Thursday, October 16, 2014

Fractured 5th Metatarsal Recovery Time

Checkout Physiobob's forum conversation on fractured 5th metatarsal recovery time here-

http://www.physiobob.com/forum/patient-corner-questions-answers/21839-fractured-5th-metatarsal-recovery-time.html

Sunday, August 3, 2014

Hypermobility

As physiotherapists we spend ALOT of time working with people who have stiff joints, tight muscles, reduced movement….. All of these things present as a lack of mobility, which is, in most cases, resulting in pain (hence why they are sitting in my waiting room).

BUT sometimes we forget about the other side of the coin….. The hypermobile ones, those that have TOO much movement, their joints have more range than required, their muscles are too flexible.

This is actually a problem that exists far more commonly than one may think, often it is asymptomatic & people won’t even be aware that their body is a little more like an elastic band than their best friends, BUT in some cases joint hypermobility syndrome can cause pain.

Joint hypermobility is usually inherited; if your mum is super super flexible, chances you will be too. There is nothing you can do to change it or prevent it, unfortunately its due to a gene representation in the connective tissue (the glue that holds our bodies together) causing it to become more pliable& more stretchy allowing for excessive movement at certain joints.

People with hypermobile joints have a higher incidence of dislocation and sprains of involved joints. The hypermobility tends to decrease with age as we naturally become less flexible.

When it comes to being hypermobility some people just live with it, other people may suffer from certain related medical conditions such as Ehlers-Danlos Syndrome (EDS), Marfan Syndrome and Osteogenesis Imperfecta BUT the purpose of this blog isn’t to overload you with information related to these issues but rather to give you a little insight into a more common presentation which is ‘hypermobility syndrome’ or HMS and when you may need to seek a little professional advice.

Do you have HMS?

There is a great little series of tests that you can do right no on your living room floor. Give yourself a score of 1 for each of the following that you CAN DO.

Touch the floor with your palms flat without bending your knees
Can you bend your left elbow back past straight
The same for your right elbow
When lying flat on floor with your left leg straight out in front of you can you lift your left heel off the floor approx 1-2 inches without lifting your knee or upper leg
The same for your right leg
Can you bend your left thumb under so that it touches your forearm
The same for your right thumb
Can you bend your left little finger back past 90 degrees
The same for your left little finger

For each one you are able to achieve give yourself a point.

What was your score out of 9? If you were able to do any of the above you have are classed as hypermobile BUT you don’t necessarily have HMS.

In a clinical setting your score along with the prevalence of certain symptoms would categories you into either minor or major hypermobility syndrome. Some symptoms include joint pain, history of subluxation or dislocation of joints, being particularly tall & slim.



If your hypermobility is causing you joint pain make an appointment with a sports physiotherapist. They will be able to assess you and answer all your questions about what you can, can’t, should and shouldn’t be doing. There are exercises that can be done to help with the pain and also allow you to partake in all the activities you wish to. It’s also nice to be educated about the risks that certain sports may present to you as a ‘hypermobile’ individual; for example if you are desperate to play high intensity collision sports such as rugby you should be aware that the risk of you dislocating your shoulder is slightly higher than your team mates who are not hypermobile.

So you have HMS? DON’T PANIC. This doesn’t mean you need to start doing things differently. Yes you can exercise, in fact it’s recommended that you do; yes you can play sport (some may be advisable to avoid); yes you can go trampolining; yes you can ski; yes you can LIVE a normal life.



via- http://yoursportsphysioblog.com/2014/05/30/are-you-hypermobile/

Why post exercise soreness is a good thing sometimes...

DOMS or delayed onset muscle soreness is the term given to sore stiff muscles following unaccustomed strenuous exercise. DOMS usually begins 24 hours after exercise and can linger for anywhere between 2-4 days.

When we talk of DOMS we’re not talking the heavy feeling in your legs when you cross the line of your first marathon, more so the pain you get the next morning when you descend the stairs for your morning coffee and your quads shake like crazy!

I personally love the feeling of DOMS… Sometimes.. It’s a sign that I’ve actually worked hard in the gym for once in my life!!

Everyone is susceptible to DOMS so don’t think if you train 7 days a week that you’ll avoid it, if you change up your exercise regime DOMS might come looking for you. When we exercise we program our muscles to deal with certain stresses and certain loads. Notice when you do your first session of squats / lunges your quads burn for days but after the 3rd or 4th time you do a similar session there is minimal post exercise soreness. This is all due to the ability of our muscles to adapt.

