Dr.Wasalat Nawaz Physiotherapist

03/08/2023

Dr.Wasalat Nawaz Physiotherapist

Contact number: 03143909120
Physiotherapy at your Home

آپ اپنے بزرگوں کو مستقل معذوری سے بچا سکتے ہیں۔

عمر بڑھنے کی وجہ سے بزرگوں کی جسمانی کمزوری کا آغاز ہو جاتا ہے جو بالآخر معذوری تک پہنچ سکتا ہے۔
فزیوتھراپی کی ورزشوں سے اس معذوری سے بچا جا سکتا ہے۔
اگر آپ کے بزرگ
*جوڑوں میں درد
*پٹھوں میں کمزوری
*کسی قسم کی بھی سرجری
*کسی بھی جسمانی بیماری
کی وجہ سے معذوری کی طرف جا رہے ہیں تو آپ ہم سے رابطہ کریں
ھمارے ماہر فزیوتھراپسٹ
آپ کے گھر میں آ کر مناسب ورزش تجویز کریں گے جس سے آپ کے بزرگ جسمانی معذوری سے چھٹکارا پا سکتے ہیں اور ایک متحرک زندگی گذار سکتے ہیں..

04/07/2023

ری ہیب مکس
فزیوتھراپی اینڈ سپورٹس انجری اینڈ حجامہ کلینک!!
نبی کریم صلی اللہ علیہ وسلم نے فرمایا شفا تین چیزوں میں ہے۔ ¡◇ حجامہ لگوانے میں¡¡◇ شہد پینے میں
¡¡¡◇ اور جسم کو آگ سے داغنے میں لیکن اپنی امت کو آگ کے داغنے سے منع فرمایا ہے ۔

حجامہ خون کو صاف کرتا ہے ،جسم کے کسی حصے میں درد ھو فوری ٹھیک کر دیتا ہے ،صحت یاب لوگ بھی کرا سکتے ہیں کیونکہ یہ سنت ہے ،اور اس میں بیماریوں سےبچاؤ کی طاقت ہے ،نیز اس سےطبیعت میں نشاط
آ جاتی ہے ۔
اور بہت سی بیماریاں حجامہ سے ختم ہو جاتی ہیں
مردوں اور عورتوں کےتمام امراض کیلے حجامہ کیاجاتا ہے ۔

آنے سے پہلے رابطہ کریں:
📞📞
03401010068

26/05/2023

Rehab Max Physiotherapy And Sports Injury Clinic
Rehab Hijama center
Contact no:
03401010068
03130404584

09/05/2023

ری ہیب مکس
فزیوتھراپی اینڈ سپورٹس انجری اینڈ حجامہ کلینک!!
نبی کریم صلی اللہ علیہ وسلم نے فرمایا شفا تین چیزوں میں ہے۔ ¡◇ حجامہ لگوانے میں¡¡◇ شہد پینے میں
¡¡¡◇ اور جسم کو آگ سے داغنے میں لیکن اپنی امت کو آگ کے داغنے سے منع فرمایا ہے ۔

حجامہ خون کو صاف کرتا ہے ،جسم کے کسی حصے میں درد ھو فوری ٹھیک کر دیتا ہے ،صحت یاب لوگ بھی کرا سکتے ہیں کیونکہ یہ سنت ہے ،اور اس میں بیماریوں سےبچاؤ کی طاقت ہے ،نیز اس سےطبیعت میں نشاط
آ جاتی ہے ۔
اور بہت سی بیماریاں حجامہ سے ختم ہو جاتی ہیں
مردوں اور عورتوں کےتمام امراض کیلے حجامہ کیاجاتا ہے ۔

آنے سے پہلے رابطہ کریں:
📞📞
03401010068
03130404584

29/03/2023

PHYSIOTHERAPY IN PLANTAR FASCIITIS

If you experiences pain in your heel that circulates in the entire foot and you probably an athlete, most specifically a marathon or a long-distance runner, then you may be suffering from plantar fasciitis.

Plantar fasciitis is heel pain caused by straining the ligament connecting your heel to the front of your foot, the plantar fascia.

