arthritis joint pain treatment

Arthritis – Do your Joints Pain?

Last Updated on 31 August, 2018

The disorder commonly affecting the knee and other joints is called as Arthritis.

We commonly see our mothers or grandmothers groaning in pain when they try to do simple activities like getting up from the floor or climbing steps. Daily simple chores seem very difficult for them. They dread even the pleasant rains and winters as they are likely to experience increase in their aches and pains with the fall in temperature.

Arthritis is an inflammation of one or more joints. It is common in adults 65 and older, but it can affect people of all ages. There are many types of arthritis but most common types of arthritis are osteoarthritis and Rheumatoid Arthritis.

1. Rheumatoid Arthritis : It is an autoimmune disease in which the body immune system attacks the lining of the joint capsule, a tough membrane that encloses the joint parts known as synovial membrane. It is characterized by fluctuating course, with periods of flares and remission.

2. Osteoarthritis : It is a chronic degenerative disorder involves wear and tear damage to the joint’s cartilage. Enough damage results in bone grinding which causes pain and restricted movement and joint effusion.

Symptoms of Arthritis

The most common symptoms of Arthritis include pain, redness in the area, swelling,  limited movement & stiffness in the joint.

Unpaid attention to these symptoms can lead you to be under the surgeon's knife.  But timely attention to the soft ringing of bells of your joints can help you deal effectively with your joint pain.

Arthritis, Joint pain : Facts, symptoms, Physiotherapy treatment


Physiotherapy is key to the treatment and management of arthritis.  It can help you to maintain independence through improving your mobility, strength and flexibility.

Used along with medication it can also help to minimise pain.

Physiotherapy for arthritis focuses on the reduction of pain and stiffness as well as increasing the level of movement and range of motion for the individual.

Our experts at ReLivaTM use a combination of modalities, manual therapy techniques and exercise and movement programmes to suit your specific condition. They will aim to reduce the swelling in the affected area along with making a strategy to control pain and stiffness. They will also devise simple exercise programmes that you can practise at home to help you build your strength and flexibility.

Physiotherapy uses a mix of Modalities

  • Heat treatments : These treatments produce heat within your body tissues. The application can be directed towards superficial or deeper parts of the body. The most common types of treatment used are infra-red radiation (heat lamps) and hot packs for superficial treatments.
  • Electrotherapy : These treatments produce electrical stimulation of your body tissues. They may be extremely useful in the treatment of both acute and chronic arthritis, where pain, swelling and muscle spasms are present. Physiotherapy exercise for Arthritis, joints pain
  • Exercise : A balanced programme of rest and exercise, and careful attention to joint posture is an important part of pain management, joint protection and maintenance of your joint function.
  • Manual therapy: Mobilisation and manipulation techniques are passive movements applied to a joint or soft tissue by the therapist in a specific manner to help restore full movement to a joint that is painful and restricted. Manual therapy is often useful in the chronic forms of arthritis and is often successful when other methods such as heat therapy and exercises have given little or no relief.
  • TENS : Transcutaneous electrical nerve stimulation (TENS) therapy is a commonly used electrostimulation method for relieving pain in rheumatoid arthritis.

Simple Tips to help avoid pain and stiffness:

  • Avoid staying in one position for long.
  • Avoid positions or movements that place extra stress on sore joints.
  • Avoid sitting on floor.
  • Modify your activities to make them easier.
  • Take proper rest when your symptoms are on a rise.
  • Try to lose weight if over-weight, as it reduces pressure on joints and alleviates pain.

At ReLiva, we want you to stay pain-free and get back to participating in the activities you enjoy as fast as possible. Get relief. Call +91 992099 1584 to speak to us today so we can connect you with a physiotherapy specialist in your area.

Last updated : 24/05/2018

Related Reading:

Joint Pain: Arthritis?

