The Use Of Physical Therapy   The foundation of a conservative approach to the treatment of spinal disorders is physical therapy. Physical therapy provides both diagnostic information for the physician and a number of valuable therapeutic interventions for the patient. Although pain control may seem the most obvious benefit to the patient, physical therapy is designed to do much more. From improving posture and core muscular strength to increasing flexibility of underutilized muscles and normalizing gait, physical therapy is a multi-dimensional program. Depending upon the specific needs of the patient, therapy may be used to simply get someone to walk after a major reconstructive surgery or it may be used to focus the energies of an elite athlete to mobilize a sacroiliac joint. We consider physical therapy to be work. Some types may be considered passive, such as the use of massage and hot packs to restore blood flow to an injured area, while others are considered active, such as performing the prescribed stretching exercises on a daily basis at home. Both passive and active therapies require patient participation. The spine specialists and the therapists work together to give our patients the tools and the training to get better. Unfortunately, the ultimate success or failure of physical therapy often lies with the patient’s dedication to the treatment protocol. We advise performing physical therapy under the guidance of a licensed therapist with specific experience in dealing with the complexities of the spine.

What Can Physical Therapy Do For You?   Physical Therapy intervention begins with a thorough initial evaluation including a history of the pain. By understanding the onset of the pain (sudden/traumatic versus gradual/for "no apparent reason"), positions that seem to make the pain better or worse, and the specific postures and stresses the individual undergoes on a regular basis-for job, recreation, or activities of daily living-the PT can help to get at the underlying problems causing the pain. For example, if someone is starting to suffer the effects of degenerative changes in the disks or spine, the PT can help to decrease the abnormal and excessive stress to the spine through postural and body mechanics training, patient education regarding work space set-up, and therapeutic exercise to address tightness and/or weakness which might be contributing to abnormal wear and tear of specific structures like the disks or joints. After the history taking is completed, the PT takes an objective look at the person. The evaluation includes assessment of spine as well as arm/leg flexibility, strength, and postural alignment among other things. Walking is also observed to note gait abnormalities that might contribute to pain. The person is then taken through motion testing in all directions of either the neck or back (often repeatedly) to help determine the nature of the pain and deficits in motion. After the evaluation, the PT will come up with a "mechanical diagnosis" (versus the medical diagnosis given by a doctor, like degenerative disk disease). Based on the findings, history, and mechanical diagnosis, an individualized treatment program is designed to address the specific deficits that have been identified.

Types of Conditions that Physical Therapy Can Help Physical Therapy can help acute and chronic neck and back pain resulting from a variety of diagnoses. Types of conditions include, but are not limited to: • Neck and lumbar sprains and strains • Degenerative disk and joint disease of the spine • Bulging or slipped disks • Stenosis • Myofascial pain of the back or neck • Chronic headaches • TMJ dysfunction

Ideal Candidates for Physical Therapy In order for Physical Therapy to be truly effective, the patient must be willing to take the responsibility for getting better. This includes regularly attending scheduled appointments to learn postures, techniques, and exercises to be employed as part of a "home program" to address the neck or back pain. While "passive modalities," including massage or various electrical or thermal agents, may be used initially in conjunction with therapeutic exercise and postural training, it is "active" things like postural and body mechanics awareness and commitment to the exercise program that are responsible for the most significant and lasting decreases in pain. An ideal candidate for PT is someone who says, "I want to learn what I can do to get rid of this pain once and for all, or at least to know how to control or prevent it." This is in contrast to a less ideal candidate who comes to PT looking for something external to be applied that will "fix" the problem.

Physical Therapy Interventions Specific Physical Therapy interventions for neck and back pain include therapeutic exercise (Figure A) (on mats, on balls, in the water, etc.), manual techniques (soft tissue massage to help improve stretching or gentle joint mobilization to help improve flexibility), training in proper body mechanics and posture, and patient education regarding ergonomics at work or in the home. (Note: ergonomics is adapting the environment to address a specific body's needs; for example, changing the set up of a work station to help employ better body mechanics with computer use.)

The Treatment of Arthritis Conservative Treatment For Your Arthritis Chronic Pain The chronic pain associated with arthritis can very seriously affect your quality of life. If left untreated, it can also lead to physiological problems such as muscle breakdown or weakness as well as psychological difficulties such as anxiety and depression.

Choices But you don't have to live with pain. Today, there are a wide variety of treatments that can help relieve the pain and discomfort of arthritis. This article discusses some of the most common non-surgical treatments for arthritis, particularly for arthritis of the spine. Remember to talk to your doctor before starting any treatment plan.

