fibromyalgia chronic pain

Fibromyalgia

Fibromyalgia is a chronic condition that presents itself as a syndrome, characterized by body aches and pain, weakness, stiffness, tender points around joints and stressful mind. We at ReLiva Physiotherapy and Rehab help you deal with the various symptoms of fibromyalgia present at any point of this chronic condition in the best possible ways at our clinics in Thane, Vashi, Nerul and Navi Mumbai.

While there is no definite cure of this condition, physiotherapy helps in reducing the symptoms as well as improving the quality of life of an individual suffering from fibromyalgia. Something as easy as postural correction and correct postural habits taught by the physiotherapist helps the patient in relieving the stress placed on the tissues as well as relaxes the body.

Pain, which is the most disabling symptom of this condition, is dealt aptly by using hydrotherapy in the form of moist hot packs that is applied at the painful area or also by using cryotherapy, as per the patients’ condition and need. Along with this, myofascial release techniques may be used to release the tension off the muscles as well as produce relaxation. Tender point release therapy is used to treat the tender points while is followed by cryotherapy to reduce pain, promote healing and prevent any muscle soreness. Pain may also be treated with the help of electrotherapy equipment like Transcutaneous Electrical Nerve Stimulation (TENS) depending on the severity of the pain.

Stiffness is reduced by incorporating various stretching exercises that help improving the flexibility of the muscles. By loosening up the tight and stiff muscles, it helps reduce the tension built up in the muscles and helps relieve any stress placed on them. This also leads to pain reduction and induces relaxation. Various active and passive stretching exercises are done and also taught to the patient with the correct dosage and method. Along with this accurate range of motion (ROM) exercises are taught to the patient that helps in keeping the joints healthy and preventing any stiff joint conditions in the future. Strength training of the muscles forms the basic line of treatment for the weakness that the muscles develop in fibromyalgia. Gradual and slowly progressing strengthening exercises are taught to the patients, starting with free exercises and moving on to resistance training.

Aerobic exercises (low-speed, low-impact) also form a very important line of treatment in patients suffering from fibromyalgia. Aerobic training not only prevents the deconditioning of the body but also helps induce relaxation. They have significant beneficial effects on physical function, well being and potentially reducing pain. Stationary bicycle, steppers (to perform graded and controlled stair-case climbing) and other devices are used to perform aerobic training. Aerobic exercises help improving the overall quality of life by training the lungs and heart and increasing their ability to function.

Relaxation techniques that are taught to the patients help relax their mind and body and hence bring the stress levels down. This in turn induces good sleep and helps fight sleep disturbances. In this way it helps the patient maintain good health by taking necessary rest periods along with supervised physical activity. Lifestyle modification would be incorporating activities like walking, cycling, swimming, gardening, etc in leisure time that not only help in relaxing the mind but also maintain the body strength to fight fatigue and pain. Outdoor sports should be taken up to maintain good body functioning, as well as aid relaxation.

What is Fibromyalgia?

Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. It is a chronic condition diagnosed by the doctors based on patient’s symptoms and physical examination. Fibromyalgia mainly includes widespread muscle pain along with painful point around the joints, which is not actually joint pain but pain in the tissues around the joint. It is usually referred to as ‘fibromyalgia syndrome’ as it presents with a group of symptoms together. Common fibromyalgia symptoms may include generalized aches and pains and crippling fatigue. Presence of tender points, disturbed sleep, mood disturbances and depression is also seen. Muscles give the feeling of being over worked all the time. There may be pain and achiness around joints in the neck, shoulder, back and hips which make it difficult for the patient to sleep or exercise. Other symptoms may include abdominal pain, chronic headaches, and dryness in mouth, nose and eyes, incontinence, irritable bowel syndrome, stiffness, numbness/tingling in fingers and feet. Tender points at specific areas around the joints give a clear picture of the condition.

Diagnosis is mainly made on comprehensive physical examination and on the patient’s medical history. Research still continues on devising any specific blood test that could help confirm the diagnosis (e.g. FM/a) to rule out any other serious condition, your doctor may ask you to carry out a compete blood count(CBC), tests for thyroid, etc. Also, since the pain and symptoms are similar to that seen in arthritic conditions like Osteoarthritis and Rheumatoid Arthritis, specific tests to rule out these conditions is also done. A detailed FAQ regarding fibromyalgia can be found here.

What causes Fibromyalgia

It is still unclear why people develop fibromyalgia but theories suggest that it is not the outcome of a single factor but combination of factors working together. One of the researches suggests that poor physical conditioning leads to the symptoms of fibromyalgia while other suggests that continuous microtrauma leads to ongoing cycle of pain and fatigue. Combination of many physical and emotional stressors is believed to be responsible for the condition. Genetics is also believed to be one of the causes and fibromyalgia is seen running in families. Environmental factors like trauma, infections, etc are also believed to be contributing to causing fibromyalgia. Hormonal and chemical disturbances are also responsible in causing pain.

