Your Physical Therapy

Massage is techniques used by physical therapist in some of cases that may needs, In general patient always thinks that massage is a good idea whatever his\her case, but you must know that massage is not always good for you. It can be harmful for some of cases 

Indications of massage is techniques

1- General muscle stiffness 

2- General muscle fatigue

3- Chronic arthritis 

4- Spasm result from central nerve system (CNS) injures such as Cerebral Palsy, Stroke, Head injury

5- Aching pain with activities of daily living 

6- Peripheral edema result from cardiac insufficiency or circulatory problems especially after excision of lymphatic nodes 

7- Peripheral nerve system lesion as in Facial Palsy if its not associated with inflammation

8- Scars resulted from closed wounds or burns

9- For increase skin elasticity and reduce aging signs

10- General relaxation

11- Lower respiratory track infection to remove sputum

12- Stimulation of motor areas in CNS or Peripheral NS lesion

Contraindications of massage is techniques

1- Burning or stumping pain

2- Acute pain result from sudden injury

3- Areas with localized swelling

4- Pain increasing gradually after short time

5- Pain at rest

6- Infected areas

7- Un-heal scars or fractures

8- Sensitive areas such as eyes, carotid arteries ets...

9- Thrombosis, embolism or atherosclerosis

10- Acute stage of inflammation

11- Sport injures such as tendinitis or tendon sprain

12- Tumors

specific gene variants can foresee which martial service members are more effected to develop persistent,

From 2000 to 2011, there were 6,144 amputations among 5,694 injured service members, according to the Armed Forces Health Surveillance Center. More than one-third had main amputations, defined as the loss of a hand, foot, leg and more. The reported happening for persistent, residual limb pain after amputation

“Traumatic amputations of limbs profoundly change the lives of affected martial service members,” Andrew D. Shaw, MD, associate professor of anesthesiology and critical care medicine, Duke University Medical Center, Durham, N.C., said in a news release. “Persistent pain after amputation is a serious problem with no effective treatments. By identifying these ‘pain genes,’ we may be able to discover the reasons why pain occurs and predict which patients are more likely to have it. In the future, we hope to discover the biology of persistent pain and develop ways to combat it.”

In the study, investigator collected blood from 49 return active duty service members who had amputations and persistent pain. DNA, RNA and plasma were extracted from the persons samples, which then were mapped using Whole Exome Sequencing technology to identify any variations the participants have in common.

Hundreds of new DNA sequence variations were identified as pathways of biological importance as the possible source of chronic, persistent pain for service members, according to the study.

“In particular, inflammation and the interaction between white cells and the extracellular matrix appear to have central importance,” the researchers wrote in the abstract.

According to Shaw, the study was one of the first to identify pain genes in humans using sequencing, even though some of them have been identified in lab studies.

“Now that we have identified these gene variations, we need to study them and then create new medicines to prevent and relieve the chronic pain for these patients,” Shaw said in the release

chronic pain after amputation, according to a study presented Oct. 14 at the Anesthesiology 2013 annual meeting in San Francisco.

The main source of this news

http://www.todayinpt.com/

or

here

Many different modalities used in physical therapy plan of treatment local heat or local cold is on of this modalities, It was used from long years , The therapeutic uses of heat is know as thermotherapy while the therapeutic uses of cold is know as cryotherapy

A- Local Heat

1- Hot Packs

kept at 70-75 C , requires 2 hours for initial heat and 30 min between uses

Advantage : 

easily , inexpensive
short time required
safe , and there is different shapes

2- Paraffin Paths

The temp of Paraffin Paths 45 - 50 C

Advantage :

maintain good contact,
easily , inexpensive
the part can be elevated

3- Fluidotherapy 

the temp is controlled its dry heating agent that transfers heat by convection

Effect and uses of heat
A- Effect

1- Increase blood flow, application of heat causes Vasodilation ( dilation of capillary )
2- Reduction of muscle spasm and relaxation of muscle contraction
3- heat causes increase extensibility of soft tissues ( stretching )

B- Uses

1- Pain control
2- Increase Rang of motion (ROM)
3- Acceleration of healing

1- Avoid use heat in Acute injury or Inflammation or muscle strain

2- Avoid use heat in hemorrhage cases or over an open wounds or burn
3- Avoid use heat in poor sensation cases
4- Avoid use heat in cases of Thrombosis


