Health Dialogue With Dr Kapil Chauhan - Leading Physiotherapist

21/06/2022

21/06/2022

14/09/2018

Ankle sprain is a very common injury where one or more of the ligaments of the ankle are partially or completely torn.

Mechanism of injury:
Ankle sprains usually occur during a rapid shift of body center of mass over the landing or weight-bearing foot. The ankle rolls outward, whilst the foot turns inward causing the lateral ligament to stretch and tear.

Signs and symptoms:
-Unable to walk or even stand with support on the injured ankle
-Tenderness, swelling and bruising can occur on either side of the ankle

A system which can be adopted is a 3 graded classification based on the severity of the injury:

Grade I Mild - Little swelling and tenderness with little impact on function

Grade II Moderate - Moderate swelling, pain and impact on function. Reduced balance, movements and instability

Grade III Severe - Complete rupture, large swelling, high tenderness loss of function and marked instability

Treatment:
The treatment phases are divided into 4 phases that hold special aim and care required to heal the injury and as well as strengthen the damaged ligament

Protective Phase (0-3 days)

Goals:
Reduction of pain and swelling and improve circulation and partial foot support

The most common approach to manage ankle sprain is the PRICE protocol: Protection, Rest, Ice, Compression, and Elevation

Recommendations for the Patient:

Protection: Protect the ankle from further injury by resting and avoiding activities that may cause further injury and/or pain

Rest: Advise rest for the first 24 hours after injury, possibly with crutches to offload the injured ankle and altering work and sport and exercise requirements as needed

Ice: Apply a cold application (15 to 20 minutes, one to three times per day)

Compression: Apply compression bandage to control swelling caused by the ankle sprain

Elevation: Ideally elevate ankle above the level of the heart, but as a minimum, avoid positions where the ankle is in a dependent position relative to the body

Foot and Ankle motion-
Perform active movements with the toes and ankle within pain free limits to improve local circulation

Function regaining Phase (4-10 days)

Goals:
Recovery of foot and ankle function and improved load carrying capacity

Keep performing active movements like before
Practice Foot and Ankle Functions like rotation and ankle foot pumps, make alphabets in the air with your toe so that the ankle moves in every possible direction

Do gentle stretching as shown in the pictures

Strengthening phase(11 -21 days)

Goals:
Improve muscle strength, active (functional) stability, foot/ankle motion, mobility (walking, walking stairs, running)
To improve balance, stand on your injured foot with your arms open, eyes open. If you can perform it well, progress to standing on that foot with eyes closed.
Keep performing stretching
Push your foot against a wall, hold it for 5 seconds then relax. Repeat 10 times.

04/08/2018

Patient's Feedback

04/07/2018

Hi there, today's theme is:
Wanna_be_well_wednesday
Topic of discussion is the infamous *pilates*
Here's a guide to give you info about what they are and some simple moves to practice yourself!
kapil: *Pilates origin*

Pilates (or the Pilates method) is a series of about 500 exercises inspired by calisthenics, yoga and ballet. Pilates lengthens and stretches all the major muscle groups in the body in a balanced fashion. It improves flexibility, strength, balance and body awareness.

Yoga brings the body and mind together and is built on three main elements – exercise, breathing and meditation. Both yoga and Pilates improve muscular and postural strength.

*Pilates explained*

In the 1920s, physical trainer Joseph Pilates introduced Pilates into America as a way to help injured athletes and dancers safely return to exercise and maintain their fitness. Since then, Pilates has been adapted to suit people in the general community.

Pilates can be an aerobic and non-aerobic form of exercise. It requires concentration and focus, because you move your body through precise ranges of motion. Pilates lengthens and stretches all the major muscle groups in your body in a balanced fashion. It requires concentration in finding a centre point to control your body through movement. Each exercise has a prescribed placement, rhythm and breathing pattern.

In Pilates, your muscles are never worked to exhaustion, so there is no sweating or straining, just intense concentration. The workout consists of a variety of exercise sequences that are performed in low repetitions, usually five to ten times, over a session of 45 to 90 minutes. A mat or specialized equipment (like gym ball) are used.

*It's versatile for most of the population*

The Pilate exercises are taught to suit each person and exercises are regularly re-evaluated to ensure they are appropriate for that person. Due to the individual attention, this method can suit everybody from elite athletes to people with limited mobility, pregnant women and people with low fitness levels.

