Plantar Fasciitis

Plantar Fasciitis:

Who are risky?

1.    Gout

2.    Ankylosing Spondilitis

3.    Ruter’s Deases

C/F:

1.    Pain and tenderness of heel

Investigation:

1.    X-ray

2.    Serum Uric acid test

3.    HLA –B27

Treatment:

1.    Rest

2.    NSAIDs

3. Physiotherapy

(It takes may be 6 to 12 months to recover)

De-Quervians Syndrome

De-Quervians Syndrome:

Who are risky?

1.    Middle age woman
2.    During pregnancy

Pathology:

1.    Thickening of tendon sheath.

C/F:

1.    Pain and swelling on styloid process of radious.
2.    Movement restricted.

Sign:

1.    Tenderness of styloid process.

Test:

1.    Finkelstrains test.

D/D:

1.    Arthritis at the base of the thumb.
2.    Scaphoid non-union.

Treatment:

1.    Rest
2.    NNSAID
3.    Steroid inj
4. Physiotherapy

Surgical Treatment:

1.    Division of the tendon sheath.

Fever in Babies: What Are the Sign

Fever in Babies: What Are the Signs?

One common sign of fever in babies is a warm forehead, although not having a warm forehead doesn't mean that your baby doesn't have a fever. Your baby may also be crankier and fussier than usual.

Other symptoms associated with fever in babies include:

·         Poor sleeping

·         Poor eating

·         Lack of interest in play

·         Less active or even lethargic

·         Convulsions or seizures

What Is Back Pain?

What Is Back Pain?

The spine is made up of 4 regions, the cervical (neck), thoracic (mid back), lumbar (low back) and sacral (base of spine). The bones that make up the spinal column are called vertebrae, with discs in between. Ligaments, muscles and tendons surround the spine to provide support and stability, and to control movement. So back pain problems can be complex.

How We Can Help?

We (Physiotherapist) assess and treat large number of back pain patients every day and use the latest treatment techniques to help our patients, including:

• Joint Mobilizations
• Manipulative Physiotherapy
• Traction
• McKenzie Therapy
• Maitland Techniques
• Specific Core Stabilization Exercises
• Electrical Modalities
• Thermal Modalities
• Postural Advice

• Acupuncture
• Dry Needling
• Massage
• Exercise Techniques & Stretches
• Ergonomic Advice
• Lifting Techniques
• Self-Management
• Preventive Advice 

How Neck Pain Can Be Treated By Exercise

How Neck Pain Can Be Treated By Exercise:

Neck Pain

We have all experienced neck pain to some degree- it may be brought on from sitting at a computer the whole day, from playing sports or possibly from an accident. Neck pain is a relatively common complaint, affecting up to 70% of individuals at some point during their life. Approximately 40-50% of the population suffers neck pain in any one year. Our Chartered Physiotherapist Niamh Connolly discusses the problem and some measures by which to reduce the chance of the problem occurring.

It tends to be a persistent and recurrent disorder where approximately 60% of individuals can expect to get some degree of on-going pain following their first episode.

The aim of physiotherapy rehabilitation of neck pain is to prevent a first episode from turning into chronic (>3 months) or recurrent pain.

The Neuromuscular system is one of the main reasons why people get a re-occurrence of their neck pain. The neuromuscular system is composed of nerves and muscles, these allow for innervations and movement of the muscles in the body. When a person undergoes pain and injury the strategies to control movement, posture and stability are compromised.

If neuromuscular function is altered this can cause:

·         Delayed activation of neck muscle

·         Changes in muscle size

·         Changes in muscle composition

·         Impaired postural endurance

·         Altered muscle activation movement

All of which can lead to neck pain:

Some examples of this type of altered function would be:

A reduced ability to maintain upright posture during a computer task, this reflects a low level of endurance in the muscles required to control the postural function of the spine, and over time if this is a repetitive position eg office / desk related job this may lead to neck/ shoulder pain.

How Is Neck Pain Treated?

The key principles in treating neck pain involve

·         Selectivity and specificity of exercise

·         Early rehabilitation

·         Pain-free rehabilitation

·         Rehabilitation for prevention of reoccurrence

How Can Exercises Help?

