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Pain Free Orthopedic & Physiotherapy, Vasai (2025)

10/10/2019

Physiotherapy for Back and Neck Pain

Physiotherapy has been shown to be effective in the management of back and neck pain. Here we will discuss what the components of an excellent physiotherapy program for back or neck pain are and learn about these painful conditions.

Back Pain Physiotherapy

Over 80% of the population will experience persistent back pain at some point in their life. Pain can be intense and will often limit an individual’s function for a period of time. Most back pain can be managed with Physiotherapy enabling people to return to an active pain free life.

Back pain comes in several types and may include different diagnoses. A skilled Physiotherapist can assess your back pain to determine what type of spinal disorder you are suffering from and design a treatment plan that will be effective at addressing your specific condition. A herniated disc requires a different treatment plan than spinal stenosis or spondylolisthesis so it is important that your Physiotherapist spend time classifying your back pain before starting treatment.

Common Treatments for Back Pain

Physiotherapy for back pain may involve some of the following treatments;

Manual (hands on) Therapy

Core muscle strengthening

Range of motion exercises

Soft tissue treatment

Joint manipulation

Postural retraining

Ergonomic advice/assessment

Thermal modalities (heat/ice)

Acupuncture or other pain-relieving techniques

Therapeutic taping

Passive electrical modalities and machines that are applied to the body have not been shown to be effective in the treatment of back or neck pain.

Neck Pain Physiotherapy

Neck pain is among the most common musculo-skeletal complaints in the developed world. While most episodes of neck pain are not an indication of any serious illness, the pain experienced can be severe causing people to seek physiotherapy treatment to reduce and ultimately eliminate their pain.

08/10/2019

Physiotherapy for Shoulder Dislocation

Physiotherapy is a critical component of recovery from shoulder dislocation. A comprehensive program focused on restoration of function and joint stability by improving muscular performance is the key to a good outcome.

Shoulder Dislocations 101

The shoulder is the most commonly dislocated joint in the human body. Almost 2% of the population experience a shoulder dislocation each year. Males are more likely to dislocate than females and young people are more at risk. This may be due to differences in shoulder stability or in participation in higher risk activities, but likely is a combination of both factors. The majority of shoulder dislocations are anterior meaning that the humerus (upper arm bone) slips out of the glenoid (shoulder cup) by being pushed forward toward the front of the body. These dislocations typically occur when the arm is abducted and forced into external rotation (think of the position of a pitchers arm in mid pitch).

Not all shoulder dislocations are the same and some result in a more unstable joint than others. One of the main differences pertains to secondary injuries that occur when the shoulder dislocates. A Bankart lesion is a is a tear in the capsule-labrum complex at the front of the glenoid and can occur when a person sustains an anterior shoulder dislocation. A Hills-Sachs lesion is a bony injury to the posterior aspect of the humerus that occurs as the bone hits the front of the glenoid. If a patient has these features and they are of substantial size the stability of their shoulder will be more compromised.

About 30%-50% of people who sustain a shoulder dislocation will have a recurrence at some point in time. There are many factors that contribute to this including;

The instability resulting from the first dislocation

Activity risk factors

Age at the time of first dislocation

The persons soft tissue mobility in general

06/10/2019

Physiotherapy for Pinched Nerve

Physiotherapy is an important intervention for pinched nerve or nerve compression. As nerves exit the spine through holes called foramina, anything that encroaches into this space can put pressure or “pinch” the nerve. Nerve compression results in significant discomfort for patients. With appropriate physiotherapy most compressions can be managed conservatively without surgery.

Causes

Degenerative disk disease

Herniated disk

Trauma, muscle spasms

Symptoms

Pain

Numbness

Tingling

Muscle weakness

Muscle spasms

Goal of Physiotherapy

The goal of physiotherapy is dependent on the extent of injury. Upon immediate injury, goal is to remain conservative and not aggravate the existing injury. Once the initial inflammation has subsided, a stepwise approach to care is initiated. After a thorough spinal examination therapy is directed to:

Improve strength

Increase flexibility

Evaluate and correct posture

Reduce clinical symptoms of pain, tingling, and numbness

Treatment

After the immediate injury and a thorough exam, a program of stretching and strengthening will be initiated to restore flexibility to the joint and muscles involved. Your program will be tailored to your area of injury. Common treatments include:

Manual therapeutic technique

Soft tissues massage, stretching and joint mobilization

Therapeutic Exercises

Stretch and strengthening exercises to reduce stress while improving mobility

Neuromuscular re-education

Improve posture, stability, and body mechanics to protect the injury

Other modalities include

E-stim, ultrasound, ice, cold laser, traction

Establish home programs

Establish daily task to advance function to the next level.