DOMS is thought to be the result of micro tearing of the muscle fibres; the amount of soreness will depends on what exercise you performed and for how long. Eccentric movements (where you’re loading the muscle as its lengthening) i.e. going down stairs or down hills; all seem to result in greater soreness.

The prevention or treatment of DOMS has been a much debated topic for several years, purely because no single treatment has been found to be 100% effective.

Some simple tips include:

Warm down and stretch properly: active recovery is best, it may be the last thing you feel like but a slow jog warm down with gentle stretching can help reduce post exercise soreness.
Ice baths: not really the weather for it but a lot of elite athletes swear by this method. (hot/cold shower may be more tolerable in winter months!)
Sports massage has been shown to have some effect
Rest: if you have just completed your first half marathon no need to engage in a strenuous training run the next day, your muscles need time to recover so take a few days off. However if your desperate to get out and about walking is a good way to get your legs moving!
Try taking Magnesium; The Great Muscle Relaxer (consult your health practitioner for more information)

Don’t be afraid of DOMS it’s often a sign that you have worked hard and pushed your body to its limits!


via- http://yoursportsphysioblog.com/2012/05/31/why-post-exercise-soreness-is-a-good-thing-sometimes/

Back Pain Myths


Back pain is one of the most common presenting problems that I see on a day to day basis… At some point in our lives 8/10 of us will suffer from an episode of back pain. Despite this statistic we arent exactly well educated when it comes to our backs!!! Here are some common “myths” about how to save our backs…

1.    “I shouldn’t lift heavy objects” : there is slight truth to this comment, repetitive lifting can put undue stress on our lower back and predispose to injury. However this can be avoided if the correct lifting technique is used. Lifting should come from the legs, bend the knees and keep the back straight….. Use your quads and buttocks; they are after all two of the biggest muscles in our bodies!!

2.    ” I always sit with good posture so I shouldn’t get back pain” while having good posture is important, even a perfect ergonomic setup won’t reverse the negative effects that 6-8 hours of sitting can have in our spine. Sitting places stress through our intervertebral discs which are the shock absorbers of the spine. The seated position also puts our hip flexors in the shortened position and encourages our deep abdominals to be lazy, particularly when you slouch ( that’s 80% of us by 3pm)

3.    “I do 100 situps a day so my back should be nice and strong”....unfortunately it takes a lot more than 100 situps a day to achieve a strong spine. Ideally you need a good core stability program. Our core stabilisers are the deepest layer of abdominals consisting of the tranverse abdominus, lumbar multifidus, pelvic floor and diaphragm. These muscles help to provide a corset and give support to the discs and joints of our spine.

4.    ” When I have back pain I should lie flat on my back in bed till it goes away”....there is no doubt that in an acute episode of back pain that rest is essential. However exercise is the best thing  for speeding up your recovery. You should consult your physiotherapist for appropriate exercises that will be safe for you in the acute phase and as your pain resides these exercises can be progressed and become a long term maintenance program for your back

5.    “Sleeping position doesn’t really impact our backs” for all the tummy sleepers our there it’s time to ditch this bad habit… The best way to sleep is on your side with a pillow between your knees (the lazy S). This position maintains the natural curves of your spine

6.    “Other health factors don’t affect my chance of developing back pain” incorrect there are several health factors that actually increase our chances of suffering from back pain.

Smoking: the chemicals in cigarettes actually dehydrate our intervertebral discs and speeds up the process of degeneration. Research indicates that smokers will take 6 months longer to fully recover from disc related back pain.

Extra pounds: carrying extra kilos will place excessive on the shock absorbers in our spine and also increase the load through the weight bearing joints causing them to wear out faster

Hydration: our intevetebral discs are made up of around 70% water. The amount of water will depend on the amount of load applied through the disc ( this will differ at night – discs tend to rehydrate over night as we sleep) when a disc is dehydrated its mechanical properties are altered significantly and can no longer absorb stress as efficiently.


via- http://yoursportsphysioblog.com/2012/05/07/back-pain-myths-busted-3/

Active Release Technique


Introduction

Active release technique (ART) is developed and patented by P. Michael Leahy. But there is little scientific proof about the effects of Active Release Techniques on different pathologies. Most evidence on ART is anecdotal and based on case reports.