It is mainly thought to be a glitch in the way the body perceives pain. One of the main theories suggests that people suffering from fibromyalgia have developed changes in the way the Central Nervous System (CNS) processes the pain messages carried out by the body. Also low level of hormones like serotonin, noradrenaline and dopamine in the brain lead to alteration in mood, appetite, sleep, behave and response to stressful situations. Also hormones help regulate the processing of pain messages in the brain.

Benefits of Physiotherapy Treatment for Fibromyalgia patients

The benefit of physiotherapy is that it allows a person with fibromyalgia to work closely with a trained professional who can design a fibromyalgia-specific treatment program. The therapist documents your progress and gauges whether you are performing/practicing good therapy habits, alignments, and movement patterns when doing ‘homework’ or exercises at home.

Anne Reicherter, PT, DPT, PhD, a licensed physical therapist and associate professor in the department of physical therapy in the School of Medicine of the University of Maryland in Baltimore, says physical therapy can help fibromyalgia patients “manage” their daily living with less pain and generally make life more enjoyable”. She explains that people with fibromyalgia pain are often caught in a vicious cycle: Pain and fatigue prevent them from being active and exercising, but inactivity can trigger more pain and fatigue.

ReLiva Physiotherapy and Rehab helps you deal with fibromyalgia by using the following in their tailor-made and effectively designed treatment program:

    • Stretching Exercises
    • Strengthening Exercises
    • Pain Relief Methods
    • Aerobic Training
    • Myofascial Release
    • Relaxation Techniques

Myths and Facts about Fibromyalgia

1.   Myth: Fibromyalgia is rare.

Fact: Fibromyalgia is one of the most common types of chronic pain disorders. Census reports more than 10 million cases per year in India.

2.   Myth: Fibromyalgia is “all in the head.”

Fact: Fibromyalgia has been described for centuries. But it wasn’t until 1981 that the first scientific study formally confirmed fibromyalgia symptoms and tender points in the body. Since then, researchers have future tested pain reaction in people with fibromyalgia.

  • Imaging studies show that the brains of people with fibromyalgia have more activity in reaction to pain.
  • Studies also have shown that people with fibromyalgia feel pain more intensely at lower levels than people without the condition.
sacroiliac joint pain

SI Joint / Pelvic Pain – Do’s & Don’ts

Sacroiliac (SI) Joint Dysfunction can cause significant discomfort and pain in sitting and lying down. The Hip joint seems to have got locked and does not allow smooth transition from one position to another. Following are few techniques that can help significantly to ease such restricted movement and pain.

1. Rolling Over in Bed:

To roll over from your back to your side, bend one knee, placing your foot on the bed.  Push the heel down, slightly lifting your buttocks and turn towards the side on which the leg is still extended straight. The top arm helps the turning motion.

 

2. Sitting:tailor position

  1. When sitting (whether you are driving a car, riding a bicycle or sitting on a chair), press your chest upward and let your shoulder blades relax and drop.
  2. Sitting in a tailor’s position is good (crossed legged with your feet crossed underneath your legs) on the floor or on a very firm bed; use your hands to pull your knees gently back towards your hips and lift your chest, and keep your shoulders low.
  3. If you have been sitting in this position for a while, stretch forward as far as you can and touch the floor in front of you while keeping your spine straight.  At the same time, look up.  Practice this stretch as often as it feels necessary and good.

Static Sitting Positions:

  • Sit on a chair with your knees apart and slightly turned out
  • Sit in positions that relax your lower back while it remains supported, using a cushion or a rolled towel behind your back; sit upright when the back is not supported
  • You can also stretch your hips by sitting high enough so that your knees are lower than your hips or by crossing your feet under your chair.
  • Use a ball cushion while you are sitting, or sit on a therapy ball; sitting on a ball cushion allows your tailbone to be free.  When you use a ball cushion or ball, you develop active stomach and back muscles over time as a result of trying to maintain your balance
  • A good posture for resting is lying on your back on the floor, putting your feet up on the couch or bed, with a small pillow to support your back and/or head
  • If you have tailbone pain, this may be caused by your pelvic floor being too tight.  Favor positions that open your hips, push your legs downward away from your torso (sitting on the edge of the chair or on a ball) or crossing your feet under your chair; let your vaginal muscles relax as much as possible

3. Standing:

  • Bend your knees slightly
  • Distribute your weight evenly on both legs
  • Point your toes slightly outward
  • This posture may feel unnatural in the beginning, but if you look in the mirror, you’ll see that it looks quite normal.

Related Articles:

Sacroiliitis, Sacroiliac Joint dysfunction

SI Pain & Pregnancy – Tips

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sacroiliitis

Sacroiliitis, Sacroiliac Joint Dysfunction

Dysfunction in the sacroiliac joint, or SI joint, is thought to cause low back and/or leg pain. The leg pain can be particularly difficult, and may feel similar to sciatica or pain caused by a lumbar disc herniation.

