KenasarePhysio

16/04/2024

15/04/2024

Exercises for sacroiliac pain
Knee-to-chest stretch

1 Do not do the knee-to-chest exercise if it causes or increases back or leg pain.

2.Lie on your back with your knees bent and your feet flat on the floor. You can put a small pillow under your head and neck if it is more comfortable.

3.Grasp your hands under one knee and bring the knee to your chest, keeping the other foot flat on the floor.

4.Keep your lower back pressed to the floor. Hold for at least 15 to 30 seconds.

5.Relax and lower the knee to the starting position. Repeat with the other leg.

6.Repeat 2 to 4 times with each leg.

7.To get more stretch, keep your other leg flat on the floor while pulling your knee to your chest.

Bridging

1.Lie on your back with both knees bent. Your knees should be bent about 90 degrees.

2.Tighten your belly muscles by pulling in your belly button toward your spine. Then push your feet into the floor, squeeze your buttocks, and lift your hips off the floor until your shoulders, hips, and knees are all in a straight line.

3.Hold for about 6 seconds as you continue to breathe normally, and then slowly lower your hips back down to the floor and rest for up to 10 seconds.

4.Repeat 8 to 12 times.

Hip Extension

1.Get down on your hands and knees on the floor.

2.Keeping your back and neck straight, lift one leg straight out behind you. When you lift your leg, keep your hips level. Don't let your back twist, and don't let your hip drop toward the floor.

3.Hold for 6 seconds. Repeat 8 to 12 times with each leg.

4.If you feel steady and strong when you do this exercise, you can make it more difficult. To do this, when you lift your leg, also lift the opposite arm straight out in front of you. For example, lift the left leg and the right arm at the same time. (This is sometimes called the "bird dog exercise.") Hold for 6 seconds, and repeat 8 to 12 times on each side.

Clamshell

1.Lie on your side with a pillow under your head. Keep your feet and knees together and your knees bent.

2.Raise your top knee, but keep your feet together. Do not let your hips roll back. Your legs should open up like a clamshell.

3.Hold for 6 seconds.

4.Slowly lower your knee back down. Rest for 10 seconds.

5.Repeat 8 to 12 times.

6.Switch to your other side and repeat steps 1 through 5.

Hamstring wall stretch

1.Lie on your back in a doorway, with one leg through the open door.

2.Slide your affected leg up the wall to straighten your knee. You should feel a gentle stretch down the back of your leg.

3.Hold the stretch for at least 1 minute to begin. Then try to lengthen the time you hold the stretch to as long as 6 minutes.

4.Switch legs, and repeat steps 1 through 3.

5.Repeat 2 to 4 times.

6.If you do not have a place to do this exercise in a doorway, there is another way to do it:

7.Lie on your back, and bend one knee.

8.Loop a towel under the ball and toes of that foot, and hold the ends of the towel in your hands.

9.Straighten your knee, and slowly pull back on the towel. You should feel a gentle stretch down the back of your leg.

10.Switch legs, and repeat steps 1 through 3.

11.Repeat 2 to 4 times.
Note

1.Do not arch your back.

2.Do not bend either knee.
Keep one heel touching the floor and the other heel touching the wall.

3.Do not point your toes.

Piriformis stretch

1.Lie on your back with your legs straight.

2. Lift your affected leg, and bend your knee. With your opposite hand, reach across your body, and then gently pull your knee toward your opposite shoulder.

3.Hold the stretch for 15 to 30 seconds.

4.Switch legs and repeat steps 1 through 3.

5.Repeat 2 to 4 times.

Precaution.

Any of the exercise which provocate excessive must be discontinued or consult your therapist be indulging in any of the exercise.

09/07/2023

Haglund’s Deformity
What Is Haglund’s Deformity?
Haglund’s deformity is a bony enlargement on the back of the heel. The soft tissue near the Achilles tendon becomes irritated when the bony enlargement rubs against shoes. This often leads to painful bursitis, which is an inflammation of the bursa (a fluid-filled sac between the tendon and bone).

Causes of Haglund’s Deformity
Haglund’s deformity is often called “pump bump” because the rigid backs of pump-style shoes can create pressure that aggravates the enlargement when walking. In fact, any shoes with a rigid back, such as ice skates, men’s dress shoes or women’s pumps, can cause this irritation.

To some extent, heredity plays a role in Haglund’s deformity. Inherited foot structures that can make one prone to developing this condition include:

A high-arched foot
A tight Achilles tendon
A tendency to walk on the outside of the heel.

