Disc Herniation | Relieving your Back pain by Physiotherapy

If you suffer from back pain due to herniated disc and are afraid that you might have to live with it. Then it's time for you to relax and get ready to lead a quality life. You can return to your daily routine by availing of Physiotherapy services. Physiotherapy not only helps to enhance the healing process, but reduces pain, and also helps the patient to get back to normal function. This blog will throw some light on the herniated disc and its physiotherapy management.

 

What is a Herniated Disc?

The spine is made up of vertebrae, which are held next to each other by the disc. The disc is a combination of strong connective tissues, made of a strong outer layer, annulus fibrosus, and a gel-like center called nucleus pulposus. The disc may start to lose water content, which makes the disc less effective as a cushion. This may cause herniation through a crack in the outer layer. Disc herniation commonly occurs in the bottom two discs of the lumbar spine. A herniated disc can press on the nerves in the spine and might cause pain, numbness, tingling, or weakness of the leg.

 

Physiotherapy Management:

Physiotherapy management comprises of a number of therapies and techniques like:

 

Cold Therapy:

Herniated disc presses on the nerve in the spinal canal, which causes pain and inflammation along the spinal walls. Cold therapy is found to be effective for pain relief because it constricts the veins along the spine, slowing the circulation and reducing inflammation.

 

Heat therapy:

Heat therapy is a non-invasive pain relief therapy for muscle and joint pain. This therapy is used to promote blood flow, blood helps to heal the area by delivering extra oxygen and nutrients, it removes waste byproducts from muscle spasms reduces pain in the joints, relaxes tight muscles, tendons and ligaments.

 

Kinesio Tape:

Kinesio-tape is a latex-free tape that can be worn for days. Kinesio Tape is applied to the spinal area to facilitate the body's natural healing process while providing support and stability to muscles and joints without restricting the range of motion. It also helps to increase blood flow and reduce pressure on the nerves which helps to decrease pain (localized as well as radiating) and inflammation.

 

Ultrasonic Therapy:

Therapeutic Ultrasound helps to increase blood flow and reduce pain. It uses ultrasonic waves that pass into the skin causing a vibration of local tissues. This vibration causes deep heating in the area without any sensation of heat. As the vibrations created by the ultrasound pass through the soft tissue, this increases heat within the tissue, which in turn increases blood flow, reduces pain, relaxes muscles, increases the extensibility of connective tissues, promotes scar tissue breakdown, and improves flexibility.

 

Vasopneumatic Compression:

Vasopneumatic compression helps to accelerate recovery. It cycles ice-cold water and air through a sleeve which is placed around the affected part of the body. This integrated cold and compression therapy helps to reduce pain, swelling, muscle spasms and enhances lymphatic function and oxygenated blood flow.

 

Transcutaneous Electrical-stimulations:

Transcutaneous electrical stimulations use electrical currents that pass through the electrodes placed directly on the patient's skin. Transcutaneous electrical stimulations cause an increase in the blood flow to promote healing and reduce inflammation. Stimulation act on the pain gate to block the transmission of pain signals, it also causes muscle stimulation for neuromuscular re-education and strengthening.

 

Low-Level Laser Therapy:

Low power laser therapy is effective in the treatment of patients with acute cases of disc herniations. It speeds up the recovery process, decreases inflammation, and pain.

 

Spinal Traction:

Spinal traction is a form of decompression therapy, it helps to relieve pressure from the spine. This type of distraction can be performed with manual techniques as well as machines. Spinal traction is indicated for the treatment of herniated discs, it decompresses spinal discs and facet joints by utilizing traction, distraction, and body positioning.

 

Manual Therapy:

Manipulative treatment for disc herniation is found to be safe, effective, and seems to be as effective as other therapies. It leads to short-term pain relief when suffering from acute low back pain and has an effect similar to NSAIDs. It includes techniques like spinal mobilization, spinal manipulation, massage, myofascial release, etc.