 Where is SI Joint and Why Does it Hurt?      Sacroiliac Joint Dysfunction

There are two Sacroiliac (SI) joints in your body, located on either side of the triangle-shaped bone at the bottom of the spine where it connects to your pelvis. The SI joints are a shock absorber for your spine and provide stability for your body as you run, walk, or jump. Interestingly enough, the SI joints usually don’t move more than 2 – 4 millimeters themselves. But each one contains many nerve endings that can cause significant pain if the joint is damaged or loses its ability to move properly. Everyday wear and tear, arthritis, or a single injury can damage these joints, changing their normal movement and creating chronic and sometimes debilitating SI joint pain that often, generally feels like low back pain.

Causes:

While it is not clear how the pain is caused, it is thought that an alteration in the normal joint motion may be the culprit that causes sacroiliac pain. This source of pain can be caused by either:

  • Too much movement (hypermobility or instability): The pain is typically felt in the lower back and/or hip and may radiate into groin area.
  • Too little movement (hypomobility or fixation): The pain is typically felt on one side of the low back or buttocks, and can radiate down the leg. The pain usually remains above the knee, but at times pain can extend to the ankle or foot.

Sacroiliitis (inflammation at SI Joint), Osteoarthritis, SI Joint Injury, Altered Walking Pattern, Infection, Prior Lumbar Fusion and Pregnancy are known to trigger SI Joint Dysfunction.

Symptoms of SI Joint Pain & Diagnosis

Some common symptoms for SI Joint Dysfunction are:

  • Low back pain: Usually a dull ache on one side of your lower back that may extend into the thigh.
  • Buttock Pain: Pain can range from an ache to a sharp stabbing pain that extends down one or both legs.
  • Low Back Pain While Climbing Stairs: Activities that require the pelvis to twist may produce SI joint pain.
  • Difficulty Sitting or Lying on One Side: Often experienced as an ache on one side that causes you to shift weight to one side to relieve the pain in the other.

It is important that a medical expert diagnose the cause of your lower back pain.  Though the symptoms may be similar, however the treatment will greatly depend upon the underlying cause.

Treatment for SI Joint Dysfunction:

Treatments for sacroiliac joint dysfunction (SI joint pain) are usually conservative (meaning non-surgical) and focus on trying to restore normal motion in the joint.

Typical treatments for sacroiliac joint dysfunction include:

  • RICE :  R.I.C.E. treatment that typically includes use of ice or cold packs, applied in 15 to 20 minute intervals as needed to reduce inflammation in the area, along with rest is recommended to ease symptoms. Depending on the duration of sharp, intense pain, ice can be continued anywhere between 2 days to 2 weeks. Once the inflammation is less, gradual return to normal activities may be advisable. Read more: RICE
    SI Joint belt
  • Medicines: Your doctor may prescribe pain medications as well as anti-inflammatory medications to reduce the swelling that is usually contributing to the pain.
  • Supports, braces and Belts: When the SI joint is “hypermobile” or too loose, an “orthotic” or SI brace about the size of a rather wide waist-belt can be wrapped around the waist and pulled snugly to stabilize the area. This can sometimes be very helpful at times when the joint is inflamed or painful. When it calms down, the support can be weaned away.
  • Physiotherapy and Exercise :

Controlled, gradual physical therapy is an evidence based technique found helpful to strengthen the muscles around the sacroiliac joint and appropriately increase range of motion. Supervised gentle exercise will help increase the flow of blood to the area, which in turn stimulates a healing response.

Contact a ReLivaTM Expert to get a customized SI joint pain treatment programs designed for your specific concerns. It may include stabilization training, stretching exercises and heat/ice therapy to compliment other treatment aspects prescribed by your doctor.

 

Coping with Sacroiliac Joint Dysfunction

Adding exercise and physical therapy to your sacroiliac joint dysfunction treatment plan can significantly help you manage SI joint pain symptoms. There are numerous gentle exercises and stretches you can do to help decrease pain caused by SI joint dysfunction.

Contact a ReLiva Expert to design overall exercise plan for SI joint dysfunction, incorporating the 3 main types of exercise—aerobic, strengthening, and flexibility exercises—into your workout routine.

Related articles :

Do’s and Don’ts for SI Joint Pain / Pelvis Pain

SI Pain and Pregnancy

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physiotherapy after surgery

Recovering After Surgery With Physiotherapy

Physiotherapy post surgery in the hospital and at Home

Physiotherapy after surgery is an integral part of treatment for patients who are or have been hospitalized as prolonged immobilization puts patients at risk for complications such as deconditioning, muscle weakness, myopathy and neuropathy, respiratory infections, and contractures. It is important for such patients to consider physiotherapy at home as an integral part of the recovery process.

