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Dr Sahil physiotherapist, Peshawar (2026)

26/10/2025

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*🧠 NERVE INJURIES & THEIR CLINICAL SIGNS 🔍 | Physio Guide*
Physiotherapists play a *key role in diagnosing and managing* nerve injuries. Understanding nerve-specific signs is crucial for targeted rehab. Here's a quick overview:

✅ *Radial Nerve* ➡️ *Wrist Drop*
Loss of wrist & finger extension. Often due to humeral fractures.
*💪 Rehab*: Splinting, strengthening extensors, e-stim.

✅ *Median Nerve* ➡️ *Carpal Tunnel Syndrome*
Numbness/tingling in thumb, index, middle fingers.
*💪 Rehab*: Nerve gliding, wrist splints, ergonomic correction.

✅ *Ulnar Nerve* ➡️ *Claw Hand*
Loss of fine motor control, 4th-5th fingers deformity.
*💪 Rehab*: Hand therapy, splinting, sensory re-education.

✅ *Long Thoracic Nerve* ➡️ *Winging of Scapula*
Serratus anterior paralysis. Scapula protrudes during arm movement.
*💪 Rehab*: Scapular stability, serratus strengthening.

✅ *Peroneal Nerve* ➡️ *Foot Drop*
Inability to dorsiflex foot. Risk of falls.
*💪 Rehab*: AFO brace, gait training, dorsiflexor strengthening.

✅ *Sciatic Nerve* ➡️ *Sciatica*
Shooting pain down the leg. Usually from disc herniation.
*💪 Rehab*: Neural mobilization, core strengthening, postural training.

✅ *Femoral Nerve* ➡️ *Femoral Nerve Palsy*
Weakness in hip flexion, knee extension.
*💪 Rehab*: Quad strengthening, balance training.

✅ *Upper Trunk (Brachial Plexus)* ➡️ *Erb’s Palsy*
Common in birth injuries. Arm held in "waiter’s tip" position.
*💪 Rehab*: ROM, motor re-ed, functional play therapy.

✅ *Lower Trunk* ➡️ *Klumpke’s Paralysis*
Affects hand muscles, may show "claw hand" + Horner's syndrome.
*💪 Rehab*: Fine motor training, sensory work, splints.

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*🧠 Early physiotherapy = Faster recovery!*
Tag someone studying neuro or physio 💡
Stay strong, stay moving 💪

--- follow Dr Sahil physiotherapist

25/10/2025

🔈 WHAT IS UPPER CROSS SYNDROME?

Upper Cross Syndrome (UCS) is a common postural imbalance that affects the neck, shoulders, and upper back. It occurs when certain muscles in the upper body become tight and overactive, while others become weak and underactive, forming a characteristic “X” or “cross” pattern of imbalance — hence the name Upper Cross.

This condition is often seen in people who spend long hours sitting, using computers or mobile phones, or maintaining poor posture (like rounded shoulders and a forward head). Over time, these muscular imbalances can cause pain, stiffness, and movement restrictions in the neck, shoulders, and upper back.

💡 Typical Symptoms of Upper Cross Syndrome Include:

➡️ Forward head posture
➡️ Rounded shoulders and hunched upper back
➡️ Neck pain and stiffness
➡️ Shoulder pain or tightness across the chest
➡️ Headaches (especially tension-type)
➡️ Pain or burning between the shoulder blades
➡️ Reduced shoulder movement or weakness in the arms
➡️ Fatigue and discomfort after sitting for long periods

💡 What Causes Upper Cross Syndrome?

UCS develops gradually due to poor posture and muscle imbalance. Repetitive or static postures lead to certain muscles becoming overused while others weaken.

🧩 The pattern looks like this:

Tight/Overactive Muscles:
➡️ Upper Trapezius
➡️ Levator Scapulae
➡️ Pectoralis Major and Minor

Weak/Inhibited Muscles:
➡️ Deep Neck Flexors
➡️ Lower Trapezius
➡️ Serratus Anterior
➡️ Rhomboids

These imbalances form an “X” when viewed from the side — tightness in the upper back and chest crossing over weakness in the deep neck and mid-back muscles.

💡 Common Causes and Contributing Factors:

➡️ Poor sitting or standing posture
➡️ Long hours on computer or mobile phones (“tech neck”)
➡️ Sedentary lifestyle and lack of physical activity
➡️ Driving or desk jobs requiring forward leaning
➡️ Weak core and upper back muscles
➡️ Stress and fatigue (which increase shoulder tension)

💡 Treatment for Upper Cross Syndrome

The main goal of treatment is to restore muscle balance, improve posture, and relieve pain. Physiotherapy plays a key role in correcting these issues through stretching, strengthening, and postural training.

