovery.

Diabetic patients may experience prolonged course.

🎯

12/02/2026

🪑 Office Ergonomics for Lower Back Pain Prevention

🧠 Why Desk Setup Matters

If you sit for 6–10 hours a day, your workstation can either protect your spine or slowly overload it.

Poor desk ergonomics can lead to:
🔴 Forward head posture
🔴 Rounded shoulders
🔴 Increased lumbar disc pressure
🔴 Muscle fatigue and stiffness
🔴 Sciatic-type symptoms

Proper desk setup helps:
🔵 Maintain a neutral spine
🔵 Reduce lumbar strain
🔵 Improve circulation
🔵 Prevent long-term disc stress
🔵 Support better posture habits

🔴 Poor Desk Setup vs 🔵 Correct Desk Setup

❌ Poor Desk Setup
• Slouched posture
• Head pushed forward
• Rounded shoulders
• Monitor too low
• Feet not supported
• Lower back unsupported

Result: Increased spinal compression and muscle fatigue.

✅ Correct Desk Setup
• Neutral spine
• Monitor at eye level
• Shoulders relaxed
• Elbows at 90°
• Feet flat on floor or footrest
• Lumbar support engaged

Result: Reduced lumbar strain and improved posture endurance.

🖥️ Desk Setup Breakdown
✔️ Monitor at Eye Level
Top of screen aligned with eye height to avoid neck strain.
✔️ Elbows at 90 Degrees
Forearms parallel to floor, shoulders relaxed.
✔️ Lumbar Support in Chair
Natural curve of lower back supported.
✔️ Feet Flat on Floor or Footrest
Prevents pelvic tilting and lower back overload.
✔️ Knees at Hip Level

Hips slightly higher than knees helps maintain neutral spine.
Small adjustments can significantly reduce disc pressure.

⏱ Quick Fix Routine (Movement Breaks)

Even perfect posture fails if you don’t move.
1️⃣ Seated Spinal Extension
Gently arch upper back and open chest for 5–10 seconds.

2️⃣ Standing Back Extension Break
Stand up, place hands on hips, gently lean back.

3️⃣ Shoulder Blade Squeeze
Pull shoulder blades together for 10 reps.
These micro-breaks improve circulation and reset posture.

🎯 Goal
Reduce Lumbar Strain & Improve Posture
Consistency beats perfection.

🚨 Important Reminder
Take a movement break every 30–60 minutes.
Your spine needs motion.

12/02/2026

Wearing a necktie too tightly can impede blood flow to the brain, leading to a decrease of up to 7.5%. This restriction occurs due to pressure on the jugular veins, which hinder the proper drainage of blood from the brain. As blood flow becomes restricted, oxygen delivery to the brain is compromised, potentially leading to dizziness, headaches, and even cognitive impairment in extreme cases. Neuroradiology studies have shown that constricting the neck can cause changes in the brain's vascular system, emphasizing the importance of avoiding tight neckwear. Research from neuroradiology sources highlights the risks, urging caution to promote better brain health.

12/02/2026

Benefits of Quadriceps Isometric Exercise
• Reduces Knee Pain
Helps decrease stress on the knee joint, especially in arthritis and knee injury.
• Improves Knee Stability
Strengthens quadriceps to support and protect the knee.
• Prevents Muscle Wasting
Maintains thigh muscle strength during rest or recovery.
• Safe for Early Rehab
No joint movement → minimal strain, perfect after injury or surgery.
• Improves Daily Activities
Makes walking, standing, and climbing stairs easier.

Simple, safe, and highly effective knee-strengthening exercise

12/02/2026

Keeping your blood pressure in check is important for your health. If it’s too high, your blood pressure can lead to serious conditions like stroke or heart disease.

While medications like beta-blockers can help lower your blood pressure, did you know that you can also eat certain foods to help lower blood pressure?

Antioxidant-rich foods may have a small impact on blood pressure levels. Foods high in vitamin C, vitamin E, potassium, selenium or L-arginine are good options if you’re looking to lower your blood pressure. Antioxidants protect your cells from damage and can reduce inflammation, which, in turn, can keep blood pressure managed.