Effects of lockdown

The whole world is under lock down due to corona virus and so is India. This has affected the life of each and every person -rich or poor, students, working individuals, kids, elders etc.

There are a lot of pros and cons of this lockdown.  But today i would like to share my experience about the lock down.

Like all the working professionals even i was affected by the lock down professionally as i had no option of work from home and that made very restless. This continued for a few days though i helped my mother to do the household work but couldn't find peace. i watched tv, netflix  series , movies etc but was still stuck there.

Then a thought came to my mind what if i had no phone, or tv and had to sit at home,what would i do??? thats when the idea came to mind i had an opportunity to do what i wanted to do, I was getting time for myself . so i took my diary and wrote down all that came to my mind. Here's the plan i made:

• Firstly, i started tele consultation for my patients who needed help. This idea helped me and my patient. they kept updating me about their condition and i could help them.
• Meditation: i know a lot of people find it difficult to sit in one place and meditate but trust me its  the best thing to do and you dont have sit in a perfect posture or place. just close your eyes and focus on your breathe (you can count your breathes this helps you relax or you can do guided mediation using you tube) initially it was difficult but then i loved doing it. I just lie down and focus on breathing for around 10-15 mins, its ok if your mind wanders cause thats when you know what you want exactly.
• Reading: I love to read but the avid reader that i was few years back i had lost it. I use to bring books and not read them but then i got back to my books and read some really beautiful books like Immortal Talks, Ikigai, Siddhartha, Sidney Sheldon.
• Reliving the childhood memories: I always loved doing art and craft, rather each one of us  is an artist but with the work load and pressure to do the best in life we forget the little child we are. I explored the different art forms which i love for eg: Pointilism, doodling, paper cutting , calligraphy, making hand made paper, miniature diaries etc. and each art taught me a new art like Pontilism - being focused, doodling- calming down, Paper cutting- precision and focus, calligraphy - writing with a pen which we dont do these days

• Exercise: i did the household activities as the maid was given holiday but i also did some yoga and pilates to keep my body active and mind calm.
• Family time: over a period of time due to work commitments I was not able to spend time with my family but this time of quarantine helped me cherish all those old moments and making new memories.
• Finding solace:The biggest thing i found was solace.In the race to prove my self and to come first i had lost the touch with the most important person in my life- myself. I started understanding myself better, taking care of myself , accepted my insecurities and fears. due to the lock down i did loose a few contacts and connections but i found the most important connection -the one i have with myself. Its right "if we cant go outside lets get inside"    

We are lucky we are getting this time folks so use it to do what you always wanted to do but couldnt do due to professional or personal commitments.          

PHYSIOTHERAPY AND BPPV

Bening paroxysmal positional vertigo or BPPV as it is commonly known contributes to around 40-50percent of the cause of vertigo- a sudden sensation of spinning inside the head.

Benign paroxysmal positional vertigo causes dizziness which is triggered by specific head positions and may last for few seconds. This usually occurs while turning in bed or getting in and out of the bed.

Role of ear in BPPV?
The human ear has a tiny organ called the labyrinth which has three semicircular canals. These canals roughly lie perpendicular to each other and contain fluid and hair like structures which act as sensors to head rotation.
The other structure called as the otholith organ which monitors head movements like up and down , left and right. It also senses the head position in relation to gravity. The otholith organ contains small calcium carbonate crystals.

For some reason the crystals become dislodged from the otholith organ and enters one or more of the semicircular canals. This makes the semicircular canals sensitive to head position changes which it wouldn't respond to in normal conditions. Thus causing spinning of head.

Symptoms of BPPV:

• Dizziness which lasts for less than a minute
• Sense of spinning of head or surroundings
• Loss of balance or unsteadiness
• Nausea 
• Nystagmus- abnormal eye movements 

Diagnosis:

Different tests are performed to rule out the cause of vertigo:

Video nystagmography, balance test.

Treatment:

Conservative:

• Canalith repositioning:

A certified vestibular therapist performs different manuevers depending on the canal affected. It has several simple manuevers for positioning the head. Each position is held for around 30 seconds.

• Vestibular rehabilitation:

Once the repositioning is done the person is adviced to perform vestibular exercises which comprises of:

1. Eye gazing exercises
2. Habituation exercises
3. Balance exercises
4. Neck exercises

The exercises to be performed are advised according to the patients condition.

Surgical :

In very rare cases surgery is required. The part of the inner ear which causes dizziness is plugged using a bone plug.