Ageing Knees? Don’t go weak in your Knees

Five Ways to check your Knee health

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Plantar Fasciitis

Plantar Fasciitis: Heel Pain

Plantar Fasciitis is a condition of the foot causing pain in the heel of the foot. Pain is usually most severe when taking the first few steps of the day or after long hours of standing. Physiotherapy is an excellent way to cure this condition and reduce the pain which is mainly caused due to the inflammation of the plantar fascia which is a dense fibrous connective tissue connecting the heel to the toes. ReLiva Physiotherapy provides treatment for plantar fasciitis at its clinics in Mumbai, Navi Mumbai, Pune and Thane. plantar fasciitis treatment

Physiotherapy in the acute/early phase of this condition focuses on pain relief methods along with the various passive and active stretching techniques to relieve the stress posed on the fascia along with reduction in the inflammation present.

Physiotherapy Treatment for Heel Pain due to Plantar Fasciitis covers:

  1. To reduce the pain as well as the inflammation, therapeutic ultrasound is used over the posterior surface of the heel.
  2. Contrast bath, i.e. keeping the foot dipped in hot water for 10 minutes followed by cold water immediately forms a very important part of the home program which helps in reduction of pain.
  3. Other methods like using taping may be used for correcting the alignment of the bones of the foot which would be contributing to the pain and inflammation because of increased load on the fascia.
  4. Along with this, stretching of the plantar fascia, calf muscles and tendon Achilles (fibrous band connecting the calf muscles to the heel bone) is taught to the patient and performed by the patient.
  5. As a part of chronic management of this condition, other therapeutic techniques like deep friction massage and inotophoresis could also be used, along with the basic stretching and pain reliving techniques.

Curing plantar fasciitis also involves few lifestyle modifications that not only help cure but also prevent the re-occurrence of this condition.

  • Basic changes like using a firm and comfortable footwear and avoiding wearing heels for women are very essential.
  • Footwear modifications like inserting an insole or using cushioned heel insets helps provide support as well as makes the surface more stable and comfortable.

    Plantar Fasciitis Heel Pain

  • Long hours of standing must be avoided and frequent short breaks must be taken to relieve the foot of the constant pressure.
  • Reduction in body weight in case of over-weight and obese individuals also helps decrease the load on the foot/heel.

After the pain has considerably subsided and the muscles gained flexibility, strengthening exercises for the muscles of the foot are done to make the muscles strong enough to take the weight of the body and the repetitive stress and prevent injury. Lumbricals and other intrinsic muscles of the foot are trained and strengthened. So take up Physiotherapy at ReLiva Physiotherapy and Rehab and make every day life easy and pain free.

Causes for Plantar Fasciitis

  • Increased load on the fascia is the major cause of developing pain and inflammation, leading to stiffness.
  • You are at a greater risk of developing plantar fasciitis if you are overweight or obese.
  • Sudden weight gain may also lead to development of plantar fasciitis.
  • Pregnant women often experience bouts of plantar fasciitis, especially during late pregnancy.
  • If you are a long distance runner or athlete, or have an active job that involves being on the foot often may also pose increased risk of developing this condition.
  • Having foot problems like very high arches, flat feet and tight Achilles tendons also contribute to the factors causing pain and stiffness.

More about Plantar Fasciitis

Plantar Fasciitis is a condition where there is inflammation of the fibrous connective tissue present in the soul of our foot. The fascia extends through the longitudinal arch of the foot and connects the heel to the front of the foot. This is an important static structure supporting the foot, taking up all the strain posed on the foot and hence helps us walk. As the load increases the fascia elongates to act as a shock absorber and support our body. Inflammation may start setting in due to the repetitive micro trauma to the tissue and the stresses placed on it, this leads to pain, decreased mobility and stiffness. The onset is gradual with pain setting in at the inferomedial heel, which is the origin of plantar fascia. Pain and stiffness are worse with rising in the morning or prolonged standing, may be exacerbated with stair climbing and toe raises.

Benefits of Physiotherapy in pain

Physiotherapy helps in dealing with the symptoms of plantar fasciitis like pain, stiffness and inflammation. It helps make life more comfortable, less dependent and also prevents the consequences if treatment is taken well in time.

ReLiva Physiotherapy and Rehab helps you in-

  • Relieving your pain.
  • Increasing the mobility of the tightened structures of the foot.
  • Improving the strength of foot muscles.
  • Making everyday life easy and pain free.