🩺 Physiotherapy Management Includes:

➡️ Stretching of Tight Muscles

Pectoralis Major and Minor

Upper Trapezius

Levator Scapulae

➡️ Strengthening of Weak Muscles

Deep Neck Flexors (chin tucks)

Lower Trapezius and Rhomboids

Serratus Anterior

➡️ Postural Correction and Awareness Training

Ergonomic advice for computer/mobile use

Sitting and standing posture retraining

➡️ Manual Therapy Techniques

Myofascial release and trigger point therapy

Joint mobilization of the cervical and thoracic spine

➡️ Electrotherapy and Heat Therapy

For pain and muscle relaxation

➡️ Core and Scapular Stabilization Exercises

To improve upper body alignment and shoulder stability

➡️ Home Exercise Program

Regular stretching and strengthening to maintain correction

22/10/2025

Carpal Tunnel Syndrome (CTS) is one of the most misdiagnosed conditions in medicine. Nerve conduction studies may find poor nerve flow to the fingers, but it can be caused by the neck, brachial plexus, and elbow rather than the carpal tunnel. That is why the surgery is so unsuccessful in the long run. NKT often finds the median nerve impinged in the lower cervicals, brachial plexus, and cubital tunnel. This blog highlights these relationships and more.

01/10/2025

Muscles have several vital functions in the human body. Skeletal muscles, like the one in your diagram, mainly serve the following roles:

1. Movement
• Muscles contract and pull on bones through tendons, producing voluntary movements such as walking, running, writing, or speaking.
• They also allow for facial expressions and eye movements.

2. Posture & Stability
• Even when not actively moving, muscles maintain a constant low-level contraction (muscle tone) to stabilize joints and help us stand, sit, and balance.

3. Heat Production (Thermogenesis)
• Muscle contractions generate heat as a byproduct, helping maintain body temperature (e.g., shivering increases heat).

4. Support & Protection
• Muscles support soft tissues (like abdominal muscles supporting organs) and act as a protective layer.
• They also regulate pressure in body cavities.

5. Control of Openings (Sphincters)
• Circular muscles (e.g., around the mouth, a**s, urinary bladder) control entry and exit of substances in the body.

6. Blood & Fluid Circulation Assistance
• Skeletal muscles, especially in the legs, help pump blood back to the heart (muscle pump action).
• They also aid in moving lymph through lymphatic vessels.

30/09/2025

HIP JOINT

The hip joint is a ball and socket synovial joint, formed by an articulation between the pelvic acetabulum and the head of the femur.

ARTICULATING SURFACES
The hip joint consists of an articulation between the head of femur and acetabulum of the pelvis.

The acetabulum is a cup-like depression located on the inferolateral aspect of the pelvis. Its cavity is deepened by the presence of a fibrocartilaginous collar – the acetabular labrum.

The head of femur is hemispherical, and fits completely into the concavity of the acetabulum.

Both the acetabulum and head of femur are covered in articular cartilage, which is thicker at the places of weight bearing.

The capsule of the hip joint attaches to the edge of the acetabulum proximally. Distally, it attaches to the intertrochanteric line anteriorly and the femoral neck posteriorly.

LIGAMENTS

The ligaments of the hip joint act to increase stability. They can be divided into two groups – intracapsular and extracapsular:

INTRACAPSULAR
The only intracapsular ligament is the ligament of head of femur. It is a relatively small structure, which runs from the acetabular fossa to the fovea of the femur.

It encloses a branch of the obturator artery (artery to head of femur), a minor source of arterial supply to the hip joint.

EXTRACAPSULAR
There are three main extracapsular ligaments, continuous with the outer surface of the hip joint capsule:

✅Iliofemoral ligament – arises from the anterior inferior iliac spine and then bifurcates before inserting into the intertrochanteric line of the femur.
It has a ‘Y’ shaped appearance, and prevents hyperextension of the hip joint. It is the strongest of the three ligaments.

✅Pubofemoral – spans between the superior p***c rami and the intertrochanteric line of the femur, reinforcing the capsule anteriorly and inferiorly.
It has a triangular shape, and prevents excessive abduction and extension.

✅Ischiofemoral– spans between the body of the ischium and the greater trochanter of the femur, reinforcing the capsule posteriorly.
It has a spiral orientation, and prevents hyperextension and holds the femoral head in the acetabulum.