02/10/2019

Physical Therapy for Rheumatoid Arthritis

Rheumatoid Arthritis (RA) is the most common form of autoimmune arthritis. It is a chronic disease that causes pain, stiffness, swelling and limited motion most often in the small joints of the hands and feet. Inflammation from the disease can affect other organs in the body as it progresses including: skin, eyes, lungs, heart, kidneys, salivary glands, nerve tissue, bone marrow, blood vessels.

Signs and Symptoms

Symmetrical joint pain and swelling, especially in small joints of the hand, wrist, and foot

Morning stiffness that usually gets better throughout the day

Generalized aching, stiffness, depression

Loss of energy

Low fevers

Loss of appetite

Dry eyes and mouth

Lumps that grow beneath the skin (rheumatoid nodules) often found on elbows and hands.

Causes

RA is an autoimmune disease, which means immune cells in the body do not function properly and attack the body causing damage to healthy tissue, in this case the joints. This then causes inflammation in the synovium, the tissue that lines the joints. The attacking immune cells also release chemicals that cause more inflammation damaging the cartilage that cushions bone.

Who gets it?

Women are more likely than men to develop the disease. RA can occur at any age, most commonly starting between 40-60. Family history may predispose you to getting RA. People who smoke, have been exposed to asbestos or silica, and who are obese have a higher risk of developing the disease.

Diagnosis:

History significant for inflammatory arthritis involving three or more joints with at least 30 minutes of morning stiffness.

Lab tests:

+ Rheumatoid factor and/or +anti-CCP antibodies

Elevated Erythrocyte sedimentation rate (ESR) and serum C-reactive protein (CRP)

Imaging: X-rays of hands, wrists or feet that show a characteristic joint erosion pattern.

Diseases with similar features have been excluded: psoriatic arthritis

28/09/2019

Physiotherapy for Shoulder Pain

Shoulder pain is a symptom that is experienced by patients across the age spectrum. While there are many causes of shoulder pain, physiotherapy is important in the initial management of many conditions. A treatment plan is tailored to the patient’s diagnosis, age, activity level, and future demands. Working with a comprehensive healthcare team including a physician and physiotherapist will ensure optimal chances of success as additional interventions such as an injection and/or surgery may also play a role.

Causes of Shoulder Pain

Subacromial impingement

Subacromial bursitis

Biceps tendonitis

Os acromiale

Acromioclavicular joint injury

Fractures

Rotator cuff tendonitis

Rotator cuff tears

Osteoarthritis

Rheumatoid Arthritis

Avascular Necrosis

Scapulothoroacic bursitis

Scapular winging

Frozen Shoulder

Imaging for Shoulder Pain

Xrays to assess for fractures, arthritis, os-acromiale, AC joint issues

MRI to assess the cartilage, labrum, tendons, and musculature

Principles of Physiotherapy for Shoulder Pain

Physiotherapy plays a role in the management of shoulder pain by improving shoulder joint and shoulder blade movement patterns, increasing strength in the rotator cuff and shoulder blade musculature, and minimizing inflammation inside and around the shoulder joint. Certain conditions also present with a decrease in active or passive range of motion. Passive range can be improved through the use of manual therapy and mobilization whereas active range of motion should be addressed with strengthening exercises as well. Focusing on inflammation, mechanics, flexibility, and strength in the neck and elbow is also important as the joints can be affected by what is above and below.

26/09/2019

Physiotherapy for Sprains, Strains and Tears

Sprains, strains and tears are descriptions used to categorize soft tissue injuries usually caused by some type of trauma. Soft tissue is slow to heal and is at risk for healing incompletely or leaving the sufferer with dysfunction. Physiotherapy for sprains, strains and tears is focussed on ensuring that the patient has the best repair possible while preserving normal function of the body part effected.