The plantar fascia consists of three bands made of the protein collagen, which is not very good at stretching. In the skin, it’s the protein elastin that combines with it to allow it to stretch without easily tearing.

Running too much too fast, wearing bad running shoes, and other factors can cause small tears in the plantar fascia. This is what causes the heel pain associated with plantar fasciitis.

The condition typically goes away on its own with adequate rest. But in some cases, the pain can continue for months.

SYMPTOMS OF PLANTAR FASCIITIS

•Severe heel pain in the morning or after rest, which usually gets better when you walk
•Dull or sharp pain at the bottom of your heel and along the foot arch
•Pain in the mid-foot area
•Tenderness in the heel area
•Pain when pushing your foot off the ground
•Hobbling when you get down from the bed in the morning
•Recurring pain after sitting still for a long period

Although many of these symptoms are mainly limited to pain, and there are genuine medications available to help bring relief to victims when they are taken, this option may not establish permanent relief, and it is by this reason physical therapy becomes another alternative option in the management of planar fasciitis.

There have been reviews made on how tight calf muscles makes pain in plantar fasciitis very worse, and under no circumstances will medication establishes that flexibility, except through physical therapy. Therefore, many protocols under physiotherapy will be of help to patients suffering from plantar fasciitis.

Some of these protocols are adopted to promote flexibility in surrounding soft tissues, reduces further strains in the plantar fascia as well as facilitate the healing of the strained fascia.

By and large, when all these essentials are obtained, then the main symptom, pain can be contained and enable the patient continue with routine activities.

1. Regular foot stretching exercises

Mainly lack of flexibility exercises poses various soft tissues to tightness and fragility. Regularly involving in flexibility exercises will keep the foot flexible and make soft tissues more pliable to withstand injuries during activities like running or even walking. There are many ways therapist can do to help achieve this goal of enhancing foot flexibility. Find attached images of some of the ways flexibility exercises can be maneuvered.

2. Use of therapeutic modalities.

In many developed countries, many treatment strategies have been adopted in the management of plantar fasciitis. Most of the cases of plantar fasciitis is being treated with shockwaves.

In a study by Ugurlar et al., 2018, they compared four types of treatment on chronic plantar fasciitis, including: shockwave therapy, corticosteroid injections, prolotherapy and platelet-rich plasma.

The study included six follow-up periods at the 1-, 3-, 6-,12-, 24- and 36-month post-treatment, and found that shockwave therapy was most beneficial in the first six months after treatment concluded (Ugurlar et al., 2018). The study also found that shockwave therapy began working within two weeks of application, with success rates between 48-88% (Urgurlar et al., 2018).

As a non-invasive treatment to supplement a physical therapy program, shockwave therapy for plantar fasciitis is a great option. It can be effective for all kinds of injuries, both chronic and acute.

Shockwave therapy is also effective in treating other common conditions, like Achilles tendinopathy and lateral epicondylitis. Talk to us about treatment options for you.

3. Orthosis application

The use of certain shoes specially made to provide more rest and comfort to the foot will be very essential to use in the case of plantar fasciitis to give rest to the foot and prevent excessive movements that will cause further tears in the fascia.

5. Cold and Heat therapy

Cold has an analgesic effect, so as heat.
When cold it applied, it causes vasoconstriction in the blood vessels, reducing inflammation and pain.
It will therefore be best option to choose at the acute phase of plantar fasciitis to curtail the inflammation associated with it. However, Heat by nature induces vasodilation effect and as well makes tissues more labile and pliable for stretching.

By the pain gate control theory, Heat can be used to manage pain. This makes Heat an important modality to choose over cold when the conditions is chronic.
Dr.Wasalat Nawaz Physiotherapist

14/03/2023

LEG LENGTH DISCREPANCY [ANISOMELIA]

This is the term used to describe inequality in the length of the two limbs comparatively.
Leg length discrepancy can be categorized into two based on where the main source of the leg length difference can be traced as;

1. TRUE LEG LENGTH DISCREPANCY
2. APPARENT LEG LENGTH DISCREPANCY.

•TRUE LEG LENGTH DISCREPANCY

True leg length discrepancy, also known as structural leg length discrepancy is a leg length difference which occurs due to difference in the length of the bones; either from the femur or the tibia.