The main aim of a physiotherapist is to assist your return to normal activities of daily living after hospitalisation. Physiotherapists typically help with many aspects of your treatment while in the intensive care unit (ICU) and will continue working with you when you transfer to a general ward until you leave hospital to go home. Even at home, in many cases a physiotherapy home care program can significantly aid the recovery of patient. ReLiva Physiotherapy's home care program is designed and our physiotherapists understand the requirements for post surgical/ post ICU patients

Our home visit physiotherapist will assess and treat neurological, musculoskeletal and cardiorespiratory complications of the patients and help them in recovery. The physiotherapist is involved in specific patient positioning, suctioning, mobilization, ambulation, strengthening and balance exercises, passive range of motion exercises and airway clearance techniques.

As per Dr Farhad Kapadia, Consultant Physician, M.D, M.R.C.P, D.A (U.K.), E.D.I.C, FRCP: "Physiotherapy may be our best tool in getting the patient rapidly functional after a critical illness, and it needs to become an integral aspect of intensive care"

Benefits of physiotherapy:

  • Enables the patients to recover from the episodes of hospital as early as possible
  • Prevent post op complications
  • Teach the patient how to manage their own recovery post discharge
  • Facilitate safe and early discharge by reducing the length of stay in the hospital
  • Improves the quality of life

Physiotherapy helps in:

  • Improve the cardiovascular endurance
  • Improved performance of daily tasks
  • Improves the strength and endurance of the muscles
  • Improves the lung capacity
  • Makes the patient mobile and independent
  • Improves the airway clearance
  • Early mobilization of ventilated patients by a physiotherapist reduces mortality, and results in improved physical function and mobility

Physiotherapy post surgery:

The main aim is to return to the normal activities as early as possible.

Routine post operative physiotherapy intervention comprises of breathing exercises, circulatory exercises and early mobilisation to prevent complications and education in home management cardiovascular fitness, limiting restrictions due to medical procedure and

Positioning: To prevent complications like bedsores, congestion in the lungs, change of positions after regular intervals become important.

Chest PT:

  • Breathing exercises are important for the patient to reduce the chest infections and improve the air entry in the lungs. It also helps complete expansion of the thorax in order to have an effective breathing. Breathing exercises includes deep breathing exercises, segmental breathing exercises, thoracic expansion exercises, pursed lip breathing exercises and active cycle of breathing techniques.
  • Coughing huffing techniques where the patient is taught how to do forceful expiration by supporting the wound to get rid of the accumulated sputum actively
  • Airway clearance: physiotherapists help to clear the excess sputum by different techniques like positioning the patient, postural drainage, suctioning and use of different expiratory devices

Limb PT:

  • It is important to maintain blood circulation following surgery to reduce the risk of deep vein thrombosis due to immobility. Hence mobility exercises are important.
  • Also, it helps to improve and maintain the joint mobility and muscle strength which eventually gets deconditioned due to illness

Mobilisation:

  • Early mobilisation is a key factor in reducing post operative complications, enabling a quick recovery and timely discharge from hospital. Patient is assisted to get out of bed by physiotherapist on the day of your operation or the following day depending upon the type of the surgery. The final goal is to increase patients mobility making them independent and training stair climbing if required.

The above mentioned treatment principles were the general ones. But the treatments differs in different surgeries viz; orthopedic surgeries, abdominal surgeries, cardiothoracic surgeries, vascular surgeries, neuro surgeries.

To determine the treatment needs,the physiotherapist assesses the patients physical function including:

  • Pain, swelling, joint range of motion, muscle strength, muscle coordination, mobility status, balance, respiratory status and cardiovascular fitness in ortho surgeries
  • Pain, discrepancies in balance, coordination, muscle weakness and fatigue, work of breathing, and loss of range of movement, loss of cardiovascular fitness and mobility status in abdominal and cardiovascular surgeries
  • Pain, muscle tone, consciousness, orientation, work of breathing, balance and coordination, sitting and standing ability, synergy patterns, gait in neuro surgeries.

If you or your loved ones, have been recently discharged from the hospital after a long stay, the patient needs to continue supervised physiotherapy treatment to ensure complete recovery in the long term basis. Please feel free to give us a call and speak to our physiotherapists should you require any assistance.

De Quervain tenosynovitis

All About DeQuervain’s Tenosynovitis

There are two stages of the treatment for De Quervain’s syndrome or De Quervains tenosynovitis. It is a painful condition affecting the tendons on the thumb side of your wrist. In case of acute stage, when there is inflammation the goal is reduction in inflammation and preserving movements. Subsequently, once the inflammation subsides the goal is improvement in function.

Acute stage treatment

  • Splint to support the thumb and the wrist and which provides support and helps healing procedure.
  • Help identify aggravating activities and suggest alternative postures
  • Cryotherapy (e.g.: cold packs, ice massage) to reduce the inflammation and edema
  • Therapeutic Ultrasound (i.e. phonophoresis) or electrically charged ions (i.e. iontophoresis)-Ways in which a medication can be driven into the soft tissues through skin and promote faster healing.
  • Plan and suggest activity modifications to correct abnormal position of the hand in a particular activity.
  • Corrective exercises: Help in maintain the correct postures of the hand and thus enable better healing, promote faster rehab and aid in the prevention of further complications.