NEUROVASCULAR SUPPLY

The arterial supply to the hip joint is largely through the medial and lateral circumflex femoral arteries – branches of the profunda femoris artery (deep femoral artery). They anastomose at the base of the femoral neck to form a ring, from which smaller arteries arise to supply the hip joint itself.

The medial circumflex femoral artery is responsible for the majority of the arterial supply (the lateral circumflex femoral artery has to pe*****te through the thick iliofemoral ligament). Damage to the medial circumflex femoral artery can result in avascular necrosis of the femoral head.

The artery to head of femur and the superior/inferior gluteal arteries provide some additional supply.

The hip joint is innervated primarily by the sciatic, femoral and obturator nerves. These same nerves innervate the knee, which explains why pain can be referred to the knee from the hip and vice versa.

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30/09/2025

Grades of Disc Degeneration on MRI

🔹 Grade I

The disc is normal, well hydrated, and very bright on T2.

🔹 Grade II

Mild early changes, still bright on T2, nucleus clearly visible.

🔹 Grade III

Gray signal, moderate loss of hydration, unclear nucleus-annulus border.

🔹 Grade IV

Dark signal, significant dehydration, and reduced disc height.

🔹 Grade V

Collapsed disc, very dark signal, and severe degeneration

30/09/2025

Slump Test in Neurodynamic Assessment

🔶The Slump Test is a widely used neurodynamic test in physiotherapy to assess the mechanosensitivity of the nervous system, particularly the sciatic nerve and lumbosacral neural structures. It provides valuable insights in cases of lumbar disc pathology, radiculopathy, or neuropathic pain syndromes.
🔶 Procedure in brief:
The patient adopts a seated “slumped” position (thoracic and lumbar flexion), followed by cervical flexion, knee extension, and ankle dorsiflexion. Each stage progressively loads the neural tissue. Symptom reproduction, sensitization, or relief upon structural differentiation (e.g., releasing neck flexion) helps determine neural involvement.
🔶Why it matters:
Helps differentiate between neural pain vs. musculoskeletal pain.
Provides guidance for treatment planning in conditions such as sciatica, disc herniation, or nerve entrapment.
Supports early detection, allowing timely and targeted interventions.
🔷Physiotherapist’s Role:

🔹Clinical Reasoning: Integrating test findings with patient history, posture, and movement patterns.
🔹Differential Diagnosis: Distinguishing between neural tension vs. musculoskeletal or joint-related pain.
🔹Evidence-Based Intervention: Employing techniques such as neural mobilization, manual therapy, postural correction, and functional strengthening.
🔹Patient-Centered Education: Communicating results in an understandable manner and tailoring rehabilitation plans
🔹Prevention & Ergonomics: Guiding patients on strategies to reduce recurrence and optimize spinal health.
🔶The Slump Test is more than a diagnostic maneuver; when interpreted within a broader clinical framework, it enables physiotherapists to design precise, targeted, and effective rehabilitation strategies.

30/09/2025

Beyond Cartilage Erosion: The Complex Reality of Osteoarthritis

Osteoarthritis (OA) is often misunderstood as simply a wear-and-tear condition affecting the cartilage in our joints. However, the reality is far more complex. OA is also characterized by muscle imbalance and abnormal joint loading, which can significantly impact joint health and function.

The Muscle Imbalance Connection is as:

Weak quadriceps_Can lead to increased stress on the knee joint, exacerbating OA symptoms.

Tight IT band_Can cause abnormal tracking of the knee joint, leading to increased wear and tear.

Weak hip abductors_ Can result in poor hip

alignment, putting additional stress on the knee and other joints.

Weak calf muscles_ Can affect ankle stability and movement patterns, impacting joint health.

Physiotherapists play a crucial role in managing OA by addressing muscle imbalances and abnormal joint loading. Through targeted exercises and manual therapies, physiotherapists can help:

Strengthen weak muscles; Improving joint stability and reducing pain.

Stretch tight muscles; Enhancing flexibility and range of motion.

Improve joint mobility; Reducing stiffness and improving joint function.

Develop personalized exercise programs; Empowering individuals to take control of their joint health.

By acknowledging the complex nature of OA and addressing muscle imbalances and abnormal joint loading, we can work towards more effective management and treatment strategies. Let's shift the focus from just cartilage erosion to a more holistic approach to joint health.

30/09/2025

As a physiotherapist, treatment exercises for spondylosis, spondylitis, spondylolisthesis, and spondylolysis focus on alleviating pain, improving mobility, and strengthening the muscles that support the spine.Let's discuss one by one. >>>>

Spondylosis

Stretching exercises: Gentle stretching can help improve flexibility and reduce stiffness in the spine.

