Mobilizations & Myotherapy Works!!!

2 months back one patient came to our department with severe pain , swelling and restricted ankle movements. He is unable to walk without support. He is a lecturer and medically diagnosed with psoriatic arthritis. Disease started 2 years back and his ankle problem started one year back. All other joints are normal. ROM of his both ankle joint is nearly zero.
Most of the ortho specialists advised arthrodesis (surgical fusion of the joint). But he went for a second opinion and consulted with a physician and he directed him to our department for physiotherapy.

We started with hotpacks, then we slowly started mobilization of the joint in classic way. But it was very painful to him. So we applied Mulligan's movement with mobilization for 10mts, followed by myotherapy, deep friction technique over the ankle joint, Ultra sound therapy to reduce swelling. After 2 session we got dramatic result. On second day he has got 25% movement of his ankle joint and swelling reduced to 50%. We continued the same treatment plan and applied crepe bandage after treatment. After 10 days there is 90% reduction in the frequency of pain, swelling disappered and ROM become near normal. He is able to walk without support but mild limping was present... Then we strated some conditioning exercises for leg muscles first with very minimal resistance and progressed with moderate resistace, by the time we continued the mobilization and myotherapy for 10 more days.

Now he is able to walk without support, gait near normal and ankle movemts are 100%!!
Mobilizations , myotherapy and exercises worked in this condition....

Is it Frozen Shoulder?

One of our patient comes with left shoulder pain and stiffness. He is having this problem 6 months back and he consulted many orthopaedicians and took lot of analgesics. Professionally he is a martial art tutor. The pain started gradually and decreased range of motion slowly. Now he has 110 degree of shoulder flexion and 100 degree abduction and 50% movement loss of rotations. All orthopaedicians diagnosed as frozen shoulder , but during the movement of his shoulder the restriction or end point feels rubbery or elastic end feel.

He came 4 days back in our clinic for physiotherapy services. On first day, our treatment protocol is same as that of frozen shoulder but we feel the end feel... so we changed the treatment protocol... we reassessed patient that find out trigger points over subscapularis, and tightness of latissmus dorsi muscles.

So we applied myofascial therapy, neuro muscular therapy and trigger point therapy for the particular muscle groups along with usual mobilization (mulligan techniques) and exercises... on third day there is 80% decrease in pain and 85% increase in range of motion...

Subscapularis is a rotator cuff muscle whose job is to stabilize the humeral head and seat it deeply into the glenoid fosa. It is the powerful medial rotator of the humerus. Problems over subscapularis produces loss of lateral rotation and abduction movement..that mimics the frozen shoulder syndrome.

A through knowledge about the muscles and their function is most useful when treating this type of disorders..where traditional physiotherapy fails..............

More snaps from IDA Talk

Talk on Work related musculoskeletal disorders in Dentistry

On 15th December , Indian Dental Association- Thrissur Branch (award winning IDA Branch in Kerala, India) on their annual meeting, organized a talk on Work related Musculoskeletal Disorders and Ergonomics in Dentistry.. Talk given by Dr.Grinto Davy Chirakekkaren (PT) on behalf of SMART Healthcare - Centre for musculoskeletal Disorders and Rehabilitation. The response was tremendous and most of the Dentists attended in the conference had met with one of the MSDs during their professional life.

Work related musculoskeletal disorders in dentists

Work related musculo skeletal disorders are very common in dentists due to the type of work and posture during their time of work.Recent surveys shows that 40-60% dentists are affected with work related musculo skeletal disorders. The most common affected sites are neck, shoulder, hand, wrist and back. The disorders around neck and shoulder are
1.myofascial pain syndrome
2.cervical spondylosis
3.Rotator cuff injuries
4.Thoracic outlet syndrome etc..
The disorders affecting forearm,hand and wrist are
1.DeQuervains disease
2.Carpal Tunnel syndrome
3.Tennis Elbow
4.Guyon's disease
5.Trigger finger
The disorders affecting back are
1.Lumbar spondylosis
2.Low back pain
3.Sciatica
4.Herniated disc

M pain and trigger points are common and most of the time they misdiagnosed simply as Cervical spondylosis and Carpal Tunnel Syndrome. So a through clinical examination is needed for every patient before starting the physio program.