Second stage treatment (once inflammation subsides):

The goal is to work on the range of motion, Flexibility, Strengthening, Preventing recurrence

  • Thermal modalities to promote and aid in healing.
  • Transverse friction massage to break the adhesions.
  • Therapeutic exercises – starting with Range Of Motion (ROM) exercises, and as the patient progresses, adding strengthening exercises
  • Ergonomic workstation assessment as needed (Design work place to prevent further injuries after assessment of the same)
  • Educating the patient to either avoid or decrease repetitive hand motions, such as pinching, wringing, turning, twisting or grasping..
  • Rehabilitation exercises to prevent recurrence.
  • A home-exercise program for the maintenance of the goals achieved by the physical therapist and hence aid in faster recovery of function..

Physiotherapy treatment DeQuervains

Ultrasound therapy for wrist

 

Exercises for wrist and thumb rehabilitation
 

What is deQuervain’s Syndrome ?

It is the tenosynovitis (inflammation of the fluid-filled sheath called the synovium that surrounds a tendon and helps them glide easily) of the two tendons that control movement of the thumb. Inflammation results in pain, swelling and constricted movement of the tendons within the tunnel on the side of your wrist (Base of thumb). The swollen tendons and their coverings rub against the narrow tunnel through which they pass. The result is pain at the base of the thumb. At first, the only sign of trouble may be soreness on the thumb side of the forearm, near the wrist. If the problem isn’t treated, pain may spread up the forearm or further down into the wrist or both and thumb and limit your range of motion. As the friction increases, the two tendons may actually begin to squeak as they move through the constricted tunnel. This noise is called crepitus. It is pai nful especially when you turn your wrist, grasp anything or make fist..

 

Wrist Pain

Wrist Pain on movement

 

 

What causes deQuervains ?

de Quervain’s tenosynovitis is basically a combination of overuse, repetitive movements e.g.; racket sports, hammering and poor hand on wrist posture. It can be idiopathic (has no specific cause).

Common causes include:

  • Repeated hand and thumb motions such as grasping, pinching, squeezing, or wringing may lead to the inflammation of tenosynovium.
  • Holding your hand at an angle to your wrist creates a compression point that excessively rubs the tendon.
  • This inflammation can lead to swelling, which restricts the smooth gliding action of the tendons within the tunnel.
  • Scar tissue from a previous injury can make it difficult for the tendons to slide easily through the tunnel.
  • Arthritic diseases that affect the whole body, such as rheumatoid arthritis, can also cause tenosynovitis in the thumb.
  • Arthritic diseases that affect the whole body, such as rheumatoid arthritis, can also cause tenosynovitis in the thumb.

 

Wrist injury

Text Thumb

Benefits of physiotherapy:

  • Physiotherapy treatment reduces inflammation and accelerates healing.
  • improve strength, range of motion and endurance and correct postural and muscle imbalance which in turn prevents recurrence of condition.
  • Ergonomic corrections and activity modifications prevent various other injuries of hand and wrist along with deQuervains.
  • Physiotherapy rehabilitation exercises helps to restart all activities early.
  • Recovery is rapid if you start treatment in early stages. Chronic condition takes time as lot of changes like adhesion formations, Muscle weakness take place. But one can expect full recovery with the rehabilitation program completion.

INTERESTING FACTS

Pregnant ladies and post-delivery mothers are affected more often. Contributory factors may include hormonal changes, fluid retention and – more debatably – lifting (baby).

Dislocated Shoulder : Managing Pain & Recovery

Dislocation is a term used when the ends of your bones are forced from their normal positions because of an external force. This painful injury temporarily deforms and immobilizes your joint. Dislocation is most common in the shoulder.
dislocated Shoulder sling

 

Shoulder Dislocation

Dislocating your shoulder means the ball joint of your upper arm has popped out of the shoulder socket. The surrounding tissues may also have become overstretched or torn.

The shoulder joint is the most mobile joint in the body and allows the arm to move in many directions. This ability to move makes the joint unstable and also makes the shoulder the most often dislocated joint in the body.

A dislocated shoulder usually happens after a heavy fall onto the arm. It takes between 12 and 16 weeks to heal after the shoulder has been put back into place.

Most people dislocate their shoulder during a sport such as basketball, volleyball, squash, rugby or in an accident. In older people the cause is often falling onto outstretched hands, for example after slipping on water or road.

It is possible to dislocate the shoulder in many different directions, and a dislocated shoulder is described by the location where the humeral head (ball of the upper arm) ends up after it has been dislocated.Types of Shoulder dislocation

1. Anterior Dislocations: Most of shoulder dislocations are anterior dislocations, meaning that the humeral head has been moved to a position in front of the joint. A common example is when the arm is held over the head with the elbow bent, and a force is applied that pushes the elbow backward and levers the humeral head out of the socket. This can occur with throwing a ball or hitting a volleyball. Anterior dislocations also occur during falls on an outstretched hand.