Symptoms of Haglund’s Deformity
Haglund’s deformity can occur in one or both feet. The symptoms include:

A noticeable bump on the back of the heel
Pain in the area where the Achilles tendon attaches to the heel
Swelling in the back of the heel
Redness near the inflamed tissue

Diagnosis of Haglund’s Deformity
After evaluating the patient’s symptoms, the foot and ankle surgeon will examine the foot. In addition, x-rays will be ordered to help the surgeon evaluate the structure of the heel bone.

Nonsurgical Treatment
Nonsurgical treatment of Haglund’s deformity is aimed at reducing the inflammation of the bursa. While these approaches can resolve the pain and inflammation, they will not shrink the bony protrusion. Nonsurgical treatment can include one or more of the following:

Medication. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce the pain and inflammation. Ice. To reduce swelling, apply an ice pack to the inflamed area, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.
Exercises. Stretching exercises help relieve tension from the Achilles tendon. These exercises are especially important for the patient who has a tight heel cord.
Heel lifts. Patients with high arches may find that heel lifts placed inside the shoe decrease the pressure on the heel.
Heel pads. Pads placed inside the shoe cushion the heel and may help reduce irritation when walking.
Shoe modification. Backless or soft backed shoes help avoid or minimize irritation.
Physical therapy. Physical therapy modalities, such as ultrasound, can help to reduce inflammation.
Orthotic devices. Custom arch supports control the motion in the foot.
Immobilization. In some cases, casting may be necessary.

When Is Surgery Needed?
If nonsurgical treatment fails to provide adequate pain relief, surgery may be needed. The foot and ankle surgeon will determine the procedure that is best suited to your case. It is important to follow the surgeon’s instructions for postsurgical care.

Prevention
To help prevent a recurrence of Haglund’s deformity:

wear appropriate shoes; avoid shoes with a rigid heel back
use arch supports or orthotic devices
perform stretching exercises to prevent the Achilles tendon from tightening
avoid running on hard surfaces and running uphill

14/01/2023

CERVICAL MYOTOME TESTING
PURPOSE To assess the integrity of the cervical spine nerve roots supplying the muscles of the
upper limb.
SUSPECTED INJURY Pathological condition of the spinal nerve root.
PATIENT POSITION The patient is sitting.
EXAMINER POSITION The examiner is positioned directly in front of or to the side of the patient’s upper
extremity.
TEST PROCEDURE Myotomes are tested by resisted isometric contractions with the joint at or near the
resting position. As with the resisted isometric movements previously mentioned, the
examiner should position the joint being tested and instruct the patient, “Don’t let me
move you,” so that an isometric contraction is obtained. The contraction should be
held at least 5 seconds, because myotome weakness commonly takes time to develop.
C1-C2 myotome (neck flexion). The patient’s head should be slightly flexed (a
nod). The examiner applies pressure to the patient’s forehead while stabilizing the
patient’s trunk with a hand between the scapulae (A). The examiner should make
sure the patient’s neck does not extend when pressure is applied to the forehead.
C3 myotome and cranial nerve XI (neck side flexion). The examiner places one
hand above the patient’s ear and applies a sideflexion force to the head while stabi
lizing the patient’s trunk with the other hand on the opposite shoulder (B). Both
right and left side flexion must be tested.
C4 myotome and cranial nerve XI (shoulder elevation). The examiner asks the
patient to elevate the shoulders to about half of full elevation. The examiner applies
a downward force on both of the patient’s shoulders while the patient attempts to
hold them in position (C). The examiner should make sure the patient is not
“bracing” the arms against the thighs if testing is done with the patient sitting.
C5 myotome (shoulder abduction). The examiner asks the patient to elevate the
arms to about 75° to 80° in the scapular plane with the elbows flexed to 90° and the
forearms pronated or in neutral. The examiner applies a downward force on the
humeral shaft while the patient attempts to hold the arms in position (D). To prevent
rotation, the examiner places his or her forearms over the patient’s forearms while
applying pressure to the humerus.
C6 and C7 (elbow flexion and extension). The examiner asks the patient to put the
arms by the sides with the elbows flexed to 90° and the forearms in neutral. The
examiner applies a downward isometric force to the forearms to test the elbow
flexors (C6 myotome) (E) and an upward isometric force to test the elbow extensors
(C7 myotome) (F). For testing of wrist movements (extension, flexion, and ulnar
deviation), the patient has the arms by the side, the elbows at 90°, the forearms
pronated, and the wrists, hands, and fingers in neutral. The examiner applies a
downward force to the hands to test wrist extension (C6 myotome) (G) and an
upward force to test wrist fl exion (C7 myotome) (H).
C8 myotome (thumb extension). The patient extends the thumb just short of full
ROM. The examiner applies an isometric force to bring the thumb into flexion (I).
A lateral force (radial deviation) to test ulnar deviation may also be performed to
test the C8 myotome. The clinician stabilizes the patient’s forearm with one hand
and applies a radial deviation force to the side of the hand.
T1 myotome (finger abduction/adduction). To test hand intrinsics (T1 myotome),
the examiner may have the patient squeeze a piece of paper between the
fingers (usually the fourth and fifth fingers) while the examiner tries to pull it away.
Alternatively, the patient may squeeze the examiner’s fingers, or the patient may
abduct the fingers slightly with the examiner isometrically adducting the fingers (J).