Definition

Active Release Technique (ART) is a soft tissue method that focuses on relieving tissue tension via the removal of fibrosis/adhesion that develops in tissue. This is because the tissue is overloaded with repetitive use. (copied from External coxa saltans (snapping hip) treated with active release techniques: a case report). It is both diagnositic and treating techniques for the disorders which may lead to weakness,numbness, tingling, burning,aching etc.

History of ART

Active Release Techniques (ART) was developed and patented by Dr. P. Michael Leahy, DC, CCSP, a Doctor of Chiropractic, based  in Colorado Springs, Colorado, and the founder of Champion Health Clinic. Dr.Leahy noticed that the symptoms of patients are related to changes in their soft tissue so he developed a this technique which revolve completely around patient's problem and his related soft tissue. He documented his first work in 1985 under the title of Myofascial Release but later patented it under the nameof Active Release Techniques.
                                                      

Purpose

It is used to treat problems with muscles, tendons, ligaments, fascia and nerves.

Active release technique is designed to accomplish three things :
  1. to restore free and unimpeded motion of all soft tissues ;
  2. to release entrapped nerves, vasculature and lymphatics
  3. to re-establish optimal texture, resilience and function of soft tissues.

Technique

First the clinician locates the areas of tension or adhesion in a specific tissue. Then the tissue is taken from a shortened position to a lengthened position while using a manual contact to maintain tension along the fibers of that tissue.

In treatment with ART the clinician uses compressive, tensile and shear forces applied by manual (hand) touch to address repetitive strain, cumulative trauma injuries and constant pressure tension lesions.
During ART therapy the practitioner applies deep digital tension at the area of tenderness. The patient is then instructed to actively move the tissue of the injury site through the adhesion site from a shortened to a lengthened position.

ART is used by conservative care practitioners (chiropractors, physiotherapists and massage therapists) with an understanding that anatomical structures throughout the body have traversing tissues located at oblique angles to one another. Areas of tissue overlap are prone to negative changes with trauma producing local swelling, fibrosis and adhesions that can result in pain and tenderness at the location of injury. During ART therapy the practitioner applies digital tension along the tissue fibers at tender areas of adhesion. The patient is then instructed to actively move the tissue fibers of the injury site from a shortened to a lengthened position. 

Effectiveness ART

A few pilot studies reported the effects of ART on different pathologies. Pilot studies do not have a control group and the group of subjects is small.
ART and adductor strains
The pilot study evaluated the effectiveness of ART to modulate short term pain in the management of adductor muscle strains amongst ice-hockey players (n= 9). Pre and post measurements were significant improved (p = 0,002 < 0,05). The study proved that ART is effective in increasing the Pain Pressure Threshold in adductor muscle pain sensitivity. The pilot study is a short term study.
ART and hamstring flexibility
The subjects (n = 20) were significantly more flexible after ART treatment on the hamstring origin and insertion. But these results aren’t generalizable because of the small sample that included only young healthy males. The pilot study was a short term study.
ART and carpal tunnel syndrome
ART was used to affect the median nerve of 5 subjects who were diagnosed with carpal tunnel syndrom. Both symptom severity and functional status improved after two weeks of treatment intervention. This is a small clinical pilot study that suggests that ART may be an effective management strategy for patients with the carpal tunnel syndrome.
ART and quadriceps inhibition and strength
ART did not reduce inhibition or increase strength in the quadriceps muscles of athletes (n = 9) with anterior knee pain. Further study is required. (copied from Influence of active release techniques on quadriceps inhibition and strength: a pilot study )

Case reports of ART
 
A patient with trigger thumb appeared to be relieved of his pain and disability after a treatment plan of Graston Technique and Active Release Techniques. There were 8 treatments over a 4 week time period. The range of motion increased and the pain was decreased at the end of the treatment.

An athlete with chronic, external coxa saltans is relieved from his symptoms because of treatment with ART. After her first visit the patient reported a pain reduction of 50%. After the fourth treatment the patient didn’t feel any pain anymore but the non-painful snapping was still present at that time. When the treatment was complete the non painful snapping was gone too.

A 51 year old male was treated for epicondylosis lateralis over two weeks (6 treatments) with ART, rehabilitation and therapeutic modalities. At the end of the treatment there was complete resolution of his symptoms. Active release technique was used in treating a novice triathlete. Initial treatment consisted of medical acupuncture with electrical stimulation, therapeutic ultrasound with Traumeel, Active Release Technique of gastrocnemius, soleus, and tibialis posterior muscles above and below the injury and Graston Technique soft tissue mobilization posterior to the medial malleolus followed by ten minutes of ice and elevation. The athlete was relieved of his symptoms and was able to return to his triathlon training.
An adolescent soccer player was relieved from his pain after 4 treatments over 4 weeks of soft tissue therapy and rehabilitative exercises focusing on the lower limb specifically posterior tibialis muscle. He had chronic medial foot pain due to striking on an opponent’s leg while kicking the ball. 