2. Posterior Dislocations: Posterior dislocations are uncommon and are often associated with specific injuries like lightning strikes, electrical injuries, and seizures.

What you should do ?

If you think you have dislocated your shoulder, go to your doctor immediately.

Don’t try to pop your arm back in yourself, as this could damage the tissues, nerves and blood vessels around the shoulder joint.

While waiting for medical help, avoid moving your upper arm as much as possible. Place something soft, such as a folded blanket or pillow, in the gap between the arm and side of the chest to support it. If you can, make a simple sling to hold the lower arm across the chest, with the elbow bent at a right angle.

Treatment

The purpose of the initial treatment of a dislocated shoulder is to reduce the dislocation and return the humeral head to its normal place in the socket. This can be done conservatively through closed reduction or non conservatively through surgery open reduction. The decision as to which one to use depends upon the patient, the situation, and the experience of the clinician performing the reduction.

A sling or shoulder immobilizer may be used for a few weeks to rest your arm while the soft tissues around the shoulder repair themselves.

Recovering from a dislocated shoulder 

After the suggested immobilization period, you will have to see a Physiotherapist for rehabilitation to strengthen your shoulder.

A Physiotherapist can show you some gentle arm and shoulder exercises to do at home with your arm out of its sling. These will help reduce stiffness, relieve some of the pain and build up strength in your shoulder muscles. For some useful exercises to get you started, write to us at contact@reliva.in.

The full movement and strength of dislocated shoulder can be successfully attained by completing the 3 phased ReLivaTM SDM (Shoulder Dislocation Management) Programme.

Physiotherapy Shoulder dislocation Management Programme

Physiotherapy Management : Shoulder Dislocation Management (SDM) Programme is divided into three phases, they are:

Phase 1:- Protection Phase

After the shoulder has been put back into its socket, the sling will help you to keep your shoulder comfortable. Your Physiotherapist will give you some gentle movements for the arm, out of the sling, to reduce stiffness and relieve some pain. You may also benefit from putting an ice pack on the sore area for 10-15 minutes.

It is important during this stage that you avoid positions that could cause re-dislocation. The most important position to avoid is holding your arm out at 90 degrees to your side with the palm facing upwards, especially if a force is being applied.

Phase 2- Controlled Motion Phase

The main focus of this phase is to increase your range of movement, increase your muscle strength and re-establish balance in your shoulder. The extent and nature of exercises will depend upon your individual condition and healing. Please follow what the physiotherapist has told you when doing the exercises.

Phase 3- Return to Function Phase

The aim of this phase is to make progress towards functional activities by helping you to regain the neuromuscular control of your shoulder. You will be able to attain your pre-injury level of activity by the end of this phase.

Dislocating the shoulder a second time

If you’ve dislocated your shoulder once, you’re more likely to dislocate it again in the future – particularly if you’re less than 20 years old.

Your chances of another dislocation depend partly on how well the tissues surrounding the joint healed the first time. Regularly doing the exercises your physiotherapist recommends and avoiding awkward arm positions can also reduce the risk of dislocating your shoulder again.

Self-Help Advice:

  • While waiting for medical help, avoid moving your upper arm as much as possible.
  • Till you see the doctor, place something soft, such as a folded blanket or pillow, in the gap between the arm and side of the chest to support it.
  • If you can, make a simple sling to hold the lower arm across the chest, with the elbow bent at a right angle till you see a doctor.
  • Use pain-killers (as advised by your doctor) or ice packs to reduce pain before you exercise.
  • Early follow-up is important to decide when to begin allowing shoulder motion.
  • It is normal for you to feel aching, discomfort or stretching when doing exercises. However if you experience intense and lasting pain, please discuss this with your doctor or Physiotherapist.
  • Avoid positions that could cause re-dislocation. The most important position to avoid in the first few weeks, is holding your arm out at 90 degrees to your side with the palm facing upwards, especially if a force is being applied.
  • Do short frequent sessions of the prescribed exercise (eg. 5-10 minutes, 4 times a day) rather than one long session.
  • Gradually increase the number of repetitions that you do.
  • Get into the habit of doing your exercises to reduce the risk of dislocating your shoulder again.

“This article is purely for general information. Please contact your healthcare expert for specialised medical care. Please go through our Disclaimer and Privacy policy.

neuralgia

Neuralgia

Neuralgia is basically a condition which leads to pain along the course of the nerve. This stabbing and unbearable pain makes it very difficult to carry out the basic daily activities. Also, since there is a glitch in the nerve conduction, the motor functions are also affected causing the movements to become difficult and tiring. All these consequences of Neuralgia can be dealt well with the help of Physiotherapy. Reliva provides physiotherapy treatment for Neuralgia at its clinics in Navi Mumbai and Thane.