*Health benefits of Pilates*

The health benefits of Pilates include:
-improved flexibility
-increased muscle strength and tone, particularly of your abdominal muscles, lower back, hips and buttocks (the ‘core muscles’ of your body)
-balanced muscular strength on both sides of your body
-enhanced muscular control of your back and limbs
-improved stabilisation of your spine
-improved posture
-improved physical coordination
-relaxation of your shoulders, neck and upper back
-prevention of musculoskeletal injuries
-increased lung capacity and circulation through deep breathing
-improved concentration
-increased body awareness
-stress management and relaxation

11/07/2017

Too Much Sleep - Still Feeling Tired?

One of the most common scenarios that most people are faced with is a constant feeling of tiredness and lethargy even after you have had a full night’s sleep. The questions popping in your mind right about now is, why is this happening? Why does the lethargic feeling fail to leave you even after you had a proper 8 hours sleep? Why is your sleep getting into the way of your professional productivity? Though there are a number of different explanations to this constant feeling of cloudiness throughout the day, hence, experts in the field have listed down some of the factors that prove to be the major causes behind this condition.

Some of these most common and powerful reasons are listed below.

Thyroid: The moment your thyroid levels start soaring, you will automatically find it difficult to keep up with the pace that your day to day life demands. The thyroid gland, which is placed right in front of the throat, is the size of the knot on your tie. This gland produces a hormone. When the activity of the thyroid gland, it starts secreting more and more of the hormones, leading to a condition termed as hyperthyroidism. The same gland when underperforms, it starts holding back the hormone secretion, leading to a condition called hypothyroidism. In both the cases the metabolism of the body slows down, leading to an increased level of tiredness even after proper sleep.

Anaemia: Another leading cause of that nagging feeling of sleepiness and draining energy is Anaemia. Anaemia causes a certain amount of fatigue in an individual. The main cause influencing this situation is the lack of presence of enough red blood cells. The main function of these red blood cells is to transfer oxygen constantly from the long to the cells and tissues. A break in this process leads to you feeling weak and also short of breath.

Diabetes: Diabetes poses a serious threat to the all over functioning of your body. It is termed as the slow killer and constantly works towards undermining the level of energy a normal individual can hold. This adversely affects your day to day life, including your performance at work and also performing your daily chores at home. The glucose in your body serves as a fuel for your daily activities. Since patients with type 2 diabetes cannot use this rising glucose in their blood properly, they end up being more tired than they ought to be.

Other conditions that lead to the same draining feeling and constant tiredness even after lot of sleep are depression, rheumatoid arthritis, chronic fatigue, sleep apnea, sleep inertia, periodic limb movement disorder, constant exposure to computer screens, tv screen, monitors, etc. There are a whole bag of other factors that lead to the constant feeling of tiredness that you are feeling. Before the end of the day, you are drained, your productivity drops and you cannot wait to hit the bed, and the same is the condition when you get out of bed. If you wish to discuss about any specific problem, you can ask a free question.

15/12/2016

Most advanced Best Three Neck Strengthening Exercises

Neck Roll and Chin Tuck

This exercise helps stretch your neck out. Lie on your back with your knees bent and your arms on your stomach. Relax your neck muscles and smile, letting your tongue widen at the base. Let your neck lengthen and pull your shoulder blades back until they reach the floor. Breath deeply and slowly roll your to the right, then the left. Repeat a few times to keep stretching.

Roll Up

This exercise helps increase strength throughout your spine, neck and your abdominal muscles. Lie face up on your back with your arms extended by your sides and your legs straight and flat on the floor. Inhale deeply and extend your arms and legs away from each other. Exhale and lift your arms to the ceiling, facing your palms forward. Lift your head, tuck your chin under and scoop your abdominal muscles in as you roll to a sitting position. Inhale deeply and extend your arms and upper body over your legs. Exhale again and roll down by rolling your spine down to the floor, pressing your spine into the floor one vertebra at a time and using your abdominals to keep you steady.