Many compensation patterns can be associated with true leg length discrepancy. These may involve;
1. Pronation; Hip or knee flexion on the longer leg
2. Supination; Hip and knee extension on the shorter leg.

If there is no such compensation, the anterior superior iliac spine and or the posterior superior iliac spine will be lower on the shorter leg resulting in the development of functional scoliosis. As a result, stance time is decreased on the shorter side as well as walking speed or velocity but cadence is increased while step length is decreased.

Many factors can cause true leg length discrepancy. This is to say that, the factors will affect the bony length in a way that will account for one being longer or shorter than the other. These will include; Bony diseases or displasia, neurological conditions, Infections affects the growth plate of the bone.

•APPARENT LEG LENGTH DISCREPANCY
This is also know as a functional leg length discrepancy. The inequality in the length of the limb in this case has no structural trace, but may be due to an altered mechanics. The length of the bones may be normal but other problems relative to soft tissues may account for the length inequality.

Actually, as we have understood from definition, a leg length inequality which occurs with normal bony lengths will be attributed to different etiology. Often many soft tissue problems may account for apparent leg length discrepancy. Commonly, hip adduction or flexion contracture and or pelvic obliquity.

Despite having these clear ways to identify either two discrepancies, there is a very reliable and sensitive way to establish that, a particular leg length inequality is structural or functional. This brings us to the methods of assessment.

ASSESSMENT OF LEG LENGTH DISCREPANCY

There are different ways clinicians can assess LLD.
Either of the two types of LLD have a specific method used by clinicians to rule them out. This can be done simply by using measuring tape or tape measure and having some landmarks on the body as your references. However, without using measuring tape, there is also another method clinicians can use to determine the limb length inequality and also know which bone is having the problem as in the case of true leg length discrepancy.

In that case, the patient is made to lie in supine. With the knees bent 90 degrees with the feet being flat on the table. clinician then ask the patient to lift the pelvis up so that the buttocks are lifted off the treatment table.

As soon as the pelvis is lifted, if there is height difference in the knees, the tibia is longer on the side where the knee lies superiorly(Figure 4A).

If one of the knees lies more anterior with respect to the other knee however, then it indicates that the femur is extremely longer on that limb(Figure 4B)

If the knees are fully aligned, then the next step is for the examiner to extend the knees passively for another unique and simple testing technique using the tape measure.

In the assessment using the tape measure, the clinician measures from the anterior superior iliac spine (ASIS) to the medial malleolus of both limbs for true leg length discrepancy testing

On the other hand, clinicians measure from either the xiphoid process of the sternum or the umbilicus to the medial malleolus of both limbs for functional leg length discrepancy.

In both cases, the values obtained from the measurement taken from both limbs will then be compared and the differences determined. When the difference is either 1-2cm, it will be considered normal. However, when the difference exceeds 2cm or as mostly regarded, if it greater than 2.5 cm, it will be regard abnormal and treatment may be required.

Leg length discrepancy must be taken serious as far as lower back pain, scoliosis and other spinal problems are concerned. There is a close relationship between low back pain and leg length inequality greater than 9mm according research.

Many authors over the years have noted that, leg length inequality may one way or another contribute to the development of low back especially if the difference is greater than 9mm.

Actually, one must be able to distinguish a leg length which may be normal and that which may be considered abnormal by considering certain figures. Many clinicians consider leg length difference of about 1cm and 2cm as normal. Having any of these figures may not pose any secondary problem and may require little to no treatment. However, when the difference is greater than 2.5 cm, it must be treated serious because this difference may be most likely to poses compensations that may threaten the body mechanics and result to other secondary problems.

Moreover, we must also treat leg length discrepancy with keen attention whenever we are handling total hip arthroplasty. Leg limb inequality is the commonest complication of total hip
arthroplasty. More importantly information regarding LLD are up next. Kindly stay tuned for it.