Pain Management forms a very important aspect of treatment in neuralgia as it is one of the most disabling symptoms in patient suffering from neuralgia. One of the passive treatments given is cryotherapy, which is the use of cold packs or ice at the area of pain. This helps by sensitizing the area and hence blocking the sensation of pain. Transcutaneous Electrical Nerve Stimulation (TENS) is also considered one of the electrotherapeutic ways of blocking pain signals to the brain and hence reduce pain, as well as the tingling sensation that is experienced by the patient. In cases of Occipital Neuralgia, where the patient has a stabbing headache, it could be relieved with the help of therapeutic massage therapy Massaging the painful area can hit key spots of the nerve blood and oxygen flow. The increased blood and oxygen flow can help to heal damaged nerves.

Apart from pain control, strengthening, improving flexibility as well as aerobic training forms an important part of the treatment. Flexibility exercises in the form of stretching help in relieving the tension from the muscles and hence reducing the pressure on the nerves, thereby reducing the symptoms. Both passive and active stretching exercises are taught to the patient and also administered as home program.

To begin with, various free exercises for the affected muscles are started to maintain the muscle properties and prevent any further consequence like disuse atrophy which may result from not using the muscle for a long time.

Once the basic exercise protocol has been started and the symptoms of pain reduce, strengthening exercises for the muscles that have been affected can be commenced. Strengthening exercises for the neck and back in case of occipital neuralgia prove very useful as they allow maintaining a better posture. Poor posture, specifically being hunched over and bending your neck down, can put pressure on your nerves and lead to headaches. Also strengthening the muscles reduce the intensity of pain then what is felt usually as the muscles are now able to work more and hence do not give up soon. In case of Pudendal neuralgia rehabilitation of the pelvic floor, abdominal, gluteal, lumbosacral and hip rotator muscles. Along with this, strengthening of certain muscles to improve core and lower extremity balance and stability are done.

As the nerve in this condition is under a lot of stress due to factors like external pressure and entrapment, nerve mobilization proves very helpful in relieving them from the tension. Various nerve mobilization techniques are used to reduce the symptoms of the respective nerve being hampered.

Aerobic training, low impact to begin with helps maintain the body functions and also induces relaxation. Walking helps keep the mind and body healthy and active.

What is Neuralgia ?

Neuralgia is a Greek word where neuron means “nerve” and algos “pain”.

Neuralgia is an intense, stabbing, burning and sharp shooting pain caused along the path of a damaged nerve it. Generally, neuralgia isn’t an illness in its own right, but a symptom of injury or a particular disorder. In many cases, the cause of the pain is not known. Older people are most susceptible, but people of any age. The pain may be continuous/ intermittent or caused just by a triggering factor. Neuralgia can occur in different parts of the body and can have various causes. Neuralgia is classified on the basis of the nerve affected or the cause of affection.

Almost everyone will experience mild neuralgia at some point, but these bouts are usually temporary and tend to ease by themselves within a few days. Some types of neuralgia are longer lasting, debilitating and so agonizing that a person’s quality of life is severely reduced.

The common types of neuralgia are:

1. Trigeminal Neuralgia: This type of neuralgia is associated with pain from the trigeminal nerve, which goes from the brain to the face. In the case of trigeminal neuralgia the affected nerves are responsible for sensing touch, temperature sensation and pressure sensation in the facial area from the jaw to the forehead. The disorder generally causes short episodes of excruciating pain, usually for less than two minutes and usually only one side of the face. The pain can be described in a variety of ways such as “stabbing”, “sharp”, “like lightning”, “burning”, and even “itchy”. The pain associated with Trigeminal Neuralgia is recognized as one of the most excruciating pains that can be experienced.

Simple stimuli – such as eating, talking, making facial expressions, washing face, or any light touch or sensation – can trigger an attack (even the sensation of a cool breeze). Attacks may be lone occurrences, clusters of attacks, or constant episodes. Some patients experience muscle spasm, which led to the original term for Trigeminal Neuralgia of “tic douloureux” (“tic”, meaning “spasm”, and “douloureux”, meaning “painful”, in French).

2. Postherpetic Neuralgia: This type of neuralgia occurs as a complication of shingles and may be anywhere on the body. Shingles is a viral infection characterized by a painful rash and blisters. Neuralgia can erupt wherever the outbreak of shingles occurred and can be mild or severe, persistent or intermittent, and can last for months or years. Here the underlying cause that is Shingles is treated to cure the symptoms of neuralgia.

3. Occipital Neuralgia: Irritation of the main nerve that runs from the back of the skull can cause occipital neuralgia. Occipital neuralgia can cause intense pain that feels like a sharp, jabbing, electric shock localized to the back of the head and neck. The pain can sometimes include the forehead. But treatments for those conditions are very different, so it’s important to see your doctor to get the right diagnosis. Other symptoms include aching, burning, and throbbing pain that typically starts at the base of the head and goes to the scalp, Pain on one or both sides of the head, Pain behind the eye, Sensitivity to light, Tender scalp and Pain when you move your neck. People can confuse it with a migraine or other types of headache, because the symptoms can be similar.