Exercise has been shown to improve neuromuscular impairments in people with neck pain however the type of exercise selected should be based on careful and precise physiotherapy assessment of these neuromuscular changes and therefore be specific to the impairments of the presenting patient.

This type of exercise usually commences early in the rehabilitation process and is used in combination with ‘hands on’/manual therapy if required; these exercises do not provoke pain and are designed to address the specific changes that have been identified via assessment in the muscle and neuromuscular system.

Exercises Used

The types of exercises used

·         target and activate the deep cervical muscles

·         retraining the endurance capacity of deep neck muscles

·         retrain the patterns of activation of the deep and superficial neck muscles

·         re-educate the use of muscles in posture and in functional tasks

·         address the strength and endurance  for functional requirements

Education and explanation regarding the rationale behind the treatment approach are a large component of this physiotherapy treatment as the patient’s compliance and contribution to the exercise program is critical.

Treating Lower Back Pain through the McKenzie Method:

Treating Lower Back Pain through the McKenzie Method:

We often discuss our physiotherapy treatments in our blog posts but do not always go into detail about the techniques and methods which are used by our physiotherapists. So today Mark Dockery of our Navan Road clinic in Dublin highlights how lower back pain is treated through the McKenzie method.

So What Is The McKenzie Method?

The McKenzie Method is a system of exercises used to elucidate the type of spinal issue a patient has and how best to treat it. It is commonly used worldwide in the diagnosis and treatment of low back pain, neck pain and peripheral joint complaints.

The method was created by New Zealand-based Physiotherapist Robin McKenzie (who passed away in May) in the early 1960s and is still in use today. The McKenzie Method is best applied with the aid of a Physiotherapist trained in the Method, who can diagnosis your particular problem and teach you the appropriate exercises to use at home.

The McKenzie Method implements primarily self-treatment strategies, and minimises manual therapy procedures, with the McKenzie-trained therapist supporting the patient with passive procedures only if an individual self-treatment programme is not fully effective. McKenzie himself states that self-treatment is the best way to achieve a lasting improvement of any type of back pain .

The 3 Focus Points Of The McKenzie Method

There are three main areas addressed by the McKenzie method for back and neck pain. They are posture, dysfunction and derangement . 

- Posture: End-range stress of normal structures.
- Dysfunction: End-range stress of shortened structures (i.e. scar tissue; fibrosis; nerve root adherence).
- Derangement: Anatomical disruption or displacement within the motion segment.

(The three mechanical syndromes – posture, dysfunction, and derangement – occur in all areas of the vertebral column, from the neck to the base of the back).

So What Might A Physiotherapist Advise?

Each distinct syndrome is addressed according to its unique nature, with mechanical procedures utilizing specific movement and positions. Examples of exercises prescribed by a Physiotherapist for a home-based programme might include:

- Lying prone (on your front). [McKenzie method treatment]
- Prone back extension (arching your back whilst lying on your front).
- Rotation mobilisation in extension (whilst lying prone).
- Standing posture exercises (importantly extension of the spinal column).
- Standing toe-touch.
- Pelvic side-shift movements (lateral tilt).

The McKenzie method encourages education and patient involvement, in managing their own treatment plans. This helps to reduce pain and restore normal function. This also may reduce the number of visits to the clinic. Overall most patients are able to treat themselves successfully when they are provided with the necessary information by their physiotherapist. Customised self treatment programmes will be provided by our physiotherapists should they deem this the correct method of treatment for you.

Self-Care for Tonsillitis:

Self-Care for Tonsillitis: 

Drink warm or cold fluids

Eat soft, bland foods

Gargle with warm, salty water (adolescents and adults)

Use acetaminophen or ibuprofen for pain relief and fever reduction

Use throat lozenges or eat hard candy (not recommended for young children)

Get plenty of rest

Drink plenty of fluids to prevent dehydration.

Your doctor is the best source of information on the drug treatment choices available to you.

Surgery to remove the tonsils, known as tonsillectomy, is performed infrequently, and mainly in cases where a patient has repeated, severe episodes of tonsillitis, or if bacterial tonsillitis does not respond to antibiotics. Having one's tonsils removed was once a childhood rite of passage. Today, however, tonsillectomies are rarely done because effective new drugs are now available for treating bacterial tonsillitis. In addition, doctors have developed a better understanding of the role of tonsils in the body's immune system, and no longer believe they should be routinely removed if they become infected.