 

Stretching Exercises:

Stretching exercises are included in the treatment plan to decrease soft tissue tightness and improve posture to balance the forces placed on the spine.

 

Strengthening Exercises:

The spine is supported by strong muscles and thus can better handle pain. Core muscle stability is important to regain strength and power. Strengthening exercises help the patient to regain functionality.

 

Treatment of disc herniation is important to control pain, development of disability, prevent a recurrence, and accelerate the return to work. Therefore immediate treatment should be taken before the condition progresses further.

 

Constipation | Managing Bowel Dysfunction with Physiotherapy

Physiotherapy is undergoing rapid growth and development to widen its horizons. A wide variety of diseases are being treated by physiotherapists. One of them is the management of constipation. Constipation occurs when the colon's muscle contraction is slow or sluggish which delays transit time. This results in hard and dry stool that can lead to straining and pain during a bowel movement. It is very important for our health and overall well-being to move our bowels regularly and with ease. In case of constipation if proper treatment is not taken at the initial stage, then it might even lead to life-threatening risks. Exercises to relieve constipation both in the short and long term are found to be effective and without any side effects. Exercises help to increase muscle activity in the intestines and with peristalsis i.e. wavelike movements that push the contents of the digestive tract forward for proper transit in the colon. In this blog, we have discussed physiotherapy management for patients suffering from constipation.

 

Constipation

Constipation is a symptom rather than a disease, the patient suffering from constipation feels bowel frequency fewer than 3 times a week, needs to strain more than 25% of the time during defection, can also have lumpy or hard stools for more than 25% of bowel movements. There is a sensation of anorectal blockage or incomplete evacuation for more than 25% of bowel movements. Constipation can occur due to hormonal changes, neurological problems, rectocele, hyposensitive rectum, stenosis of the internal anal sphincter, irritable bowel syndrome (IBS), colon cancer, sedentary lifestyle, older age, even certain medications, mental health, eating disorders, etc.

 

Physiotherapy Management:

Physiotherapy treatment involves lifestyle modification and regular exercises. The patient is educated about the toileting techniques, to avoid straining during a bowel movement to decrease the risk of developing pudendal nerve dysfunction. These techniques include:

• While sitting on the toilet, the patient should lean forward with feet positioned on a step stool this position decreases the anorectal angle, thus easing the evacuation of stools.
• Another technique helps to move bowels more easily by attaining a squatting position when the knees are higher than the hips.
• The patient is asked to perform huffing or forced respiratory expiration during defecation, this helps to activate the abdominal oblique muscles, which assist in the propulsion of stools.

Propulsive abdominal bowel massage:

Propulsive abdominal bowel massage is a safe, non-invasive technique and can be performed by the patient independently. This technique promotes bowel mobility throughout the colon, this helps in increasing peristalsis in the gut. The patient applies constant moderate pressure to the abdomen with 2 or 3 fingers. Initially small, clockwise circular movements at the right anterior superior iliac spine, located at the base of the ascending colon are recommended. Further progression is made by moving up the ascending colon towards the base of the rib cage, the place where it meets the transverse colon. The circular movements are applied across the transverse colon toward the left upper quadrant of the abdomen and then down over the descending colon toward the left anterior superior iliac spine. This massage should be performed for 10 minutes on daily basis.

 

Pelvic Floor Exercises:

Pelvic floor exercises help to relax and tighten the muscles in the pelvis. Relaxing the pelvic floor muscles at the right time during defecation can help to pass stool more easily. A catheter is inserted into the rectum to measure muscle tension. The physiotherapist guides through the exercises to alternately relax and tighten the pelvic muscles. Relaxing the pelvic floor muscles at the right time during defecation can help to pass stool more easily.