Objectives of Physiotherapy for Sprains, strains and Tears

Relieving pain

Limiting movement of vulnerable tissue

Remodelling scar tissue to ensure a strong and functional repair

Maintaining normal range of motion

Preserving bodily function

Strengthening supporting musculature

Common Treatments for Sprains, Strains and Tears

Manual (hands-on) therapy

Therapeutic exercise prescription and performance

Soft tissue release / stretching techniques

Bracing

Taping

Pain relieving modalities

Counselling / planning on return to activity, work or sport.

A skilled physiotherapist will be able to use some of the techniques above to relieve pain and ensure you have as complete a recovery as possible from your injury.

22/09/2019

Physiotherapy for Sciatica

Physiotherapy for Sciatica, pain that originates from the back and radiates down the leg, can be a very effective treatment modality. One of the most common causes of sciatica is a disc herniation in the lumbar spine. When the herniated disc impinges or compresses a nerve root, sciatica is a symptom reported by patients. It is well known that 90% of patients with a lumber disc herniation improve with nonoperative care within 3-6 months.

Signs and Symptoms:

Pain that starts in your lower back to your buttock and down the back of the leg.

Pain can be an ache or a sharp burning sensation.

Pain can worsen with coughing, or sneezing this can indicate a disc “slipping out”

It is possible to feel numbness or tingling in the affected side.

Severe symptoms include trouble walking due to pain.

Causes:

Sciatica happens when the sciatic nerve becomes pinched.

There are discs between the bones of your spine (vertebrae) that act as shock absorbers. Sometimes they can slip or bulge out and can cause pressure on the nerve. This is the most common reason for sciatica.

Bone outgrowths called “bone spurs” can press on nearby nerves.

There is a muscle that lies deep within your buttocks called the piriformis muscle – sometimes this muscle can become tight or spasm which can put pressure on the sciatic nerve.

Sometimes other medical conditions (like tumors) can injure nerves near the spine.

Risk Factors/Who it Impacts

Most common changes in the spine are due to age, such as slipped disc, or arthritis. These conditions can increase risk of experiencing sciatica.

Obesity: more stress, due to weight, on your spine can cause spinal changes

Sedentary lifestyle: Sitting for long periods of time can contribute to development of sciatica

Diabetes can lead to increase risk of nerve damage and contribute to development.

Diagnosis:

Usually diagnosed based on the exam findings by your physician

21/09/2019

Physiotherapy for Labral Tears of the Hip

Physiotherapy for labral tears of the hip can be effective in individuals who have been referred for this condition. The majority of patients who have hip labral pathology have been diagnosed with femoroacetabular impingment. Individuals can have impingement secondary to a pincer lesion or cam lesion (i.e. bone spurs). Some patients can also have a mixed presentation with both a pincer and cam.

Clinical Presentation

Patients most commonly present with an acute or gradual onset of pain along the anterior groin region. Pain may also be present in a c-shaped distribution around the hip joint. Some patients may report clicking or snapping, while a minority may also experience symptoms posteriorly. There are many causes for hip pain and labral pathology is just one. A careful workup to exclude other common conditions such as hernias, osteitis p***s, back pain, and problems related to the pelvic floor and reproductive organs must also be performed.

Imaging

Patients will be worked up with xrays, a MRI, and if the patient is a surgical candidate a 3D CT scan may also be performed for preoperative planning.

The Role of Physiotherapy for Labral Tears

Physiotherapy should be used for the initial management of labral pathology. Additional treatment may consist of an intra-articular injection. In general, physiotherapy for labral tears should progress through phases. Restoration of the hip joint’s normal range of motion is an early goal. Along with this, soft issue mobilization (specific to the adductors, tensor fascia lata, iliopsoas, and quadratus lumborum) should also be performed, as well as, strengthening core musculature and lower back muscles. Finally, working on agility and functional exercises in multiple planes can be undertaken. The timeline for this aforementioned approach can be over 3-6 months in the non-surgical setting.

Following surgery, rehabilitation progresses in more milestone driven manner.

20/09/2019

Physiotherapy for Tennis and Golfer’s Elbow

Tennis and Golfer’s Elbow is also referred to as lateral and medial epicondylitis of the elbow, respectively. Both conditions can be managed with physiotherapy as the initial form of treatment.