The Neck Pull

The neck-pull exercise is a more advanced version of the roll up. Similarly, it strengthens your spine, neck and abdominal muscles. However, this exercise is more difficult because your arms remain behind your neck instead of free to use to propel you up. Lie face up with your hands behind your head and your legs extended out and hip-width apart. Inhale while flexing your feet, pressing your heels into the mat. Exhale and scoop your abdominal muscles in as you roll up, pressing your lower back into the mat. Tuck your chin under and lift your head while rolling off the mat. Inhale deeply as you sit tall, then exhale as you scoop your stomach in and roll back down to the mat.

Swan-Neck Roll

The swan-neck roll stretches your throat muscles and your spine. Lie face down on your stomach. Position your hands under your shoulders and press your upper body off the matt, keeping your elbows close to the sides of your body and pulling your shoulder blades down your back. Tilt your jaw out slightly. Inhale as you draw your abdominal muscles and roll your head, neck and back up. Lengthen your chin and look to your left, stretching your neck. Roll your chin down to your chest, then back up, rotating it in circles to stretch it. Roll your chin to the right and repeat rotating stretches. Exhale as you roll back down.

14/12/2016

Sundowner's Syndrome: Causes, Symptoms, and Treatments

A person with sundowner's syndrome experiences increased episodes of confusion, agitation, and activity as the day progresses to night. There may be agitation and personality changes that are dramatically unlike the person's normal behavior.

This can be frightening for the individual and their caregiver.

While most people are "winding down" or relaxing as the day goes on, those with sundowner's syndrome become increasingly active.

Sundowner's syndrome is often associated with dementia, a condition that affects a person's memory, personality, and their ability to reason.

There are nonmedical ways to reduce the incidence of sundowner's syndrome. Prescription medications can enhance sleep, and they may also reduce symptoms.

Treatment aims to ensure the person with sundowner's does not experience severe fear or accidentally injure themselves.

Causes of sundowner's syndrome

As the day goes on, regular activities can become tiring for a person with dementia. By late afternoon, the person can be totally exhausted. This exhaustion may progress through the evening.

People with dementia may find late afternoon and evening a particularly difficult time.

Dementia can lead to confusion and difficulty with processing and reasoning. It can also affect the internal body clock that recognizes when it is daytime and nighttime and, therefore, time to sleep.

If the body clock is not working properly, sleeping and waking patterns may be disrupted, and they can cause the confusion and exhaustion that feature in sundowner's.

Other events that may lead to symptoms include:

Hospitalization or moving to a new, unfamiliar placeMedications wearing off as the day goes onTransitions from day to night, reminding a person of when they were younger and expecting a spouse or children to come home

Hormonal imbalances may also play a role.

Risk factors

Some risk factors have been associated with sundowner's syndrome.

One is Alzheimer's disease. Around 20 percentof people with Alzheimer's will experience some degree of sundowner's syndrome.

A person with a history of alcohol or substance abuse also has a higher chance of experiencing sundowner's, often with more severe symptoms.

Some behavioral cues are linked to a higher risk of symptoms.

These cues include:

Changes to day and night experiences, such as poor sleepIncreased stress, such as after visiting an unfamiliar place or going to see a doctorLow lighting and shadows that can increase paranoia and fearHaving a frustrated and exhausted caregiverDifficulty separating dreams from reality

Symptoms of sundowner's syndrome

Symptoms of sundowner's syndrome typically occur between the hours of 4:30 in the afternoon and 11:00 in the evening.
Sundowner's syndrome can lead to sleep problems.

These include:

Confusion as to where or who a person is
Mental confusion that will not respond to reasoning
Paranoia
Sleep disturbances, such as inability to sleep at night, possibly leading to excessive sleep during the day
Sudden changes in behavior unexplained by any other trigger
Trouble speaking clearly
Trouble thinking clearly
Visual hallucinations
WanderingYelling or aggressive behavior

Those with sundowner's syndrome have usually been diagnosed with some form of dementia, such as Alzheimer's disease. However, not everyone with Alzheimer's disease or dementia will have sundowner's syndrome.

Complications

Sundowner's syndrome can increase the likelihood of injury in a person with dementia. They may fall or remove a necessary medical device.

Sometimes, the person may become violent or highly agitated, potentially resulting in injury to themselves or others.

Research published in Psychiatry Investigationsuggests sundowner's syndrome may speed up the decline in mental function in a person with Alzheimer's disease.