 

Breathing Exercise:

Stress or anxiety can be the major reason for constipation, to relieve it breathing exercises can help relax the mind and relieve stress or depression. There are a wide variety of breathing exercises like diaphragmatic breathing alternate nostril breathing, 4-7-8 breathing, or even the simplest normal breathing can be done by just inhaling and exhaling slowly.

 

Cardio Exercises:

Cardiac exercise is a type of aerobic exercise that can help the cardiovascular system. These exercises increase blood flow, build endurance, and improve bowel movement. These exercises are simple and easy to do and tremendously help get relief from constipation. Common cardiac exercises are walking, running, jogging, cycling, jump- rope and swimming.

 

Bird Dog:

The person is asked to attain a dog posture by placing the hands and legs on the floor. Then asked to raise the left arm and right leg backward in a way such that they are parallel to the floor for a few seconds and then return to the starting position. The patient is then asked to change and raise the right arm and left leg in a similar way for 30 seconds. This exercise should be done 10 times.

 

Bridge:

The patient is asked to lie on the back while the legs are outstretched. Then bend the knees so that both the knees are pointed up with feet on the floor. The patient is then asked to extend the arms along the body's sides with palms facing down. Further, the arms and feet are pushed down while lifting the cheek. This posture should be maintained for 30 seconds.

 

Deep Squat:

Deep squatting exercises have incredible results because it imitates the natural defecation posture of humans. These exercises are done 10-15 times. Initially, the patient is asked to start slowly by raising and lowering the body gently. The squatting posture is held for 10- 15 seconds.

 

Forward Lunges Exercises:

The patient is asked to stand straight with the torso tightened, shoulders and back relaxed. Keep the neck straight and stable while exercising, take a step in the forward direction with one leg, bending both the legs downwards. As the patient lands forward, the knees should make a straight line with the ankle. While the back knee shouldn't be touching the floor. Try shifting the weight on the heels instead, but don't take the strain on the knees. Hold this position for 5 to 10 seconds and then come to the starting position. Repeat the same with the opposite leg. do 10-15 repetitions with each leg.

 

Wind Relieving Pose:

The patient lies on the floor on the back and hands by the sides. Then bends one of the legs and brings it towards the chest such that the knee is touching the chest. Once the leg is brought close, hold and pull the leg with a gentle hand. Hold this position for 10 to 30 seconds and then release the leg and return to the starting position. Repeat the exercise with the opposite leg.

 

The best time to do the exercises is in the morning. Exercising creates adrenaline. It is the type of chemical that is a good remedy for stress, makes the body more relaxed. Keeps the body in a good mood, ready for action. Though some people can exercise in the evening, adrenaline can them keep awake during the first half of the night, as the effect of adrenaline goes after 4-5 hrs.  If the patient feels any discomfort or irritation around the abdominal area, then he/she should stop doing exercise.

 

Multiple Sclerosis: Regaining of Strength and Function by Physiotherapy

Multiple sclerosis (MS) is a chronic neurodegenerative condition that largely affects young adults between the ages of 20-50, and is thus often known as the great crippler of young adults. It is a disabling disease of the brain and spinal cord, in which the immune system attacks the protective myelin sheath that covers nerve fibers and thus causes communication problems between the brain and the body. Slowly, the disease can cause permanent damage or deterioration of the nerves. Symptoms of this disease vary widely depending on the type of nerve affected and the amount of damage. Some people with severe MS might lose the ability to walk independently, whereas others may experience long periods of remission without any new symptoms. There is a range of treatments that may help to treat this condition like medication, hypnosis, tai chi, rehabilitation, etc. Rehabilitation services include a team of professionals working together to provide quality life to the patient. Physiotherapists are one such professional. The physiotherapist helps to create an individualized program that suits the abilities and addresses the goals of an individual. In this blog, we have mentioned a few exercises which are used by physiotherapists to provide education and treatment to promote good health and general conditioning to reduce fatigue and help the patient to feel and function at their best.