More information about Plantar Fasciitis


A heel spur is a pointed bony outgrowth of the bone of the heel (Calcanues). This bony outgrowth could be felt by the examiner during palpation and can also be seen on a radiograpy film, unlike that of plantar fasciitis. Although many people with plantar fasciitis have heel spurs, spurs are not the cause of plantar fasciitis pain. One out of 10 people has heel spurs, but only 1 out of 20 people (5%) with heel spurs have foot pain. Because the spur is not the cause of plantar fasciitis, the pain can be treated without removing the spur.Achilles tendinitis occurs when the tendon that connects the back of the leg to the heel becomes swollen and ultimately painful near the back of the heel or leg. It is typically diagnosed as a result of "overuse" by the runner; and it is often brought about by increasing pace, distance, frequency or speed work. Also, pain is usually localized directly with the tendon, but it may radiate around the entire back of the ankle.

Contributing factors:

Your pain may be caused due to:

  • Sudden gain in weight
  • Trauma leading to heel pain
  • Footwear
  • Walking or running uphill


Related Reading:

Things you must know about Heel Pain

Muscle Strain, Sprain & Injury: RICE


DISC Prolapse

Last Updated: 25 August, 2018

Slip disc is such a commonly heard term among the back pain sufferers. Already about 70% of Indian Population is reported to have suffered from back pain atleast once during their lifetime. Slip disc or disc protrusion or PIVD makes the largest chunk among the possible cause for this LBP.

As we age the discs that are present in our vertebral column, become less flexible and begin to harden, making them more prone to tears. A herniated disc can be caused by a single excessive strain or injury. However, as degeneration of the discs progresses with age, some people may suffer herniated discs from more minor exertions or twists.

Slip Disc

First line of treatment, if you have recently had a slip disc

Immediately after having an episode of PIVD, care should be taken to:

  • Stop the offending /painful movements and activities
  • Lying on your back with feet on a chair & knees at 90 degree angle can sometime be quite comfortable for the back.
  • Apply a cold pack atleast 4-5 times a day for 10 minutes at time
  • See a health care provider (Physiotherapist/orthopedic) to assess the causes and undertand your pain clinically


What are the treatment options for Prolapsed disc?

Treatment of a PIVD depends on the level of severity and discomfort you are facing and how far the disc has slipped out of its place. Usually the line of treatment includes:

  1. Local pain relief: Muscle relaxants or analgesics or non-steroidal anti inflammatory drugs under the ortho’s prescription can be useful.
  2. Physiotherapy – Once the initial inflammation has settled, an appropriate physiotherapy program can relieve the pain. A Physiotherapist will also prescribe an exercise program that strengthens the core and other involved structures.
  3. Surgery - Severe nerve entrapments may require minor surgeries like microdiscectomy.

Tips to manage Prolapsed disc at home

Inspite of the line of treatment you choose for slipped disc, you still need to consider the following tips to manage PIVD better:

  • Sit for only short period of time

    - Your back wants movement and sitting in a chair for an extended period of time puts your back into a loaded flexed position, which your spine will not like. Try to change positions every 30-40 minutes by standing up, going for a little walk, or grabbing a glass of water. While you are sitting for short periods, you want to make sure you sit with good posture and proper lumbar (lower back) support.

  • Apply heat to the affected area

    By using heat you are helping to decrease muscle spasm and improve blood flow through the body. Try using a hot water bottle for 10 minutes or as often as required. Just be sure to place something between your skin and the heat pack to prevent any skin burns.

In case there is swelling or localized warmth, use ice pack for 10 minutes. Read more about using heat and ice.

RICE protocol for Ankle Sprain

  • Find a comfortable sleeping position

    It is important to sleep with proper support so if you like to sleep on your side, place a pillow between your legs to take off any extra pressure through your hips and lower back. If you prefer sleeping on your back, place a pillow or rolled up towel underneath your knees so they are propped up allowing your lumbar spine to relax in a neutral position. These small modifications can help ease any pressure on your spine

  • Healthy exercise lifestyle

     Most importantly, continue your exercise program as a part of maintenance and do regular follow ups with your physiotherapist.

How does Physiotherapy help in treating Prolapsed disc?

Physiotherapy provides a successful treatment for spinal disc prolapse rehabilitation. Typically the treatment includes back pain relief and protection, exercise program for lower abdomen and core stability, restoration of function and preventing a recurrence.