When to see a doctor

Sometimes it can be difficult to distinguish between sundowner's syndrome and delirium that results from another condition.

In an older person, an underlying infection, such as a urinary tract infection, can cause symptoms similar to those of sundowner's syndrome.

Changes to medications or adding new medications can have a similar effect.

If the person starts behaving in an unusual way during the evening, a caregiver should seek medical attention.

No definitive test can detect sundowner's syndrome. A doctor will ask a caregiver about symptoms and will try to rule out other potential causes, such as an infection or medication change.

Lifestyle tips for sundowner's syndrome

It can be difficult for a caregiver to see the changes in personality when the person they care for has sundowner's, but there are some ways to alleviate symptoms and to help a confused person to remain calm.

Engaging in activity can help to establish a routine with good sleep patterns.

Sundowner's is largely triggered by changes in light. Bright surroundings indicate daytime, while dark ones usually indicate night.

It is the fading light and the onset of nighttime that can trigger the symptoms of sundowner's, so it is important to get lighting right.

People should keep the lights bright as the daylight fades and then use nightlights or low-light lamps throughout the night. These low-level lights will help a person know where they are if they wake up in the night.

There are a number of other ways to help a person with sundowner's syndrome to stay oriented to their surroundings.

Examples include:

A vision check: This is important to ensure the person is still seeing clearly. Someone who cannot see shapes clearly is more likely to experience visual hallucinations.Sleeping and waking schedule: Maintaining regular waking and sleeping times can increase familiarity and enhance sleeping. A person with sundowner's should be encouraged to have a mid-morning nap, but not to have another nap before bedtime.Eating regularly: Ensuring meals are eaten at similar times each day can help. During the evening, it is better to avoid items that can disturb sleep, such as ni****ne, caffeine, alcohol, large meals, and excessive quantities of sweets.Activities: Engaging in activities to redirect the person's thinking may reduce confusion or uncertainty. Examples include folding napkins or laundry, watching television, or listening to music. Activities and outings such as medical appointments, bathing, or other errands can aid sleep at night.Avoid disruption: Caregivers should try to avoid triggers known to contribute to symptoms. Events that can distract a routine or disrupt the sense of calm include loud television, boisterous children, or loud music.Music: Many older people with sundowner's syndrome enjoy listening to soft music from a favorite era. The music is familiar and many elderly people with sundowner's may find it soothing.Declutter: Keeping a house tidy and free of clutter can prevent confusion and reduce the risk of injury.

If the individual is upset or confused, a caregiver can help by doing the following:

Approach them in a calm mannerRefrain from arguing, but calmly and gently remind them of the timeReassure them that everything is okayAllow them to pace or do whatever is necessary until the episode starts to subsideRefrain from physically restraining them

Medications for sundowner's syndrome

If lifestyle-related tips do not work, medications may help to reduce any agitation and aggressive behavior.

Examples include:

Benzodiazepines, such as Xanax, Va**um, and Restoril, to reduce anxiety and promote sleepHypnotics to promote sleep, including eszopiclone (Lunesta) or zolpidem (Ambien)Antipsychotics, such as haloperidol (Haldol) and droperidol (Droleptan), to reduce hallucinations and agitation

Doctors may be reluctant to use antipsychotics in older adults as some studies have suggested that they may increase the risk of death in older people with dementia.

Taking a medication does not guarantee that symptoms will stop. Some medications may work for a short time before the symptoms come back.

Some people may experience adverse effects from the drugs that lead to a decline in other aspects of their health. A caregiver should discuss potential side effects with a doctor or pharmacist.

07/12/2016

- The Tongue in Diagnosis -
The tongue has important and unique exam findings, some are Here...!

04/12/2016

Now new research also proved the fact that "prolonged sitting" is a major culprit or you can say a ban.
So one must avoid prolonged sitting.
According to ergonomic guidelines one person should take a break of 1-2 minutes after every 20 minutes of continuous sitting. And a break of 5-10 minutes after every 90 minutes of continuous sitting at your work place.
Below given research proved that these measures are more important rather then only depending on moderate exercises one times a day. This will help you to check your sugar control and improve your body aches.

So today's Mantra is "Sit Less and Walk More"