1- Cold Packs

temp 0-5 C
duration : 10-15 min, can be repeated after 1-2 hours

Advantage

easy, inexpensive
cover large area of body
can be applied with elevated

2- Ice Massage

Advantage

inexpensive
can be observed during treatment
can be use for small or large area of body

Effect and uses of Cold

A- Effect

1- initial decrease of blood flow then increase in blood flow ( Vasoconstrection then Vasodilation )
2- increase pain threshold and decrease sensation of pain
3- decrease spasticity
4- facilitation of muscle contraction

B- Uses

1- inflammation , acute injury control
2- Edema control by decrease intravascular fluid pressure and increase blood viscosity After trauma using ice with compression and elevation
3- Pain control
4- symptom management in multiple sclerosis

Contraindication of use cold
1- cold hypersensitivity
2- cold intolerance
3- over an area with peripheral vascular disease
4- over an area with circulatory compromise
5- over regenerating peripheral nerve

What the muscles strain? 

muscle strain is overstretch or may be tear of the muscle fibers its common in hamstring muscles and low back muscles

There are 3 grades of strain :

1- Mild strain : its mild tear of muscle fibers and its take from 1-3 weeks to recovery 

2- Moderate strain : its more that mild and the tear is take more number of fibers and need more than 4 weeks or more to recovery 

3- Sever strain or full rupture : its complete tear of muscles fibers or tendons its not common and its can be recovery by surgery then physical therapy that's may take 6 weeks or more 

Sign and Symptoms

1- Pain 

2- Limitation in rang of motion (ROM)

3- Muscle weakness

4- Swelling 

5- Inability to do actives by effected part

Warning 

Avoid using heat, stretching, and massage 

A- Heat can increase risk of inflammation 

B- Stretching delay heeling and make time more longer for recovery
C- Massage can increase severity of the case and can distributed the inflammation area 

Treatment of muscles strain

Physical therapist have a great experience in muscles strain cases and they can deal with muscle strain 

At first physical therapist plan of treatment is to apply The optimal management is the RICE technique its ( Rest, Ice, Compression and Elevation ) for mild and moderate grade of muscles strain
Rest and never use the muscles of effected part at lest 14 week 

Ice to prevent any inflammation and to reduce pain
Compression to keep joint or part as whole from and unwanted movement and reducing swelling by using compression with Elevation the part 

For Sever muscles strain with complete rupture the physical therapist not starting any plain of treatment until the surgery give good result and then applying the same in mild and moderate muscles strain some cases need to use assistive devices like crutches

Infantile Torticollis is deformity of the neck due to contracture of one sternomastoid muscle . The head become inclined laterally to one shoulder and the face is deviated to the opposite side the child is born with normal neck , the causes are usualy either abnormal intrauterine position of the fetus or difficulties in labor. The deformity can be noticed at the first 1 week of age , Stiffness of sternomastoid muscle may be proceeded by the appearance of sternomastoid muscle swelling in infancy. In many cases of torticollis there is no history of appearance such a swelling, The sternomastoid swelling appears when child is 2-3 weeks and disappears is few months .Only 20% of cases develop facial asymmetry in adult life the face of affected side become shorter and wider

Sign and symptoms 

Babies with torticollis look like normal babies but there is one deferant you can see it if the baby turning. A baby with torticollis might:

1- Tilt the head in one direction but that is difficult to see in very young infants

2- have difficulty breastfeeding on one side or prefers one breast only

3- difficult to turn toward you 

4- Some babies may have Positional Plagiocephaly (flattened head syndrome)

Suspected complications on neglected cases of Infantile torticollis

1- hearing loss at the ear of affected side

2- vision deterioration at the eye of affected side

3- asymmetry of face

4- compensatory scoliosis of the back

5- affected psychological status of the child

Physical Therapy Rehabilitation For Infantile Torticollis

4- strengthening exercises for neck and trunk with gravity assosiat

5- massage of the stiffed muscle of the neck

6- Home Program: teach the family how to carry thew infant, how to play with him and how to feed him in the proper way that insure the correct position of the neck and inhance good normal growth of the neck and head

On the last post we Bell Palsy we show the common causes and sign of Bell's Palsy, On this post we will show the Physiotherapy way for treat the Bell's Palsy

A. Electrotherapy

The electrotherapy modalities reviewed included:
electrical stimulation (ES), Ultrasound, electromyography and biofeedback
No evidence support electrical stimulation benefit for acute facial paralysis but it's effective for chronic condition
Biofeedback is more effective when muscle activity presents
Ultrasound can be beneficial for acute conditions

B. Neuromuscular retraining

When each muscle group is being assessed, the patient observes the action of these muscles in the mirror and instructed to perform small symmetrical specific movements on the sound side to identify the right response. Each patient presents with different functional disability, so there are no general list of exercises.