A tonsillectomy may be recommended for an individual with chronic tonsillitis. A tonsillectomy may be necessary if you experience frequent episodes of tonsillitis within a year (five to seven episodes is usually the benchmark), or have five episodes a year for two straight years.

The tonsils may also be removed if they are large and are blocking the throat. Tonsils that are too large can cause breathing problems for children or adults, and a tonsillectomy is sometimes recommended to relieve this problem. Enlarged tonsils also may be removed if they seem to be causing a problem known as obstructive sleep apnea, which is a condition wherein breathing is blocked during sleep when the airway pulls shut. It can occur in children as well as in adults.

If tonsillitis is not effectively treated, it may lead to a condition called peritonsillar abscess, and require a tonsillectomy. A peritonsillar abscess is a collection of pus or infected material around the tonsils. It can occur when one or both of the tonsils become infected, and pus spreads from the tonsils to surrounding tissues. The condition can develop when antibiotics fail to cure an otherwise ordinary case of tonsillitis, or when tonsillitis improves, and then gets worse. Peritonsillar abscess may spread to the roof of the mouth, the neck, and the chest. The airway could then become obstructed, a situation requiring emergency treatment, which may include removing the tonsils. Peritonsillar abscess is infrequent, and is more common in adolescents and young adults than in children.

A tonsillectomy can be performed in the hospital or at an outpatient surgical facility. A tonsillectomy is usually done by an ear, nose, and throat specialist, or a general surgeon, often as same-day surgery. After administration of general anesthesia, the patient's mouth is held open to expose the tonsils. The tonsils are then grasped with clamps, pulled forward, cut free of surrounding tissue, and removed. The doctor will seal the blood vessels to stop the bleeding. The doctor may also remove another set of tonsillar tissues, called the adenoids, from the back of the upper part of the throat. The combined procedure is referred to as tonsillectomy and adenoidectomy.

In most cases, patients can go home several hours after surgery, although very young children (age three or under) or those with other medical problems typically require an overnight stay. The most common complication is bleeding, which may occur immediately after surgery or several days later. If bleeding occurs while you are at the hospital or outpatient center, you will be taken to the operating room for additional care. If minor bleeding occurs at home, try rinsing your mouth with ice water. Call the doctor or go to the emergency room if bleeding becomes excessive.

Side effects such as a sore throat, fever, nasal congestion, earaches, and moderate pain are likely for several days after a tonsillectomy. Consume easily swallowed foods and liquids such as custard, gelatin, pudding, ice cream, popsicles, and iced drinks for about a week after surgery. Gradually introduce more solid foods, but avoid crispy or sharp-edged foods such as bacon, toast, or chips until the throat is fully healed. Drink plenty of liquids to prevent dehydration, but do not serve citrus juices or acidic fruits that can cause irritation. Your doctor may prescribe antibiotics to prevent infection. For pain relief, the doctor may suggest acetaminophen or prescribe a pain medication. Do not use ibuprofen or aspirin, as they can increase the risk of bleeding.

A full recovery takes about two weeks. Children should rest in bed for several days, and gradually resume a normal schedule. During the recovery period, the pain may fluctuate. Contact your doctor if pain and other symptoms do not improve.

If eating is painful, you may experience weight loss. If your throat hurts, use the pain medication recommended by your doctor, and consume only easily swallowed foods. Any weight lost during the recovery period will usually be regained quickly once a normal diet is resumed.

Acupuncture may be used to treat tonsillitis pain. Acupuncture treatment may provide relief from the pain of tonsillitis, according to The World Health Organization, and may be one option to consider if conventional forms of treatment have not been successful. Many doctors can make referrals to certified acupuncturists, or identify organizations that can provide information and referrals. Although acupuncture is widely used in many parts of the world to treat a range of health problems, including tonsillitis, it is not known how widely acupuncture is used in the United States. Consult your doctor if you are considering acupuncture therapy to relieve the pain of tonsillitis.