𝐏𝐡𝐲𝐬𝐢𝐨𝐭𝐡𝐞𝐫𝐚𝐩𝐲 & 𝐖𝐞𝐥𝐥𝐧𝐞𝐬𝐬

26/11/2022

15/09/2022

Meniscal Tear

12/09/2022

✔️Why positioning is important ❓

✔️Correct positioning can help to reduce the risk of👇👇👇

• Aspiration
• Contracture
• Pressure Areas
• Shoulder Pain
• Swelling of the Extremities

📍Aims of Positioning

• Normalise Tone or Decrease Abnormal influence on the Body
• Maintain Skeletal Alignment
• Prevent, Accommodate or Correct Skeletal Deformity
• Provide Stable Base of Support
• Promote Increased Tolerance of Desired Position
• Increased Stimulation to Affected Side
• Increased Spatial Awareness
• Promote Patient Comfort
• Facilitate Normal Movement Patterns
• Control Abnormal Movement Patterns
• Manage Pressure
• Decrease Fatigue
• Enhance Autonomic Nervous System Function (Cardiac, Digestive and Respiratory Runction)
• Facilitate Maximum Function
• Improved Ability to Interact with the Environment

🎗️Types of positioning 🎗️

A survey of physiotherapists’ current positioning practices found the most commonly 5 recommended positions to be:
1. Sitting in an armchair as recommended by 98% of respondents.
2. Side lying on the unaffected side then
3. Side lying on the affected side.
4. Sitting in a wheelchair and
5. Supine lying were less commonly recommended.

05/06/2022

of glenohumeral joint

⚬ articulation of humeral head with glenoid of scapula lacks bony stability, but allows for largest range of movement of any joint

⚬ static and dynamic soft tissue stabilizers compensate for lack of bony stability of glenohumeral joint

– static stabilization is provided by

● glenoid labrum (fibrocartilaginous rim), which serves to deepen glenoid fossa.
● superior, middle, and inferior glenohumeral ligaments, which serve to reinforce joint capsule and prevent anterior and inferior dislocation.

– dynamic stabilization is provided by

● rotator cuff muscles (primary stabilizers), which function to hold humeral head centered on glenoid.

● long head of biceps tendon, which offers additional stabilization of anterosuperior aspect of joint.

⚬ other structures offer important protection and stabilization of glenohumeral joint, including

– biceps pulley

● consists of coracohumeral and superior glenohumeral ligaments
● provides fixed stabilization of long head of biceps tendon, and is integral to stabilizing anterosuperior glenohumeral joint.

– coracoacromial arch
● comprised of coracoid process, acromion, and coracoacromial ligament.
● provides fixed protection and support to anterosuperior aspect of glenohumeral joint.

Wasalat's physio diary.

04/06/2022

What is tendinopathy?

Simply put, it is an abnormal tendon in pain due to overload. In other words, tendinopathy does not exist without overload.

Jill Cook presented a continuum model of tendon pathology.

It is broken down into 3 stages. 1st stage is called reactive tendinopathy, which is caused by acute compressive or tensile load or direct trauma to the tendon. It sometimes presents with minimal thickness in the affected tendon. This is natural for the tendon to reduce stress by increasing its cross-sectional area.

What does a tendon contain?

It majorly have water, up to 90%. When you take it out of the tendon, it mainly contains type 1 collagen, which is responsible for tensile strength of the tendon. Importantly, it also has ground substance, which consists of glycosaminoglycans, proteoglycans and other proteins. What they do is attracting water from the blood into the tendon when the tendon is loaded. The tendon needs that fluid to reduce stress, which is a normal process for the tendon to adapt the given load.

However, once it is overloaded, that is a different story. It gains increased accumulation of water in the tendon, which will derange the arrangement of the collagen fibres of the tendon.

That is a reactive tendinopathy. It can present with pain and minimal tendon swelling but not all the time.

It still has good collagen integrity, which still helps the tendon reverse to its normal state with optimal load management.

If not, then it can experience the 2nd stage of the continuum model of the tendon pathology, which is called "tendon dysrepair". What is it?