Presentation

Medial epicondylitis is less common and is more difficult to treat. Both conditions are most often caused by overuse injuries due to repetitive loads and microtrauma. They can also be caused by one incident that is acute in nature. Patients can present with rest pain and activity pain that is caused by inflammation and/or tendinosis. Some patients can also get partial to complete tearing of the tendons on the medial or lateral side of the elbow joint which is associated with weakness. Patient who do not respond to physiotherapy, injections and bracing should undergo advanced imaging to assess for such tears.

Imaging

Patients with suspected tennis elbow should undergo xrays and MRI exams to confirm the diagnosis. The objective of the MRI is to rule out related conditions and to determine whether a tear in the lateral extensor tendons or medial flexor-pronator tendons is present. In patients who have golfer’s elbow and associated numbness or tingling in the arm, nerve conduction velocity tests are also indicated.

Principles of Physiotherapy for Tennis and Golfer’s Elbow

Activity modification, rest, passive stretching, bracing and the use of anti-inflammatories comprises the treatment strategy for this condition. Counter-force bracing, shock-wave therapy, and kinesiology taping has also been shown to be effective. There is also evidence for the use of adjuvant treatments such as corticosteroid or platelet-rich plasma injections to manage this condition. The majority of cases can be managed with physiotherapy.

19/09/2019

Physiotherapy for Meniscal Tears

Physiotherapy has been shown to be as effective as arthroscopic surgery for meniscal tears of the knee. Given that Physiotherapy is much less invasive, it has become the first line therapy for meniscal tears.

What is the Meniscus

The menisci are crescent shaped cartilaginous structures inside your knee that act as shock absorbers and improve the stability and mobility of the joint.

Symptoms

The most common symptom associated with meniscal tears are:

Knee pain

Knee swelling

Knee locking

Knee stiffness

How Does the Meniscus Tear?

There are two categories of meniscal tears. Degenerative meniscal tears develop from excessive “wear and tear’ on the knee joint over time. These are seen as part of the typical arthritic process that a knee can go through over time. They become a problem when the tear becomes severe enough to cause pain or limit the function of the knee joint. Acute meniscal tears result from trauma. They usually involve a twisting motion of the knee. The meniscus can get caught between the femur and tibia while in motion causing the structure to tear.

Meniscal Tear Physiotherapy Objectives

The objectives of physiotherapy for meniscal tears are the following;

Restore full pain free joint range of motion

Reduce swelling

Reduce pain

Restore joint proprioception and balance

Strengthen all of the muscles that control the hip, knee and ankle.

Deliver a sensible return to sport/activity plan

A very small percentage of acute meniscal tears need to be managed with arthroscopic surgery. Before making that determination, the patient should do a trail of Physiotherapy for several weeks to ensure that the problem cannot be managed without surgery. In some rare cases a patient will sustain a large meniscal tear and the knee will be “locked” in a bent position. If this is the case the patient should be evaluated and considered for arthroscopic surgery as soon as possible.

18/09/2019

Physiotherapy for Tendonitis

Physiotherapy is an effective treatment for tendonitis. Tendons connect muscle to bone. Tendonitis is a result of a tendon being inflamed from overuse, injury, infection, or autoimmune disease.

Signs and symptoms:

Swelling and pain of the joint/tendon

Reduced range of motion

Causes:

Minor or major injuries to site

Overuse injury of joint/tendon

Incorrect posture

Infections

Inappropriate stretching

Where does Tendonitis commonly occur:

Base of thumb

Elbow

Shoulder

Hip knee

Achilles tendon

Physiotherapy Objective

Like other forms of inflammation, the main objective is to reduce irritation to the tendon. Common first line remedies include rest, ice, stretching, and topical/oral NSAID use. When symptoms continue, physiotherapy can be a very beneficial modality in reducing irritation to the ligament.

Physiotherapy Treatments:

Acute injury

Range of motion activities

Splinting

Chronic Injury

Eccentric Exercises

Shock wave

Active release therapy

In the hands of a well-trained physiotherapist, patients can dramatically reduce symptoms of pain and inflammation when applied in conjunction with first line remedies.