The movements should be initiated slowly and gradually so that the patient can observe the angle, strength, and speed of each movement, because rapid movements can't help the patient in controlling the abnormal movement

The patient can apply a manual resistance as isolated facial movement improved in affected side to be obvious without synkinesis.(with out other muscle move ) abnormal movement

C. Manual massage
Massage can be done with other treatment options. It can be done to improve perceptual awareness.

Massage technique on the face include:


1. Effleurage
2. Finger or thumb kneading
3. Wringing
4. Hacking
5. Tapping
6. Stroking

D. Exercise
by applying different Facial expressions like

1- Cheek puff and hold without let the air outside
2- ٍSmile
3- Frowning moving Eyebrows several time 

Facial palsy is neurological Problem result from lesion of the 7th cranial nerve leading to partial or total paralysis on the effected side of the face muscles the patient should early start with physiotherapy as fast as its possible because early rehabilitation can back you to normal 

Facial Palsy Causes 

A- Sudden exposure to cold air currents or weather changes

B- Traumatic accidents

C- Tumors

D- Diabetes persons more exposure to nerve palsy four times than others

E- Pregnant women are more exposed to Bell's palsy three times more than others 

F- Middle ear infection

Sign and symptom 

The severity of symptoms depends on the extent of facial nerve damage

A- dry eyes and mouth

B- Inability to blink or close the eye, tearing

C- Impaired or loss sense of taste

D- Inability to speaking or form sentence

E- Hypersensitivity to sound

To See the Treatment Tips Follow this Link
Physiotherapy for patient with facial palsy 

Means of Core Stability 

Core stability is a group of muscles surrounding your back and abdomen. These muscles are also known as the 'core', Core stability means ability of the person to control his/her the position and movement during some specially exercises this exercises work centrally in a axial point in body, core stability exercises works deeply in your back and abdomen muscles which connect to the spine, pelvis, shoulders and help your to maintenance good health neutral posture and improve for all arm and leg movements

Core stability exercises benefits 

1- Improve coordination in your limbs 

2- Increase your functional activities 

3- Improve your body postural 

4- Increase your body Range of motions (ROM)

5- Reduce risks factors of injury

6- Improve general body power

1- Breathe normally and do not hold your breath, holding breath is sign that you are not relaxed

2- You can use Core stability exercises as cooling down after hard exercises

3- Don't let your abdominal muscles bulge that mean you using your rectus abdominus muscle instead of the transverses abdominis

A) Support your feet by chair placed under your heel if you find that exercises hard hold to 1 Minute then relax repeat this for 5 time

B) increase difficulty of the exercises by remove the chair and hold 30 seconds then relax repeat this for 3 time

a) Lie on your back with your knees flexed and your feet flat on the floor.

b) Rise up your pelvis so that you form a bridge position with a straight line running from your shoulders to your knees.

c) Release your left leg off the floor and extend it so that it continues the straight line. You should be able to feel your right buttock, your back, and lower abdomen working to keep the position.

d) Hold for 30 seconds then repeat 3 times for each legs. 

Note : avoid your pelvic tilt at all while your leg raised

a) Balance on the floor on your hands and knees. back should be flat and your hips parallel to the floor.

b) Raise one leg behind you as much as you can and don't rotating your hips or arching your back. The movement should be slow and controlled.

c) hold for 30 seconds then relax repeat 3 time for each legs

a) Balance on the floor on your hands and knees. back should be flat and your hips parallel to the floor.

b) Raise your right arm out in front of you then raise your left leg out behind you, keeping it straight

c) hold for 30 seconds then relax repeat this in the other side and relax. Repeat this exercise 3 time for each side