                                      Dr. Pranjal Kankariya

The spinning world- overview of vertigo

Vertigo is condition which can have a number of reasons including the vestibular (inner ear) , cervical, or organic causes.

What is vertigo?

Vertigo is an illusion of movement. A person suffering from vertigo often complaints of dizziness and spinning sensation. Vertigo is sometimes considered as a symptom of an underlying condition.

Symptoms:
Spinning of the surrounding or sensation of falling
Abnormal eye movements or nystagmus

Tinitus( ringing ears) or congestion in ears
Nausea
Disorientation
Headache
Double or blurred vision
Loss of balance are some of the common symptoms seen in patients with vertigo. However not everyone suffering from vertigo show all of the above symptoms.

Causes:
The  known causes of vertigo are:
Vestibular neuritis : infection of the inner ear.
Benign paroxysmal positional vertigo (BPPV): displacement of crystals in the semicircular canals of the ear.
Migraine associated vertigo(MAV)
Menieres disease: increased inner ear pressure.
Other then these vertigo is also seen in patients with headinjury, cancer,Drug abuse ,Multiple sceloris, however the evidence is low.

Diagnosis
A set of tests including blood and balance test are advised to rule out the cause of vertigo. Other then these other major tests like videonystamography(VNG), and  video head impulse test( VHIT) are also performed.

 Treatment:
Medications to reduce inner ear infection if any and to control the dizziness.
Repositioning of the inner ear crystals in BPPV using different manuevers.
Vestibular and balance rehabilitation.
 


                                      Dr. Pranjal Kankariya

Mouse shoulder

Mouse is become a common feature of our life's. It helps us while using the computers and makes it more simple to use. 

However, the use of mouse results in a lot of musculoskeletal disorders, few of them are:

Mouse shoulder

Mouse arm

Carpal tunnel syndrome

Trigger finger

Out of these mouse shoulder and carpal tunnel are commonly seen.

Mouse shoulder:

What is mouse shoulder?

It is collection of symptoms in neck and shoulder blade area noticed in people using computer for long periods.

Symptoms:

The symptoms may be just pain, or might be associated with burning and heaviness.

The pain is usually deep and worsens with use of mouse.

The pain is felt in shoulder blade, neck and sometimes even in the chest area.

How does it take place?

The shoulder and shoulder blade is attached to the ribcage and spinal column via muscles and soft tissues.

When we use the mouse without any support for the arm and forearm the muscles have to work more in order to maintain the position of the unsupported arm hence placing them under continuous stress. 

Treatment:

The pain usually subsides with rest during the initial stages, however in later stages even rest doesn't help.

1.Simple NSAIDs can help relieve pain.

2.Icing

3.Using support and taking frequent breaks

4.Physiotherapy:

    Tens, ultrasound,Dry needling, taping

    Exercises: scapular strengthening,                  pectoral stretching, ROM exercises along      with neck stretching and strengthening        exercises, postural exercises.

    Perform simple desk stretches at work.

5. Use of ergonomic mouse.

Hence, proper ergonomics and exercise can prevent you from developing any of the above symptoms and conditions.

The giant support of your body

Today we all exercise to be fit yet while doing so most of us forget to train one of the most important group of muscels in the body which is one of the major supporting system in our body- The Pelvic floor muscles or PFM or pelvic diaphragm.

What are pelvic floor muscles?

Pelvic floor muscles are group of muscles and ligaments which support the pelvic organs like bladder, bowel, uterus( in females) ,urethra in humans.

Structure of PFM:

It is a funnel shaped musculature which separates the pelvis from the genitals.

It comprises of the following:

1. Leavtor ani muscle which is the largest component and is divided into 3 parts- pubococcygeous,puborectalis, and iliococcygeous.

2. Coccygeous muscle

3. Fascia covering the muscles

Importance and function of PFM:

1. Provide support to abdominal viscera like bladder, intestine,uterus and bowel etc.
2. Resist the change in intra abdominal pressure while coughing or sneezing or lifting heavy objects.
3. Support and stabilize the spine.
4. Bowel and bladder control.

Pelvic floor disorders:

• Urinary incontinence or lack of urine control
• Fecal incontinence or lack of bowel control
• Pelvic organ prolapse
• Pelvic pain.