16/09/2019

Physiotherapy for Rotator Cuff Injuries

The spectrum of injury for rotator cuff pathology ranges from tendinosis (i.e. intrinsic wear and degeneration) to partial tears, and ultimately to a complete tear. Patients with tendinosis and partial tears may experience shoulder pain while patients with complete tearing of the rotator cuff may also endorse shoulder weakness. Night pain is also a common symptom in patients with rotator cuff pathology.

It is important to note that the incidence of rotator cuff pathology increases with age yet despite this, the majority of people are likely asymptomatic. It is when patients experience symptoms that intervention is required. Physiotherapy is the mainstay of initial treatment and can be accompanied by additional interventions such as anti-inflammatory medications, subacromial corticosteroid injections and/or surgical intervention.

Principles of Physiotherapy for Rotator Cuff Injury

After a confirmed diagnosis of rotator cuff pathology and the exclusion of diagnoses related to the neck and remainder of the arm, physiotherapists and patients will work together to focus on four major goals. These include:

Decreasing Inflammation by avoiding positions and activities that cause shoulder pain.

Restoring proprioception and muscular control by focusing on intact rotator cuff muscles, as well as, the smaller muscles that stabilize the shoulder blade

Improving active and passive range of motion

Achieving incremental improvements in rotator cuff strength, thereby allowing for enhanced participation in advanced daily activities and leisure activities.

According to the MOON shoulder group (an multi-centre evidence base research group), the majority of patients who have rotator cuff pathology can be treated without surgery. With the use of an appropriate structured rehabilitation program, physiotherapists and patients can work together to achieve the aforementioned goals and improve quality of life

14/09/2019

Physiotherapy for Parkinson’s Disease

Parkinson’s disease is a chronic and progressive movement disorder. Development of the disease is gradual, but worsens over time. Parkinson’s involves the malfunction and death of vital nerve cells in the brain (neurons).

Signs and Symptoms

Resting tremor, or shaking, most often of the hands, but also can occur in the arms, legs, jaw and face. It often appears as a back and forth rubbing of the thumb and forefinger called a pill rolling tremor

Bradykinesia or slowness of movement

Rigidity or stiffness of the limbs and trunk

Postural instability, which is impaired balance and coordination

Speech changes – talking softly, quickly, slurring words, or hesitation before talking

Causes

The cause of Parkinson’s disease is unknown. There is a genetic mutation that has been identified, but it is uncommon except in cases where many members of the same family are affected.

The symptoms of the disease are caused by dying neurons. These cells produce dopamine which is a chemical messenger which controls movement and coordination. As the disease progresses the amount of dopamine produced in the brain decreases, which leaves the person unable to control movement normally.

Who gets it?

Parkinson’s beings in middle age or late in life, the risk of getting the disease increases with age. Mean age to develop it is 60. Men are more likely than women to get the disease and having a close relative with Parkinson’s increases your chances of developing it. Studies also show an ongoing exposure to herbicides and pesticides increases the risk of development.

Diagnosis

Neuropathologic examination is the best way to diagnose the disease. A patient must have Motor Parkinsonism:

Bradykinesia (slowness in movement) and resting tremor (shaking present at rest, which goes away when person initiates movement) or rigidity (resistance to passive movements of major joints).

Treatment

Pharmacologic (drug therapy)

13/09/2019

Physiotherapy for Dizziness

Dizziness is the 2nd most common symptom reported to family physicians and a condition that eventually affects almost every person. It is a general term that often describes light-headedness, vertigo, imbalance, rocking and swaying. Physiotherapy can be an excellent way to improve balance, regain stability and desensitize the sensations of dizziness.

CAUSES

Dizziness can result from an impairment to a variety of different areas of the body and sometimes from a combination of those different systems. Here are some of the most common:

Vestibular organ or nerve dysfunction (vestibular neuritis/labyrinthitis, Meniere’s, inner ear infection)

BPPV (benign paroxysmal position vertigo)

Concussion or head injury

Stroke or tumor

Neurological disease such as multiple sclerosis

Hypotension and dehydration

Medications

Heart dysfunction (attack, arrhythmia, heart valve)

Degenerative changes associated with ageing

HOW PHYSIOTHERAPY CAN HELP

Assessment

Dizziness can be difficult to diagnose, with experts often disagreeing. Vestibular physiotherapists interact with dizziness patients regularly and can provide valuable input into the assessment findings. Particularly as these therapists tend to incorporate testing from a rehabilitative perspective. This allows the assessment findings to be easily incorporated into relevant treatment techniques.