Post ART treatment exercises

Once the ART  has released the restrictive adhesions between tissues, post-treatment exercises become a critical part of the healing process and act to ensure the RSI does not return.

There are four fundamental areas that must be addressed in any exercise program:
 
Flexibility - Good flexibility enables muscles and joints to move through their full range of motion. Poor flexibility leads to a higher chance of injury to muscles, tendons, and ligaments. Flexibility is joint-specific; a person may have excellent range of motion at one joint, yet be restricted in another.
Stretching exercises are only effective if they are executed after the adhesions within the soft-tissue have been released. Stretching exercises that are applied to adhesed tissues will only stretch the tissues above and below the restrictions. The actual restricted and adhesed tissues are seldom stretched, leading to further biomechanical imbalances.

Strength - Strengthening exercises are most effective after the adhesions within the soft-tissue have been released. Attempts to strengthen already-shortened and contracted muscles only results in further contraction and restriction. This causes the formation of yet more adhesions and restrictive tissues, and exacerbates the Repetitive Injury Cycle. This is why the application of generic or non-specific strengthening exercises for RSI seldom works.

Balance and Proprioception - Proprioception describes the body's ability to react appropriately (through balance and touch) to external forces. Proprioception exercises should begin early in the rehabilitation process. Effective proprioception exercises are designed to restore the kinesthetic awareness of the patient. These exercises form the basis for the agility, strength, and endurance required for complete rehabilitation.

Cardiovascular - Cardiovascular or aerobic exercises are essential for restoring good circulation and for increasing oxygen delivery to soft-tissues. Lack of oxygen and poor circulation is a primary accelerant of repetitive strain injuries.

ART and performance

ART is seen effective in athlets of every level.It can provide patients with a means to enhance their sports performance by identifying and releasing restrictions that reduce their performance in that activity. This typically occurs after the practitioner conducts a biomechanical analysis of the patient's motion. During the biomechanical analysis and the subsequent treatment, the practitioner:
  • Evaluates gait, motion, and posture.
  • Identifies the biomechanical dysfunctions that are restricting the performance.
  • Finds the soft-tissue structures that are the primary cause of the biomechanical dysfunction as well as affected structures along the kinetic chain.
  • Treats the soft-tissue dysfunctions with ART to restore full function to the affected structures.

ART Performance Care is applied after trauma-based injuries have  resolved. ART Performance Care concentrates upon removing restrictions that inhibit full range of motion, and in restoring full function and performance to affected soft-tissues. This process can result in significant increases in sports performance - power, strength, and flexibility.

Abbreviations in Physiotherapy

Abbreviations assist healthcare professionals to make effective use of their time. These abbreviations should be recognised and agreed upon in order to ensure best practice.

For the detailed list of abbreviations used in Physiotherapy field, visit-
http://www.physio-pedia.com/Abbreviations_in_physiotherapy 

Physiotherapists: helping reduce sickness absence rates

Physiotherapists are established as one of the key types of professionals working alongside occupational health (OH) doctors and nurses to cut down on sickness absence rates. The collaboration between the two professional groups has led to discussions on how physiotherapists could be assessed under the Safe Effective Quality Occupational Health Service (SEQOHS) accreditation scheme.

Employers that contract physiotherapists to provide OH services are seeing good returns because people are able to stay in work through a combination of preventive measures and fast, effective treatment.

These physiotherapists work with employers to provide safe, effective work environments and offer advice and treatment to employees who begin to develop a problem that could result in sick leave. In many cases, this early intervention prevents any absence from being necessary.

If someone does go on sick leave, they are seen as soon as possible before their condition worsens, to ensure that symptoms are treated and any underlying behavioural or environmental factors, such as poor posture or a poorly designed work station, are dealt with to facilitate a swift return to work.

 

Physiotherapy and the Health and Work Service

This is good for the individual, saves money for the employer and boosts the economy overall by keeping a taxpayer in work.

This “triple win” was cited in early February 2014, when the Government made the latest announcement on its new Health and Work Service (HWS). The service will offer an assessment to anyone who has been off sick for more than four weeks to help identify ways to get them back to work.