It presents similar to reactive tendinopathy. However, the biggest difference between those 2 stages is greater breakdown of the extracellular matrix of the tendon. It has more accumulation of water in the tendon. It presents with more disrupted tendon arrangement. However, it still has a good collagen integrity, which means an ability to reverse to its normal state.

However, the last stage, degenerative tendinopathy, can present with cell dysfunction and death that can compromise protein production in the tendon. Due to the lack of the protein, it has poor collagen integrity, which can lead to risk of tendon rupture.

It distinctly demonstrates neurovascular ingrowth. What does it do?
It is created to compensate for hypoxia of the degenerative tendon.

Why?

Tendons dont have good blood supply. Once it is degenerative, it even has less of it. Therefore, the increased neurovascular ingrowth delivers blood to the degenerative tendon.

However, some studies show that it does not seem to repair the affected tendon and does not appear to cause pain. It is debatable about how changes in neurovascular structures impact on the tendon pain and function.

Jill Cook support that there is no inflammatory proliferation process in the tendinopathy. However, there are many studies that describe increased inflammatory cells and markers in the tendinopathy. This may be due to different methods of identifying the inflammatory cells between studies. Therefore, this is still debatable about whether or not the overloaded tendon is inflamed.

BUT

Does this affect your clinical management?

No! Why?

We mainly treat our patients, based on their symptom behaviours. We do not have to know what tendon cellular environment is formed. We understand that reactive tendinopathy responds well to anti-inflammatory medications. This makes people think that there is inflammation. Possibly. BUT We understand that prolonged usage of meds and steroid injection can prevent collagen synthesis of the tendon, which will slow down its healing process.

Regardless of the inflammatory or non-inflammatory tendon status, the key factor for the development of tendinopathy is a mechanical load!

Back to what I said above. Tendinopathy does not occur without overload. We find the optimal load to the individuals' tendon, so as to enhance the tendon load capacity. So, the tendon can absorb shock and release energy in stretch shortening cycle activities, which are heavy fast loading activities, such as basketball, running, changing directions.

What is stretch-shortening cycle?

It is a high (heavy)- fast load. For instance, when you hit the ground, your tendon rapidly elongates and stores energy, then when you push off, it recoils to release energy.

As this activity is heavy fast loading to the tendon, it can increase the risk of the tendinopathy.

Wasalat's physio diary.

31/05/2022

Approach of Knee pain.

31/05/2022

ACROMIOCLAVICULAR LIGAMENT SPRAIN

TESTS AND MEASURES :

• Acromioclavicular shear test
• O’Brien test
• Acromioclavicular resisted extension test
• Crossover impingement/horizontal adduction test
• Pain provocation test
• Disabilities of the Arm, Shoulder, and Hand (DASH) score to assess physical function
• Shoulder Pain and Disability Index

29/05/2022

Trigger finger ( Treatment )



• NSAIDs
• Corticosteroid injection into flexor sheath.
:
• Objective of treatment is to reduce infammation in the flexor tendon sheath and restore mobility of the tendon under the A1
pulley at the MCP joint
• Acute phase
○ PRICE: Protection, rest, ice compression, elevation
○ Immobilization/splint
○ Buddy taping to reduce exacerbating activities
○ Ice massage
○ Pulsed ultrasound
• Chronic phase
○ Gradually increase workload as pain and discomfort diminish
○ Continue intermittent taping or splinting to reduce repeated
motions that may exacerbate symptoms
○ Addressing pain
■ Ice
■ High-voltage pulsed stimulation
■ Iontophoresis
■ Ultrasound
■ Extracorporeal shockwave therapy
○ Addressing swelling
■ Ice
■ Massage
○ Addressing weakness, joint instability
■ As symptoms improve, gradually resume activities
■ Establish full, pain-free finger ROM
■ Incorporate stretching and progressive strengthening exercises as warranted to restore full mobility and strength

28/05/2022

Different positions of the arm result In different members of the rotator cuff muscle group residing underthe acromion

24/05/2022

Position of the scapula in relation to the spine
( important )