With proper medication and self-care, most cases of tonsillitis will resolve within a week or two. Tonsillitis generally is cured within a week or two, particularly with plenty of rest and fluids. Chances of a full recovery are also increased when the full, 10-day course of antibiotics prescribed for bacterial tonsillitis is taken as directed. If bacterial tonsillitis is not treated, or if it is undertreated because all medication was not taken, there is an increased risk of rheumatic fever or kidney disease.

It probably will not be necessary to see a doctor for a follow-up visit unless complications develop, or if you or your child have had a tonsillectomy. If you or your child had a tonsillectomy, your doctor may want to follow up in a few weeks to make sure that healing has progressed. Since most cases of tonsillitis resolve on their own, however, you probably will not need to follow up with your doctor if you didn't have surgery. Call the doctor's office if your or your child's symptoms do not improve after a few days, or if the symptoms become worse.

Treatment for Tonsillitis:

Treatment for Tonsillitis:

While most cases of tonsillitis can be treated at home or by a primary care physician, emergency care may be needed in severe cases. Go to the emergency room if you or your child have extreme difficulty swallowing (i.e., can’t swallow saliva), have difficulty breathing, or feel very sick. Intravenous fluids may be necessary for children who have become dehydrated because of their inability to swallow fluids.

Contact your doctor any time you or your child have a sore throat or other symptoms of tonsillitis that cause more than minor problems such as mild fever or headache. Call your doctor if pain relievers have not improved your fever, or if a sore throat is preventing you or your child from drinking an adequate amount of fluid. You should also call your doctor if other symptoms have not improved in 24 hours. In most cases, the doctor will recommend an office visit or self-care.

Most cases of tonsillitis improve within a few days. However, you can hasten recovery by resting and modifying your diet to avoid irritating your throat. Because a sore throat makes some foods hard to swallow, drink plenty of liquids, and eat soft, bland foods including soup, ice cream, and popsicles. Either warm (but not hot) fluids—such as tea with honey or hot chocolate—or very cold fluids such as milkshakes can help soothe the throat. Soft drinks such as ginger ale are also acceptable, but avoid orange juice, lemonade, or other acidic drinks that could irritate the throat. Older children and adults can gargle every few hours with warm, salty water (use 1/4 teaspoon of salt in 4 oz of water). You can also use a cool-mist humidifier to increase the amount of moisture in the air.

You should stay in bed or pursue quiet activities as long as you are feeling unwell so that your body will have time to heal. Viral tonsillitis may last as little as 24 hours, and most people recover within a week.

Cases of bacterial tonsillitis may take longer to cure. Symptoms such as fever and sore throat usually improve within a week, although a complete recovery may take closer to two weeks. It is probably not be necessary to remain in bed after the first few days of treatment.

Over-the-counter medications can reduce pain and relieve fever. If you have viral tonsillitis, antibiotics will not help, and the condition will usually be left to run its course. In this case, use over-the-counter medications for pain relief.

Use a product such as acetaminophen or ibuprofen (i.e. Tylenol or Advil) for pain relief and fever reduction. Follow the dosage recommendations on the package, which are based on age and weight, or follow your doctor's instructions. Do not give products containing aspirin to children or teens unless your doctor recommends this type of medication. In this age group, aspirin is associated with a condition called Reye's syndrome, which is potentially fatal.

Throat lozenges may be used for adults and children over the age of four to reduce the discomfort of a sore throat. Hard candy such as butterscotch may have a similar soothing effect, but neither candy nor lozenges should be given to young children who may accidentally swallow them and choke.

Sacralization:

Sacralization:

Symptoms/Chief complain (C/C):

1.    Usually occurs in any age.
2. Onset is gradual.
3. Low back pain.
4. Radiating pain may presnet.

Signs/On Examination (O/E):

1.    No tenderness.
2. SLR (-) ve.
3. Pain may presnet in back ward bending.

Investigaiton: X-ray lumbo-sacral spine A/P view.

Treatment:

1. Lumber traction.
2. Mobilizing exercises of lumber spine.

De Quervain’s Disease:

De Quervain’s Disease:

Symptoms/Chief complain (C/C):

1.    Pain in the radial side of the dorsum of wrist.
2. Active movement of thumb is painful.

Signs/On Examination (O/E)

1.    Swelling may present on radial styloid.
2. Tenderness present on radial styloid.
3. Crepitus may present on palpation.
4. Abduction and extension of thumb against resistance is painful.