Medications People with arthritis today have numerous pain medications that can be used to relieve their pain. Some require a doctor's prescription, some do not. However, do not assume that just because a drug is available without a prescription or "over the counter", it is safe for everyone. Talk to your doctor about which pain medications are best for you. Be sure to let your doctor know what other medications you are taking, even for other health problems.

Non-Prescription Medications: Acetaminophen (ie, Tylenol) - this is the drug of choice for mild to moderate arthritis pain because it has very few side effects and is relatively inexpensive. It is used to help relieve pain but does not reduce inflammation. Acetaminophen may cause liver problems in people who consume large amounts of alcohol. Non-steriodal anti-inflammatory drugs, or NSAIDs (aspirin, ibuprofen, naproxen) - these medications are often used for moderate to severe arthritis pain. They treat pain as well as inflammation. Like acetaminophen, they are relatively inexpensive. However, many patients report stomach upset from NSAIDs. These drugs may also interfere with other medications or cause serious side effects. Talk to your doctor before taking NSAIDs. COX-2 Inhibitors (Vioxx®, Celebrex®) - a new type of NSAID that may not cause stomach irritation. Works well for moderate to severe arthritis pain. These drugs are often more expensive than other NSAIDs.

Prescription Medications: Opioids (oxycodone, morphine, codeine, meperidine) - may be used to for short-term treatment of severe or sudden onset of arthritis pain, however, they are rarely prescribed due to their addictive nature. Narcotic analgesics - while acetaminophen is an analgesic, sometimes arthritis sufferers need additional pain relief. There are a number of narcotic analgesics available by prescription that may help. These include propoxyphene hydrochloride (Darvon®) and acetaminophen with codeine. Narcotic analgesics may cause serious side effects when used over long periods of time. Topical analgesics, ointments or creams - these are medications that are rubbed into the skin. They usually have fewer side effects since they only affect the area of the body where they are applied. Corticosteroids - these are not used for pain but are strong medications used for types of arthritis that include inflammation, such as rheumatoid arthritis.

Physical Therapy and Exercise   In addition to medications, many people with arthritis can find relief from physical therapy and exercise. Physical therapy is a treatment method that focuses on pain relief, healing, restoring function and movement, improving body mechanics, as well as overall fitness and wellness. Your doctor will prescribe physical therapy as part of your treatment plan and will refer you to a physical therapist. Physical therapists are rehabilitation professionals trained in the variety of exercises and treatment options that are appropriate for arthritis sufferers. Your therapist will work closely with your doctor and you to develop an exercise regimen specifically for you. Exercising can help arthritis sufferers in many ways. Exercise reduces joint pain and stiffness and increases flexibility, muscle strength and endurance. It also helps with weight reduction, which is important since extra weight can place too much pressure on joints.

Types of Exercise   Generally there are 3 types of exercises that are appropriate for people with arthritis: Range-of-motion exercises. These exercises should be done daily to help maintain normal joint movement, relieve stiffness and increase flexibility. Range-of-motion exercises for the spine may include bending forward, back and to each side. Strengthening exercises. These exercises can also be done every day (unless you have severe pain) to help increase muscle strength. Strong muscles help support and protect joints affected by arthritis. Your therapist will instruct you on proper ways to lift and flex during these exercises. Endurance or aerobic exercises. These exercises can be done three times a week for 20-30 minutes. They improve cardiovascular fitness, help control weight and improve overall function. Examples include walking and bike riding.

Other Therapies   In addition to therapeutic exercise, your therapist may use other treatments such as: Heat therapy -warm towels or heat packs are placed on the spine to relieve pain by increasing blood flow and relaxing tissues. Cold therapy - ice packs or ice massage applied to painful areas of the spine to reduce swelling and pain. Water therapy - exercising in a large pool to reduce pressure on the spine. The heat and movement of whirlpools may also provide pain relief. Massage - can help increase flexibility and circulation. Be sure to find a trained professional who is experienced in treating people with arthritis. TENS (transcutaneous electrical nerve stimulation) - a type of therapy in which electrodes are applied to the back and a mild electrical current is sent to specific nerves. Many people continue their exercise programs even after their prescribed physical therapy is finished. Your therapist will instruct you on the proper ways to do your exercises at home and give you tips on how to continue your treatment on your own

Bracing Another area of treatment for arthritis pain involves the use of braces or "assistive devices" to help support your back and/or relieve pain. Spinal bracing can help control back pain by limiting motion and relieving pressure on the vertebrae. Your doctor will let you know if bracing is an option for you. In addition, devices such as canes, splints or walkers may also help you get around easier and with less pain.