 

Multiple Sclerosis

Multiple sclerosis may differ greatly from person to person and the course of the disease depends on the location of the affected nerve fibers. Multiple sclerosis often causes numbness or weakness in one or more limbs that can occur on one side of the body at a time, or the legs and trunk, shock-like sensations that occur on neck movements, especially while bending the neck forward i.e. Lhermitte sign, Tremor, lack of coordination or unsteady gait, vision problems. Patients may also feel slurred speech, fatigue, dizziness, tingling, or pain in parts of the body even problems with sexual, bowel, and bladder function. It can also cause problems with mobility and gait. Some people with MS have a gradual onset and steady progression of symptoms without any relapses, known as primary-progressive MS. And those with relapsing-remitting MS, eventually develop a steady progression of symptoms, with or without periods of remission, within 10 to 20 years from disease onset. This is known as secondary-progressive MS. The rate of disease progression varies among people with secondary-progressive MS.

The causes of multiple sclerosis are unknown. It is an autoimmune disease, in this condition body's immune system attacks its tissues. This immune system malfunction destroys the fatty substance (myelin) that coats and protects the nerve fibers in the brain and spinal cord. When the myelin sheath is damaged and the nerve fiber is exposed, causing the messages that travel along that nerve fiber to slow down or get blocked.

 

Physiotherapy Treatment:

Physiotherapy helps the patient to achieve and maintain optimal function essential for the quality of life. The physiotherapist evaluates and treats the body's ability to move and function by emphasizing pain, strength, walking, balance, fatigue. Most individuals living with MS have difficulty in physical activity.  Physiotherapy treatment includes a combination of exercises, equipment, and management strategies that help the patient. Physiotherapists can keep them moving and prevent the worsening of symptoms.  The therapist designs a treatment plan and a list of recommendations to improve the mobility, strength, and physical wellbeing of the patient. Exercise is not only beneficial for physical well-being but also for emotional and mental health.

 

Balance exercises:

These exercises are given to minimize the increased risk of falls and gait deviations. The physiotherapist provides balance retraining by strengthening and flexibility exercises. Balance can be improved by the use of visual causes or techniques to reduce upper extremity tremors. Balance training focuses on controlling the posture so that the patient can control the body mass more stably. Balance exercises involve standing on one leg at a time and then challenging the balance by performing another movement. For example, balancing in tree pose, or standing on one leg while doing a bicep curl. While maintaining a pose, care should be taken that the individual doesn't fall. Increasing core strength also helps with balance.

 

Mobility exercises:

Walking requires balance, coordination, upper limb control, strength, and endurance. The tools for mobility are now lighter and easier to handle. The physiotherapist can recommend the mobility tools that are appropriate for the patient and also teaches the individual to use them.

 

Strengthening exercises:

Weakness is a common problem in patients with MS. Strengthening training can help improve muscle endurance and strength.  This can help to increase functionality, walking ability, and physical independence. Exercises help to design and execute training program that helps to address areas of weakness and imbalance in the body e.g. marching exercises help to strengthen the legs, improve balance and increase fitness. Resistance training also requires the muscles to work against weight or exterior force, this can be done by using one's body weight, working with dumbbells or resistance bands, and using weightlifting machines. Strengthening exercises can help to retain muscle mass, which is important in maintaining function.

 

Stretching exercises:

Multiple sclerosis patients are characterized by involuntary stiffness or muscle spasms. Spasticity can affect the mobility and independence of an individual. Therefore, proper positioning, stretching, and bracing can be used to help minimize the effects of spasticity. Structured physiotherapy programs are planned to improve mobility, muscle strength, aerobic capacity, and quality of life. Daily stretching can be beneficial as it increases range of motion, improves flexibility, and decreases spasticity. Stretching should be done for 10 to 15 minutes per day, the focus being spastic muscles. The muscles should be moved slowly to give them time to respond to the stretch and hold each stretch for 20 to 60 seconds, but shouldn't be painful.