ReLiva Physiotherapy provides Disc prolapse rehabilitation for managing such symptoms at its clinics in Mumbai, Navi Mumbai, Pune and Thane. The treatment phases are described hereunder:

A.Back Pain Relief & Protection:

Our physiotherapists will use an array of treatment tools to reduce your back pain and inflammation. These include: ice, electrotherapy, and unloading taping techniques. Apart from these certain techniques or exercises that unload the inflamed structures are also utilized to provide pain relief and reduce inflammation.

B.Prolapsed Disc Exercises:

  • As your pain and inflammation settles, our physiotherapist will turn their attention to restoring your normal joint alignment and range of motion, muscle length and resting tension, muscle strength and endurance.
  • Our physiotherapist will commence you on a lower abdominal and core stability program to facilitate your important muscles that dynamically control and stabilize your spine.
  • Our physiotherapist may recommend a stretching program to address your tight or shortened muscles.

C.Restoring Full Function:

Depending on your chosen work, sport or activities of daily living, our physiotherapist will aim to restore your function to safely allow you to return to your desired activities. Everyone has different demands for their body that will determine what specific treatment goals you need to achieve. For some it is simply to walk around the block. Others may wish to run a marathon.

Your physiotherapist will tailor your back rehabilitation to help you achieve your own functional goals.

D.Preventing a Recurrence:

Back pain does have a tendency to return. The main reason it is thought to recur is due to insufficient rehabilitation. In particular, poor compliance with deep abdominal and core muscle exercises. You should continue a version of these exercises routinely a few times per week.

What is Prolapsed disc or PIVD?

To understand Prolapsed Intervertebral Disc (PIVD), also known as herniated disc or disc protrusion or disc prolapsed; it is important to understand the central structure of our disc.

A prolapsed /herniated disc means displacement of the content of the disc beyond its boundaries into the intervertebral space. Your disc is made up of 2 layers- thick outer layer called Annulus Fibrosus and the soft gel-like center called Nucleus Pulposus.

You can relate this stricture to a cream biscuit. The biscuits as the tough outer layer annulus and the cream as the central gel like structure nucleus.

These discs act as cushions or shock absorbers between the vertebras.



PIVD is actually an age related problem. But trauma, strains, torsion or heavy lifting can cause disc prolapse/herniatons. It can occur in any disc of the spine but lumbar (lower back) and cervical (neck) disc prolapses are common forms.

What are the causes of Disc Prolapse?

Pain caused due to disc prolapse/ herniation may seem to occur suddenly but it is usually a result of a gradual process accumulating due to many of the following causes:

  • Ageing
  • Being overweight (creating more pressure on the spinal column)
  • Smoking (which can contribute to the degeneration of discs)
  • Incorrect lifting of heavy weights.
  • Repetitive strenuous activity.

Less common causes would be traumatic injuries like a fall or an accident that puts pressure on the disc and causes its displacement.

What are the signs and symptoms of prolapsed disc?

The most common symptom of a herniated disc are:

  • Pain &/or numbness
  • Pain that extends to the arms from your neck OR pain that extends to the legs from the lower back (sciatica pain)
  • Pain worsenig at night while asleep or with certain activities tha defines the pressure on your discs
  • Pain worsening on standing/sitting
  • Pain on walking specific distances
  • Muscle weakness in higher degree of disc involvement
  • Tingling, aching or burning sensation in the affected area

The type of pain or symptoms may vary from person to person depending on the severity of disc involvement.

If problems with bowel or bladder function are experienced this may be a sign of cauda equine syndrome - a rare but serious complication of a herniated disc. Immediate medical attention should be sought if this is suspected.

How much time does it take to recover from prolapsed disc?

Your discs do not have a blood supply (blood is what brings the healing to any damaged structure). This means that your disc doesn’t have any repairing powers of its own and if injured, your spinal disc cannot repair itself.

After a disc injury, your disc would undergo the following 3 stages:

  • Significant dysfunction due to pain
  • Long phase of instability which makes you more prone to back pain episodes
  • Body tries to re-stabilise the segment and you may have lesser episodes of pain.

Either ways, a physiotherapist at ReLiva will plan your treatment based on your assessment and your recovery stage. The time frame of recovery varies based on the severity of structural involvement. But in general your recovery stages would be as follows :

1. Acute inflammatory stage

– in this stage, your pain has just started but is very severe in nature and constantly present. No movement or position helps you relieve the symptom.