Strengthening exercises: Core strengthening exercises can help stabilize the spine and reduce pain.

Mobility exercises: Gentle mobilization techniques can help improve spinal mobility and reduce stiffness.

Spondylitis

Breathing exercises: Deep breathing exercises can help improve lung function and reduce stiffness in the chest and spine.

Stretching exercises: Gentle stretching can help improve flexibility and reduce stiffness in the spine.

Posture correction: Good posture can help reduce strain on the spine and improve breathing.

Spondylolisthesis

Core strengthening exercises: Strengthening the core muscles can help stabilize the spine and reduce pain.

Pelvic tilts: Pelvic tilts can help improve mobility and reduce stiffness in the lower back.

Stabilization exercises: Exercises that target the transverse abdominis muscle can help stabilize the spine.

Spondylolysis

Core strengthening exercises: Strengthening the core muscles can help stabilize the spine and reduce pain.

Hip and pelvic exercises: Strengthening the hip and pelvic muscles can help improve stability and reduce strain on the spine.

Modification of activities: Modifying activities to avoid exacerbating the condition can help reduce pain and promote healing.

These exercises can be modified to suit individual needs and abilities. A physiotherapist can work with patients to develop a personalized exercise program to manage symptoms and improve spinal health.

29/09/2025

✅ Hip imbalance, or a lateral pelvic tilt, occurs when one hip sits higher than the other and can stem from structural differences like leg length discrepancies or issues like scoliosis, but it's often caused by muscle imbalances, tight muscles from prolonged sitting, poor posture, and repetitive activities. Symptoms include a higher or lower hip appearance, pain in the hips, back, knees, or feet, and potentially a feeling of asymmetry when standing or walking. Treatment may involve physical therapy, which can provide strengthening and stretching exercises to correct imbalances.

❄️Causes of Hip Imbalance❄️

❇️ Leg Length Discrepancy: A significant difference in leg length can naturally cause one hip to appear higher.

❇️ Poor Posture: Daily habits of sitting or standing in a default position for extended periods can lead to some muscles tightening while others weaken.

❇️ Muscle Imbalances: Overuse or underuse of certain muscles can create an imbalance.

❇️ Repetitive Activities: Engaging in repetitive tasks, such as lifting or sports, can strain tendons and create muscle imbalances in the hips.

❇️ Structural Issues: Conditions like scoliosis can lead to an uneven pelvis.
Symptoms of Hip Imbalance

❇️ Visual Difference: One hip appears noticeably higher than the other.

❇️ Pain: You may experience pain in your hips, back, knees, or feet.

❇️ Stiffness and Tightness: Certain muscles in the hip and pelvic area may feel tight.

❇️ Altered Gait: You might notice yourself shifting weight or a general off feeling when you walk.

❇️ Weak Glutes: Weakness in the muscles of the buttocks can contribute to hip misalignment.

❄️Treatment and Management❄️

❇️ Physical Therapy: A physical therapist can diagnose the cause of the misalignment and recommend exercises to strengthen weak muscles and stretch tight ones.

❇️ Stretching and Strengthening Exercises: Targeted exercises can improve flexibility and restore muscle balance.

❇️ Posture Correction: Becoming more aware of your posture and correcting it can help prevent further imbalances.

29/09/2025

Understanding Posture and Alignment Issues.

-Common Postural lssues: Forward head posture,

rounded shoulders, kyphosis (hunchback), lordosis

(swayback), and scoliosis (lateral spinal curvature).

-Causes: Sedentary lifestyle, prolonged sitting, weak

Core muscles, tight hip flexors, p0or ergonomics, or

repetitive movements.

-Goals: Strengthen weak muscles (e.g., core, back,

glutes), lengthen tight muscles (e.g., chest, hip

flexors), and improve body awareness.

Therapeutic exercises focus on strengthening weak

muscles and stabilizing the spine and joints.

Perform these exercises 3-5 times per week, starting

with 1-2 sets of 10-15 reps, and progress as

tolerated.

Stretching helps lengthen tight muscles that

contribute to poor posture. Hold each stretch for

30-60 seconds, breathing deeply, and perform 2-3

rounds daily.

Massage therapy can release muscle tension, improve

circulation, and enhance body awareness.

Additional Tips:

Ergonomics:

Adjust your workspace: Keep your computer screen at

eye level, use a chair with lumbar support, and keep

feet flat on the ground.

Avoid slouching or crossing legs for long periods.

Movement Breaks: Stand, stretch, or walk for 1-2

minutes every 30-60 minutes of sitting.

therapy, alignment

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01/06/2025

Gout

Dr Sahil physiotherapist

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