Alternative Treatments Today many people look outside traditional medicine to find relief for chronic pain such as from arthritis. Some of these may be helpful. However, you should be wary of treatments that make claims that seem unrealistic, such as a complete cure or 100% guarantee pain relief. If it sound too good to be true, it probably is. Here are a few common alternative treatments that many people have found to be helpful for spinal arthritis: Traditional Chinese Medicine (TCM) - TCM is based on the belief that the body needs to be in balance in order to remain healthy. Pain and illness result when the body is out of balance and there is a disturbance in the body's energy. TCM treatments focus on returning the body's delicate balance. Some examples of TCM treatments include acupuncture (inserting thin needles into the skin to stimulate healing), herbal medicine (the use of plants to heal the body and relive pain) and various types of massage. Yoga - Yoga is a type of exercise program that includes gentle stretching, controlled breathing, focused concentration and meditation. Yoga is not for everyone; talk to your physician before starting any exercise regimen. Relaxation Therapy - Relaxation therapy teaches you to release the tension in your muscles and may help reduce arthritis pain. Your physical therapist may be able to teach you how to use relaxation techniques at home.

Lifestyle Modification An important part of arthritis treatment is to change those habits in your life that may contribute to your pain. Some lifestyle changes you may need to consider include: Losing weight Eating well-balanced and nutritional meals every day Establishing a regular (daily) exercise program Reducing or removing stress in your life There is no cure for arthritis, but as you can see from this article, there are ways to control the pain and allow you to remain active and healthy. Don't let arthritis pain take charge of your life - learn to control it and live each day to the fullest.

Guidelines For Exercise In Treating Back Pain   The Role of Exercise in Back Pain Most people know regular exercise will improve their appearance and general health, but few realize the positive effects that good physical conditioning can have on their low back pain. Many studies show dramatic improvements of low back pain in individuals who are physically fit. In addition, the person in good physical shape is much less likely than the average person to injure their back during work or daily activities. The benefit of exercise for your low back depends on three key principles. First, you must attain satisfactory aerobic fitness. Second, you should focus part of your work-out on the muscle groups that support your back. Third, you must avoid exercises that place excessive stresses on your back.The ideal aerobic exercise involves the large muscle groups of your body (arms and legs) in a smooth, cyclical fashion. Recommended exercises include swimming, fast walking, cycling, and using a ski machine or elliptical exerciser. You should achieve the appropriate heart rate for 30 minutes at least three times per week. Of course, you should consult your family physician and review your aerobic program before getting started. He/she can give you the appropriate target for your heart rate during aerobic exercise. It is always optimal to approach your aerobic goals slowly, especially if you have not recently worked-out. Part of your work-out should stretch and strengthen the muscles of your low back, abdomen, pelvis and thighs. Flexibility in these areas will greatly decrease the chance of further injury to the back. By strengthening these muscle groups, the body's weight distribution and posture are improved, resulting in less stress on the low back. It is best to perform these exercises after a good "warm-up", such as your aerobic routine. Ask your health club staff or physical therapist for instructions on specific stretching and strengthening exercises for these areas. While the merits of good conditioning cannot be overstated, the wrong type of exercise may actually worsen your low back problem. Activities that impart excessive stress on the back such, as lifting heavy weights, squatting, and climbing are not advised. In addition, high impact exercises such as running, jumping, and step aerobics can aggravate a low back condition. When walking, wear well-cushioned shoes with good arch supports and use a treadmill or a track made for athletics. Cycling on a recumbent stationary bike can relieve stress on the back. With the help of your physician, physical therapist and health club staff, you can achieve proper physical fitness. Your low back pain may be decreased and your lifespan increased!

Physiotherapy O.P.D. • Dr. Mitali Shah is Chief Physiotherapist. B. Physio. FAPI. She is specially trained for weight reduction exercises. • O.P.D. timing 7.30 a.m. to 9.00 p.m. • Ground floor & First floor of ASUTOSH annexe building. • Call 3046534 or 3046300 for appointment.

Physiotherapy Department • Fully A.C. department with advanced instruments like Ultrasound, Diathermy, Interferential, Wax bath, Traction. • Fully automatic Whole body massage chair with D.V.D. player & T.V. • Special physiotherapy for Cerebral palsy children.

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