 

Endurance exercises:

These exercises can improve walking distance and quality of life measures. Physiotherapists can help design a tailored and comprehensive exercise program that can alleviate the effects of fatigue. Modifying exercises to help manage fatigue so that the individual can continue doing the things he/she loves. Endurance exercises can be done to be stronger, but in MS weakness comes not only from the disease but from deconditioning. So if an individual has a lot of fatigue, then he/ she is resting more or is more sedentary. Their muscles become deconditioned, to counter this, 3-4 four days of strengthening training per week should be done.

 

Aerobic exercise:

Aerobic exercises, provide cardiovascular conditioning and is important for cardiovascular health. The physiotherapist recommends doing cardio exercises 3 days a week for 30 minutes each time. Alternatively,

3 -10 minute sessions if 30 minutes is too difficult to maintain. An individual with MS can do low-impact aerobic exercises like walking, bicycling, or using an elliptical machine.

 

Water aerobics:

In water aerobics, water produces force to work against, providing resistance. Because of this, water aerobics is one of the best exercises that can be done in the case of MS.  Water aerobics is a great mode of exercise because of the buoyancy, which makes it easier to move.

 

Functional movement:

Functional exercises are beneficial because these exercises recruit multiple muscle groups at the same time, for example, push-ups, use core, chest, and back muscles. Another benefit is that some of the exercises, like squats, mimic motions that an individual does in daily life like sitting down in a chair or standing up from the chair. These exercises are very helpful, for people with MS, because they train the muscles to perform daily tasks effectively.

Exercises not only help to maintain function but also reduce inflammation in the central nervous system and have a positive impact on the disease. People with MS feel less fatigued and improve their mood after doing resistance training. But patients should keep in mind that results don't happen overnight, they should be followed with a consistent schedule to experience any potential benefits of exercises for MS.

 

Poliomyelitis | Treatment, and Management of Muscle Weakness by Physiotherapy

Polio, also known as Poliomyelitis is a viral disease that destroys the nerve cells, it is present in the spinal cord, causing muscle weakness or paralysis to some parts of the body. It is a contagious disease caused by a poliovirus - Picornaviridae. Poliovirus can spread from person to person or by food and water containing human faeces. Paralytic syndrome and Post-polio syndrome have a cluster of disabling signs and symptoms like loss of reflexes, loose and floppy limbs, progressive muscle or joint weakness and pain, fatigue, etc. The symptoms of polio are highly variable, ranging from viral problems without paralysis to quadriplegia and even respiratory failure.  And thus the treatment intervention varies from patient to patient. These interventions include surgery that can be done to reestablish balance in the muscles around the joints to prevent deformities. Further physiotherapy is also one of the best treatment options available for polio patients. The treatment aims to achieve an acceptable physical status for the patients by designing non-fatiguing exercises which are appropriate to deal with muscle overuse weakness.  In this blog, we have discussed physiotherapy management for patients suffering from poliomyelitis.

 

Physiotherapy Treatment for Poliomyelitis

Exercise programs for polio patients are specifically tailored to the individual's functional status and needs. The exercises should not overly fatigue the patient as these can decrease the patient's functional level.  Physiotherapy treatment of post-polio muscular pain can include activity reduction, pacing (rest periods during activity), thermotherapy, cryotherapy, transcutaneous electrical stimulations (TENS) and stretch, use of assistive devices, and lifestyle modifications.

 

Inspiratory Muscle Training:

Inspiratory muscle training can be performed at home by using a spirometer or simple breathing exercises. The patient performs training for 20 minutes with 1 minute of exercise, 1-minute rest, and repeat 10 times, done every day for a period of 10 14 weeks.

 

Active and Passive Movements of Joints:

Joint movement exercises are not recommended when the muscles are in spasm or are very tender. Without eliciting pain simple activities are done for hips, ankles and other joints to keep them moving through a full range each day. In case of paralyzed joints, active movements may have to be replaced by doing passive movements.