Causes of pelvic floor muscle disorder:

• Aging
• Obesity 
• Chronic constipation 
• Pregnancy and child birth
• Hormonal changes
• Incorrect lifting of heavy objects regularly

Symptoms:

• Increased frequency of urination and/or painful urination
• Low back ache with no other known cause
• Painful intercourse

Does pelvic floor disorder or dysfunction affect only females?

 This is a myth as the condition can affect both males as well females though is commonly seen in females specially post childbirth and menopause.

Treatment for pelvic floor disorder

Conservative treatment -

1. Physiotherapy-

Electrical stimulation for weak muscles, kegels exercise, core strengthening, biofeedback, vaginal cones( for females) are sone physiotherapy interventions.

                      The 4 steps of pelvic floor exercises are-Locate, squeeze, hold and release

          
             

.

      2. Coping strategies
   
      3. Pessaries.

If conservative treatment fails the last option would be surgical repair of the muscles.

Hence, exercise of pelvic floor muscles is important for both males and females particularly post the ages of 30 years. 
For futher guidance contact your physiotherapist.

                   

Dr. Pranjal 
BPT 

Balanced exercise

 

                 BALANCED EXERCISES

 

Exercise and fitness have become a very important part of our life's today.
Most of us exercise regularly and still face problems like back pain, knee pain , neck pain etc. If exercise is so important than why so people who are into fitness still face problems??
The reason for this is firstly improper exercise and secondly lack of balanced exercises. We all know that everyone's body is different from each other than how can same exercises have an effect on everyone. Hence the exercise plan should be according to the person's needs, body type and any physical problems if any.

                 

Secondly, lack of balanced exercises. This is one of the major points which we forget while exercising. When a person talks about diet there is always a balanced diet which has all the nutrients in it.

Similarly, when we talk about exercise and fitness we should include all the types of exercises i .e . Stretching, strengthening, endurance and power, balance and coordination etc . When we would include all these in our routine it shall give a better effect.

To understand this better imagine your muscles to be a rubber band, when you keep stretching it for long time it would loose its tensile strength. The same thing happens with muscles when u continuously do stretching exercises the muscles loose its tensile strength and thus result in pain and discomfort.
Most of the problems in our body occur cause of imbalances in the muscles. Some muscles go in for weakness and some go in for tightness. Thus, one needs to understand which muscle needs to stretched and which has to be strengthened.

 So next time when you start exercising include stretching, strengthening, endurance and power training.

Dr. Pranjal
P.T.

Neck is your voice

We all are aware that a bad posture affects us in many ways. It might give us back problems, neck pain, also affects our personality and confidence to carry ourselves.
However, what most of us don't know is that a bad neck posture affects the quality of your voice. It is indeed something that we never thought about.
How does the neck affect one's voice? What exactly happens?
The voice box which produces the voice is attached to the muscular and skeletal system of our body. Hence the way your body is positioned will affect the quality of voice produced. For example: excess tension on the larynx will produce a harsh, strained voice.
Also poor neck posture affects the breathing mechanism of the body which further hampers the voice production.

Rounded shoulders reduce the space for the thoracic cage to expand and relax for appropriate breathing which powers the voice thus altering the quality of voice produced.

Now imagine the head and neck dropped too forward what would happen?? The muscles in the head and neck get constrict and have to work hard to maintain the head and neck position. Moreover the area around the larynx is also compromised.
Not everyone notices the change in voice individuals who are into professions where they have to vocalise would understand it better for eg: voice over artists, vocalists, singers etc.

Specially voice over artists who have to speak before the microphone tend to go in for a forward neck posture thus affecting their voice over a period of time.

How should one deal with the problem??
Firstly being aware of the problem and diagnosing it correctly addresses the disorder half way.
One can do simple postural Correction exercises like stretching , strengthening exercises.

Breathing or pranayam also have great results in such cases.

Wallet sciatica

Wallet sciatica sounds funny right?? But isn't funny as the name. Wallet sciatica as the name suggests is pain caused due to wallet. It is also known as hip pocket syndrome and is commonly seen in males.
  The wallet consists of cards, licence, cash etc which makes it bulky and when you place it in the back pocket and sit on it causes discomfort and pain.

                       

  What exactly happens when you place the wallet in back pocket it pinches or presses against the sciatic nerve which lies just behind the hip joint thus eliciting pain or tingling in the area. The pain may be localised to the buttock region or sometimes may move down towards the leg or upwards towards the spine.                          The wallet not nly causes compression of the nerve but also affects the soft tissues like muscles and ligaments in the area.