Treatment

a) Habituation

Strategies to gradually allow your head and body to desensitize to specific movements or positions that cause an increase in symptoms.

b) Compensation

The use of other systems in your body to provide your head with the balance and movement information it needs to maintain stability. Areas such as your brain, your eyes, the motion sensing joints in your legs and spine.

c) Functional Exercise

Exercise prescription to improve strength and conditioning, to stabilize your gait, and to normalize movement patterns.

d) Education

$Physical Therapy for OsteoporosisOsteoporosis is the leading cause of fractures in the elderly. It is a disease where l...$

12/09/2019

Physical Therapy for Osteoporosis

Osteoporosis is the leading cause of fractures in the elderly. It is a disease where low bone mass leads to a decrease in quality of bone, results in increased bone fracture risk.Fractures can cause pain and disability. Primary osteoporosis includes two types:postmenopausal and senile types. Secondary osteoporosis is when another medical condition (vitamin D deficiency, hyperthyroidism) leads to excess bone loss.

Signs and Symptoms:

No clinical features are noticed until there is a fracture. Patients without symptoms assume they cannot have osteoporosis.

Most common type of fractures are vertebral fractures, and go unnoticed until the patient needs a chest or abdominal x-ray.

Distal radius fractures (forearm/wrist) are more common in postmenopausal women. (type I primary)

Hip fractures are a common consequence in the elderly (type II primary)

Pain is more likely to be common in osteomalacia in the absence of fractures.

Causes:

Age related changes – cells respond less to factors that help bone growth. This is senile osteoporosis or type II – patients are more likely to suffer wrist, vertebral and hip fractures.

Decreased physical activity can increase rate of bone loss.

Genetic factors can contribute to development of osteoporosis (small % of cases)

Calcium nutritional state contributes to peak bone mass. Patients with calcium deficiency during rapid bone growth (when younger) are at higher risk.

Hormonal influences: Estrogen helps with bone growth and lack of estrogen (post-menopausal) leads to higher risk of having osteoporosis. This is type I osteoporosis – fractures of distal forearm and vertebral bodies are more common.

Who does it impact/Risk Factors:

Females (especially postmenopausal women) are more likely to have lower peak bone mass. 85% of women in nursing homes overage of 80 years have osteoporosis.

Senile osteoporosis is most common in age >70 years.

A

11/09/2019

Physiotherapy for Neurological Conditions

The term ‘neurological conditions’ comprises a wide range of diseases and injuries that effect the central and/or peripheral nervous system. It is however possible to subcategorize neurological conditions. Presented below is a overview of the types of physiotherapy treatment that patients with neurological conditions benefit from.

Physiotherapy for Degenerative Neurological Conditions

Two examples of degenerative neurological conditions are Multiple Sclerosis (MS) and Amyotrophic Lateral Sclerosis (ALS). These are diseases that degrade the function of the neurological system over time. Little can be done to stop the progression of these types of diseases but Physiotherapists can still have a profoundly positive effect of the quality of life of patients living with these diseases.

Physiotherapy for degenerative neurological conditions is focused on:

Strategies to compensate for any lost neurological function

Exercises to preserve function that remains

Preservation of the patient’s joint mobility and strength

Preservation of balance

Preservation of activities of daily living (such as dressing, cooking, cleaning etc)

Prescribing devices to aid with tasks that have become difficult

Prescribing mobility aids

Education on their condition

Evaluation of the progression of their condition

Physiotherapy Secondary Neurological Conditions

A secondary neurological condition can be defined as one that has developed as a result of some other pathological process. Two examples of this are Stroke, which develops as a result of an event limiting blood flow to part of the brain and the neurological impairment that can result from a mass or tumor in the brain. The symptoms and impact of these conditions depends entirely on what part of the brain is effected and how widespread the damage is. Recovery after stroke, or after the successful treatment of a brain tumor is possible owing to the amazing ability of the brain

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