 

Posture Splinting and Support:

Correct posture of the patient in bed is maintained to prevent deformities. Detachable supports like above-knee calipers, support knees, and ankles, keep the knee straight and also help to prevent any hip flexion deformities. Spinal supports for the patient with a flail spine helps to support the back.

 

Mobilization:

Gradually mobilizing the patient i.e progressing from supports in bed, to support in a chair, from sitting to standing and walking. Progressive mobilization of the paralyzed patient out of bed, from a wheelchair used in severely disabled patients to a walking machine, parallel bars, crutches, and calipers are used in less severely disabled patients. Patients with weak quadriceps are capable of walking without calipers by supporting the knee with a hand or by forcing back their knee. This may be done in the patient with strong hip extensors and moderate plantar.

 

Strength Training:

Supervised progressive resistance training regime with voluntary contractions and rest interval is given to allow recovery from fatigue. To safeguard against the possible risk of overuse, the initial training load is minimum and eventually increased gradually.

General warm-up exercises are followed by low-resistance, high-repetition exercises for all major muscle groups, both for upper extremities, lower extremities, and also for the trunk. More emphasis is laid on training the quadriceps muscle.

 

Cardiovascular Fitness Exercises:

A correct level of exercise must be recommended to gain maximal cardiovascular fitness without worsening levels of chronic fatigue. Excessive cardiovascular exercise has proved to increase levels of chronic fatigue, though some amount of exercise is necessary for improving cardiovascular fitness. Therefore a moderate intensity, short sessions, frequent rests with adequate recovery time between session days is preferred.

 

Stretching of Muscles and Joints:

Stretching of Muscles and Joints helps in the prevention of contractures. Joints must be stretched in the direction opposite to that of the contracture, should be done once a day at least 3 times. For flexion contracture of the hip, backward pressure should be in the upper third of the thigh, the opposite hip must be fully flexed to eliminate lumbar lordosis, and the leg is brought down in slight adduction to stretch the abductors which are usually tight. The patient is laid on his face in bed, with a pillow under the lower thigh. The hips can also be extended while the patient is in this position. Flexion contracture of the Knee is manipulated by exerting pressure near the joint.

 

Manipulation of Ankle and Foot Deformities:

The most important deformity to correct is equinus. The ankle is firmly supported as the foot is dorsiflexed, in case of varus of the foot or adduction of the forefoot then it is important to be firm but gentle and avoid too forceful manipulation. Firm pressure for 5 minutes in the opposite direction to the deformity, and is repeated and followed by a surgical correction to prevent a recurrence.

 

Orthosis: 

Children with weak limbs and with the possibility of deformity are encouraged to wear calipers till the growth period is completed.  They can walk without support but the caliper must fit properly.

 

Crutches:

Crutches are required in patients with bilateral calipers or a caliper on one leg with weakness of the opposite leg or spine, also needed in patients with weakness of the hip on the side with severely affected lower leg. Crutches should be correct both in length and in the position of the handgrip. In case of weakness of the trunk or arms, the top of the crutch should be well padded to avoid pressure in the axilla and radial nerve palsy.

 

Hydrotherapy:

Training sessions can be held in the hydrotherapy pool, designed to train general physical fitness including resistance and endurance activities, balance, stretching, and relaxation. The patient exercises at the intensity level where muscle fatigue is not present during or after the training session.

 

Aerobic training:

The patient exercises at 70% of maximal heart rate in an aerobic exercise program is found to be beneficial. For example, training on the treadmill 3 times a week for 20 minutes per session in an aerobic exercise program.

 

The patient should follow these exercises on regular basis or as recommended by the physiotherapist. There is no cure for poliomyelitis, as it has paralyzed thousands of people all over the world. Thus treatment mainly focuses is on increasing comfort, speeding recovery, and preventing complications.