2. Acute stage without inflammation

– here the symptoms are intermmittent in nature and usually related to offending activities or movements.

  1. For eg: if you cannot stand longer that 15 min/sit longer than 30 min/walk for more than a mile. Attempting these activities beyond your mechanical limits will aggravate your pain symptoms.

3. Subacute stage

- usually at this stage, certain movement & postures still provoke the pain.

4. Chronic stage

- when this stage is reached, emphasis is placed on returning the highest level of activity that require you to perform repeated movement or we can say repeated loading. For eg: lifting something or playing a sport etc.

What are the complications of a Prolapsed disc?

An untreated slipped disc can manifest in various ways:

  • An untreated, severe slipped disc can lead to permanent nerve damage.
  • In very rare cases, a slipped disc can cut off nerve impulses to the end of the spinal column called as cauda equina in your lower back and legs. If this occurs, you may lose bowel or bladder control.
  • Another long-term complication is known as saddle anesthesia. In this case, the slipped disc compresses nerves and causes you to lose sensation in your inner thighs, the back of your legs, and around your rectum.

While the symptoms of a slipped disc may improve, they also can worsen. If you cannot perform the activities you once could, it’s time to see your doctor.

Frequently asked Questions – FAQs for prolapsed disc

frequently asked questions FAQ

Q Do you have to have surgery for a PIVD?

The treatment of a bulging disc depends on your symptoms. Most patients with a bulging disc do not need surgery. Your symptoms can usually be managed with conservative treatment such as pain medications and physical therapy.

Q What happens if you leave slipped disc untreated?

A lot of times, back pain symptoms are ignored until they do not hamper/restrict your daily activities. An untreated PIVD can lead to permanent nerve damage. In very rare cases, a displaced disc can cut off nerve impulses to the cauda equine (lowest part of the spinal cord) nerves in your lower back and legs. If this occurs, you may lose bowel or bladder control. This could be a debilitating condition.

Q How should I sit with a prolapsed disc?

  1. Keep your back flat against your chair with a pillow/cushion against your backrest mainatining your shoulders tall
  2. Keep your knees at the same level as your hipswhile sitting at your desk
  3. Keep your feet flat on the floor

Q Can exercise help in the recovery of Prolapsed disc?

Exercise is an important component of PIVD treatments. Exercises under the supervision and expert guidance of the physiotherapist will reduce your pain and ensure a long term good health to your spine.

Interesting Facts about PIVD:

  • A bulging disc may be as painful as an herniated disc
  • Prolapsed discs cannot be diagnosed with an x-ray. You need an MRI
  • Many disc pain conditions are misdiagnosed

If I were to gather a group of middle age folks (45 average age) who have NEVER had back pain before and shoot MRIs on them all, here's what we would find:38% would have disc bulges,

  • 37% disc protrusions (aka: contained herniations),
  • 11% disc extrusions (aka: non-contained herniations),
  • 0% disc sequestrations (aka: free fragments) and
  • 4% nerve root compression by the disc herniation.

A more shocking statistic is that 60% of asymptomatic middle aged people would have findings of disc bulge or worse (protrusion, extrusion) on MRI!

In case you have been suffering from prolapsed disc, do not accept you life with pain. You can recover and return to the activities you enjoy.We have seen great success in treating patients with PIVD, LBP, slipped disc and will be happy to help. Contact us at 9920991584 and we will connect you to a physiotherapist near you.

Related Reading:
Exercises for Back Pain
What’s causing your pain? Is it poor posture

Back Pain: cause, Self care, FAQs
Understanding Spondylosis VS Spondylitis

This article is based on the contribution from Dr Anuradha Mandlekar (PT). Dr Anuradha is a senior physiotherapist and heads the clinical team at ReLiva Physiotherapy & Rehab.

We provide Physiotherapy services at our fully equipped clinics in:

Mumbai | Chembur MulundThane  | Kapurbawdi  | Ghodbunder Rd | Kalwa 

Navi Mumbai | Vashi | Nerul | CardiumKharghar | Pune | Kalyani Nagar | Wakad

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