07/01/2023

Some brachial plexus injury presentation.
Early detection after birth, physical therapy is helpful.

07/01/2023

Walking stick usage.
The stick should be placed forward at the same time as the affected leg and then the unaffected leg follows. If using two sticks at the same time, a four-point gait may be used by bringing one stick forward, then the opposite leg, then the other stick, followed by the other opposite leg.

07/01/2023

02/01/2023

Thoracic outlet syndrome

Thoracic outlet syndrome (TOS) is a group of disorders that occur when blood vessels or nerves in the space between your collarbone and your first rib (thoracic outlet) are compressed. This can cause shoulder and neck pain and numbness in your fingers.

Common causes of thoracic outlet syndrome include physical trauma from a car accident, repetitive injuries from job- or sports-related activities, certain anatomical defects (such as having an extra rib), and pregnancy. Sometimes doctors don't know the cause of thoracic outlet syndrome.

Symptoms
There are three general types of thoracic outlet syndrome:

Neurogenic (neurologic) thoracic outlet syndrome. This most common type of thoracic outlet syndrome is characterized by compression of the brachial plexus. The brachial plexus is a network of nerves that come from your spinal cord and control muscle movements and sensation in your shoulder, arm and hand.

Venous thoracic outlet syndrome. This type of thoracic outlet syndrome occurs when one or more of the veins under the collarbone (clavicle) are compressed, resulting in blood clots.

Arterial thoracic outlet syndrome. This is the least common type of TOS. It occurs when one of the arteries under the collarbone is compressed, resulting in bulging of the artery, also known as an aneurysm.
It's possible to have a mix of the three different types of thoracic outlet syndrome, with multiple parts of the thoracic outlet being compressed.

Thoracic outlet syndrome symptoms can vary depending on the type. When nerves are compressed,

signs and symptoms of neurogenic thoracic outlet syndrome include:

Numbness or tingling in your arm or fingers

Pain or aches in your neck, shoulder, arm or hand

Weakening grip

Signs and symptoms of venous thoracic outlet syndrome can include:

Discoloration of your hand (bluish color)

Arm pain and swelling

Blood clot in veins in the upper area of your body

Arm fatigue with activity

Paleness or abnormal color in one or more fingers or your hand

Throbbing lump near your collarbone

Signs and symptoms of arterial thoracic outlet syndrome can include:

Cold fingers, hands or arms

Hand and arm pain

Lack of color (pallor) or bluish discoloration (cyanosis) in one or more of your fingers or your entire hand

Weak or no pulse in the affected

Treatment for thoracic outlet syndrome usually involves physical therapy and pain relief measures. Most people improve with these treatments. In some cases, however, your doctor may recommend surgery.

01/01/2023

Here are some common causes of knee pain:

MEDICAL CONDITIONS

Arthritis -- Including rheumatoid arthritis, osteoarthritis, lupus, and gout

Baker cyst -- A fluid-filled swelling behind the knee that may occur with swelling (inflammation) from other causes, such as arthritis.

Cancers that either spread to your bones or begin in the bones

Osgood-Schlatter disease

Infection in the bones of the knee

Infection in the knee joint

INJURIES AND OVERUSE

Bursitis -- Inflammation from repeated pressure on the knee, such as kneeling for a long time, overuse, or injury

Dislocation of the kneecap

Fracture of the kneecap or other bones

Iliotibial band syndrome -- Injury to the thick band that runs from your hip to the outside of your knee

Patellofemoral syndrome -- Pain in the front of your knee around the kneecap

Torn ligament. -- An anterior cruciate ligament (ACL) injury, or medial collateral ligament (MCL) injury may cause bleeding into your knee, swelling, or an unstable knee

Torn cartilage (a meniscus tear) -- Pain felt on the inside or outside of the knee joint

Strain or sprain -- Minor injuries to the ligaments caused by sudden or unnatural twisting

29/12/2022

Gait pattern.