                        

The other major complication of sitting on a wallet is change in the position of the pelvis.
The hip and the pelvis play a major role in maintaining the posture of an individual. When you sit over a wallet or a purse that side of the pelvis is placed slightly higher than the opposite one thus causing it to tilt to one side.

                             

The pelvis and hips are the foundation of the spine, everything that sits on that foundation will be affected by this wedge. If you wear your wallet in your back right pocket you will create a high right side and a slightly lower left side. The body will compensate for this by pulling the spine towards the side of the wallet (the right) to even out the imbalance, the head may also be pulled to one side to keep the eyes level with the floor.

The two halves of the pelvis can also rotate slightly due to a constant force being applied to one side and this may lead to sacroiliac joint dysfuntion .
If left untreated it shall lead to permanent changes on the spine n postural stress.

Not only carrying the wallet in the back pocket is a problem but also placing it in the front pocket while sitting or driving causes irritation and friction between the hip and torso thus further leading to other problems.
Hence always be aware that you are not sitting with a wallet or mobile or cards in any of your trouser pockets.
Also the symptoms of pain and restricted movement and decreased activity are common symptoms of a lot of other problems and hence proper diagnosis and treatment is necessary.

Are u suffering from Runners knee?

My knee is hurting whenever I climb down the stairs or run downhill said one of my patients who is a sports person and physically very active. He was worried as he thought he had some major knee problem, but on examining him he was diagnosed as having runners knee. Runners knee is very common now a days and hence I decided to write about it today.

What is runners knee??

Runners knee or patellofemoral joint syndrome is when the knee cap starts rubbing against the underlying bone causing improper movement of the quadriceps muscle leading to pain and restricted movement.
It is often Misdiagnosed as osteoarthritis of knee joint as the symptoms are some what the same.

Runners knee is common in young adults specially runners and hence the name. However it is also seen in individuals who play games like basket ball, volley ball or who tend to walk a lot.

 Causes:

1. Weak knee and hip muscles.
2. Tight calf and hamstring muscle
3. Improper training techniques
4. Biomechanical issues like flat feet
5. Weak gluteal muscles

Symptoms:

• Pain is the major symptom and is usually noticed on the front side of the knee and sometimes around the knee cap.
• Swelling may or may not be present
• Reduced joint of motion are some of the main symptoms.

Treatment:

• First line of treatment is to reduce the pain which can be done by medications like NSAIDs , pain killer
• Physiotherapy:
• Modalities like ultrasound, ift, tens can be used to reduce pain.
• Taping for any correction and pain relief
• Exercise therapy: strengthening of weak muscles and stretching of tight muscles along with gluteal muscles activation.
• Orthosis: arch support for flat feet, quadriceps tendon support.

Prevetion:

Proper technique and foot wear.

Warm up before any sport.

Use of any orthosis if required

These are just basic exercises but if you r having any problem you need to show it to the doctor.

Pain while eating or speaking??

Jaw pain and physiotherapy

Just last week I had almost 3 patients at my clinic complaining of pain near the jaw and inability to chew or eat anything hard. So I decided to write this blog about temperomadibular joint or the TMJ.
Let's just know what it is exactly first. The TMJ is the joint just front of your ears and is the one responsible for opening and closing of your mouth.
Symptoms of TMJ pain:

• Pain on opening and closing of mouth
• Clicking and/ or grinding
• Inability to fully open the mouth or clench the jaw.

Causes and contributing factors of TMJ pain:

• Prolonged mouth opening eg: dental procedure
• Stress
• Injury
• Poor neck posture
• Grinding of teeth 
• Improper biomechanics or asymmetric of the jaw.
• Muscle imbalances.

Diagnosis:

TMJ pain or dysfunction is usually diagnosed by assessment and if required x-ray or ct-scan may also be advised.

 

It is also important to note that the joint is linked with your neck and hence the pain may be secondary to it.

Physiotherapy treatment:

• For pain relief: ultrasound, taping , myofascial release of muscles and fascia. 
• Icing or hot fomentation can also be done according to the condition.
• Posture correction of cervical spine 
• Joint mobilisation
• Relaxation and lengthening exercises
• Strengthening and stabilisation exercises.
• If required a night guard is given to people who have a habit of grinding or clenching the teeth in sleep.

This is however just a general information about the TMJ pain, for proper treatment a d guidance visit your doctor or physical therapist.