Treatment:

1. Complete rest of the hand with resting splint.
2. Ice.
3. UST with Naproxen gel.
4. NSAIDs.

Nerve Ablation Treatment for Wrist Joint Pain:

Nerve Ablation Treatment for Wrist Joint Pain:

Radiofrequency Nerve Ablation

Radiofrequency needle is much smaller in diameter than cryo probe. Radiofrequency needle is placed just like cryo probe over pinched or irritated nerve. Radiofrequency waves are generated at the tip of the needle, which results in increased temperature. Temperature is maintained between 75 to 90 degree C for 75 to 90 seconds to accomplish nerve ablation.

·         Radiofrequency nerve ablation using radiofrequency heat.

·         Alternative to phenol or alcohol injection is radiofrequency or cryo nerve ablation procedure,

·         Radiofrequency or cryo needle following nerve stimulation is placed over pinched or irritated nerve. Radiofrequency needle generate temperature of 75 to 90 degree C over nerve and Cryo probe is cooled down to -90 degree C to cause a nerve lesioning resulting in nerve ablation.

Cryo Nerve Ablation

Procedure involves placing of cryo probe over irritated or pinched nerve. Cryo probe is much wider in diameter than radiofrequency needle. Procedure involves tiny incision to insert cryo probe. Probe is placed over nerve following nerve stimulation test. Probe temperature is maintained at -70 to 90 degree C for 3 minutes.

Chemical Nerve Ablation For Wrist Pain.

Chemical Nerve Ablation (Nerve Destruction):

Procedure is selectively performed using alcohol and phenol to destruct (ablate) irritated or pinched nerve. This treatment is very rarely needed for wrist joint pain.

Indication for Nerve Ablation to Treat Wrist Joint Pain-

·         Chronic Wrist Joint Pain Caused By Nerve Irritation Or Pinched Nerve

·         Pinched Nerve Pain Caused By Wrist Joint Fracture Or Dislocation Not Responding To Pain Medications, Physical Therapy, Corticosteroid Injection And Surgery.

·         Pinch Nerve Pain Following Surgery.

·         Radial, Median or Ulnar Nerve Neuropathy Causing Selective Peripheral Nerve Pain.

Nerve Ablation Techniques-

·         Phenol Injection of Pinched or Irritated Nerve.

·         Alcohol Injection of Pinched or Irritated Nerve.

Diagnosis of Pinched or Irritated Nerve-

·         Pain Specialist Will Conduct Detailed Examination To Diagnose And Evaluate The Nerve Causing Pain.

·         Pinched Or Irritated Nerve Is Identified By Nerve Conduction And Nerve Stimulation Study.

Procedure Notes-

·         Procedure is performed in Out-Patient Surgery.

·         Choice of Treatment Is Discussed With Patient Prior To Surgery.

·         Treatment is performed under Local Anesthesia.

·         Needle is placed over Nerve for Phenol or Alcohol Injection.

·         Phenol Injection for Wrist Joint Pain- Phenol is selectively injected near or over the nerve. Procedure is painful and pain lasts for short period. Phenol destructs peripheral nerve by neurolysis. Procedure is very rarely performed.

·         Alcohol Injection for Wrist Joint Pain- Alcohol is very rarely used. Alcohol injection is very painful and pain lasts for prolonged time. Nerve when regenerate causes severe neuropathic pain.

Complication Following Phenol or Alcohol Injection-

·         Destruction of surrounding soft tissue, since liquid phenol and alcohol spreads rapidly in soft tissue

·         Severe scar tissues are formed because of surrounding soft tissue damage. Chemical inflammation of soft tissue is induced by phenol and alcohol.

·         Nerve regeneration follows severe neuropathic pain

·         Cryo or radiofrequency nerve ablation is preferred over phenol or alcohol injection. Alcohol or phenol spreads over surrounding soft tissue causing severe destruction and scarring.

Contraindication for Wrist Joint Phenol or Alcohol Injection

·         Septic Arthritis

·         Skin Infection

·         Septicemia

·         Allergies to Phenol