4. Pudendal neuralgia: Irritation of the pudendal nerve (severe pain in the distribution of the nerve), i.e. pudendal neuralgia, may result in sensory symptoms in any or all areas it supplies and spasms of the muscles supplied by it. The sensory symptoms could manifest as itching, burning, tingling, cold sensations, and/or burning and shooting pain. The sensory symptoms may extend into the groin, abdomen, legs, and buttocks. The pudendal nerve is the only peripheral nerve that has both somatic and autonomic fibers. Thus, a person can experience increased heart rate and blood pressure, decreased motility of the colon, decreased blood flow, and perspiration with pudendal nerve stimulation.

Signs and symptoms may include the following, but they vary between individuals:

The diagnoses of different types of neuralgia are difficult and could take time to reach the right diagnosis. This is due to the mixed picture that the symptoms give. A person suffering from trigeminal neuralgia could first visit a dentsist as he may suffer from jaw and tooth pain, similarly a patient developing shingles could visit a neurologist before a skin specialist. Your doctor would take a detailed history and ask you the details about how and when the condition developed to make an accurate diagnosis.

What causes Neuralgia ?

The underlying cause of any type of neuralgia is damage to a nerve. Each nerve in your body is protected by a coating called the myelin sheath. When the myelin is damaged or wears away from the nerve, the stabbing, severe, shock-like pain of neuralgia results. There are many different factors, including old age, which can cause damage to the myelin. Unfortunately, in many cases of neuralgia, a cause can never be found. The possible causes of neuralgia are as follows:

1. Pressure on Nerve:The myelin on nerves can be worn away by pressure. The pressure may come from a bone, ligament, blood vessel, or a tumor that is pressing on the nerve. The pressure of a swollen blood vessel is a common cause in trigeminal neuralgia.

2. Entrapment of the nerve:The nerves may get entrapped between the muscles/ muscle tendons or because of the pressure caused by the bones. This leads to an interrupted transmission of signals along with increasing the wear and tear of the myelin sheath causing it to be degenerated faster.

3. Infection: The cause of Postherpetic neuralgia is shingles, an infection caused by the varicella-zoster virus – the same virus that causes chickenpox. This is because the condition causes inflammation of the nerve and leads it to be irritated. The likelihood of having this infection increases with age. Lyme disease, HIV, and syphilis can also cause neuralgia.

4. Diabetes: Many people with diabetes will suffer from some type of neuralgia because excess glucose in the bloodstream can lead to myelin damage

5. Multiple sclerosis: MS is a disease that is caused by the degradation of myelin. Among the many symptoms that result from MS is neuralgia, often in the face.

6. Less Common Causes: If the cause of neuralgia cannot be blamed on an infection, MS, diabetes, or pressure on the nerves, it may be from one of many less common factors.These include:

Benefits of Physiotherapy treatment for Neuraliga

Nociceptive Pain vs Neuropathic Pain

  • Pelvic pain with sitting, but improvement with standing or sitting on a toilet seat.
  • Discomfort with tight clothing.
  • Bladder and/or bowel symptoms (hesitancy, frequency, urgency, retention, constipation, pain
  • Dyspareunia
  • Genital pain
  • Anal pain
  • Abnormal pudendal nerve motor latency test
  • Pudendal nerve block may decrease symptoms
    • chronic kidney disease
    • porphyria (a rare blood disease)
    • medications like cisplatin, paclitaxel, or vincristine (prescribed to cancer patients)
    • trauma, such as that caused by surgery
    • chemical irritation
    • Exercise offers a host of benefits: Besides giving you more energy and strengthening your muscles, it can reduce pain, making day-to-day activities easier to do. Another added exercise bonus is that it can send stress levels plummeting, which can make your pain more manageable.
    • ReLiva Physiotherapy and Rehab helps develop an overall treatment plan for neuralgia which not only helps in relieving pain but also helps cope up with the difficulties encountered in everyday life.
  • Nociceptive painThis is the type of pain that all people have had at some point. It is caused by actual, or potential, damage to tissues. For example, a cut, a burn, an injury, pressure or force from outside the body, or pressure from inside the body (for example, from a tumour) can all cause nociceptive pain. The reason we feel pain in these situations is because tiny nerve endings become activated or damaged by the injury, and this sends pain messages to the brain via nerves. Nociceptive pain tends to be sharp or aching. It also tends to be eased well by traditional painkillers such as paracetamol, anti-inflammatory painkillers, codeine and morphine.Neuropathic painThis type of pain is caused by a problem with one or more nerves themselves. The function of the nerve is affected in a way that it sends pain messages to the brain. Neuropathic pain is often described as burning, stabbing, shooting, aching, or like an electric shock. Neuropathic pain is less likely than nociceptive pain to be helped by traditional painkillers. However, other types of medicines often work well to ease the pain. Neuralgia is a type of neuropathy.
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