Clearly, physiotherapists will play a big part in this service, fulfilling two roles. First, they will use their expertise in movement and function to assess a person’s condition, identify the causes of the problem and then suggest the steps that could help them return to work. These steps might include changes to working practices and patterns, alterations to the work environment or seeing a health professional for treatment.
This is where the second role comes in: providing treatment at the earliest opportunity to prevent problems from becoming long-term, chronic conditions.

Physiotherapists use body posture as a tool that can be adapted to meet job demands with minimum stress on the musculoskeletal system. They give expert advice to maintain fitness and flexibility, and to develop a reserve of strength to meet demands of an individual’s job. They also identify how habitual patterns of movement and working predispose musculoskeletal problems, and work with individuals and groups to improve musculoskeletal health, prevent injuries and improve efficiency.

Up to 30% of sickness absence is because of a musculoskeletal condition and, in many cases, early access to a physiotherapist could have dealt with the immediate problem and corrected any other factors to avoid a recurrence.

 

Evidence of improvement

Pilot schemes of the HWS have already shown promising results; for some people, physiotherapists have been able to support an earlier return to work than might otherwise have been possible.

In April 2013, the BBC reported on a scheme running in Leicestershire that helped a warehouse worker who had developed a shoulder injury. His GP referred him to the scheme, which in turn arranged for him to receive physiotherapy immediately, rather than wait on an NHS list for several weeks.

By providing this fast access to physiotherapy and then arranging a phased return to work, the employee was able to get back to his job much quicker than his GP had initially anticipated. As noted at the time by Dame Carol Black, whose report on sickness absence led to the creation of the pilot schemes, too many people fall out of work when their condition could have been managed: “It wastes human life. It ruins people’s sense of self-worth, dignity. It’s bad for families, bad for the economy, and bad for the community.”

 

Benefitting both the public and private sectors

Much of the coverage around that service has focused on help for the private sector, but OH physiotherapy is also helping public bodies make critical savings during this time of austerity.

In 2012, Staffordshire County Council contracted a private OH physiotherapy company to reduce its sickness absences. The rapid-access physiotherapy service begins with a telephone triage to allow contact with the employee within 24 hours of first being off work. During the call the nature of the problem is established, with self-management advice and exercises discussed. If necessary, a face-to-face physiotherapy appointment can be arranged at a convenient time and location for the employee.

Since the start of this rapid-access physiotherapy programme, the council has reported an 8% drop in staff absence, amounting to 9,000 fewer sick days per year, a 12% reduction in musculoskeletal absences and a 300% return on investment.

A dedicated physiotherapy service is now in place for staff with conditions such as pain and stiffness in joints, muscles, nerves and soft tissues. It offers rapid treatment to help staff to return to work quickly.

 

Rolling out good practice

In the NHS, although more work still needs to be done, there are signs that it is getting a grip on high levels of sickness absence. Perhaps ironically, the health service historically has not done a great job of looking after the wellbeing of its own employees. The Boorman Review, published in 2009, said that the NHS could save £555 million per year by providing fast access to services such as physiotherapy to help keep staff fit for work. The review also highlighted that improved staff health ensured better treatment for patients, because sickness absences had led to cancelled appointments and longer waiting times. Yet even last year, an audit conducted by the Chartered Society of Physiotherapy found that about 40% of health trusts in England still did not have a health and wellbeing strategy in place for its staff – despite this being a key recommendation from Boorman.

At a time when the NHS is tasked with saving £20 billion by 2015, it is remarkable that this simple way to reduce costs is being overlooked.

 

Services that work

There are, of course, pockets of excellence. Fast Physio is a dedicated, inhouse service that provides rapid access for employees at East Lancashire Hospitals NHS Trust. Urgent referrals are seen for an assessment, management and advice within three working days, and routine assessments within 10 days. Employees also get telephone and email advice to enable them to self-manage their injury more effectively, and there are recommendations for workplace adjustments where appropriate. Advice and support is provided for both managers and employees during an individual’s return to work. After the service had been running for 18 months, there had been a 32% reduction in days lost to musculoskeletal-related sickness.

 

Proven investment

Physiotherapists have been demonstrating their effectiveness and return on investment across all sectors for a number of years in OH.

When PricewaterhouseCoopers analysed the impact of health and wellbeing initiatives at 55 organisations, ranging in size from 70 to 100,000-plus employees, it found consistent evidence of reduced absence and increased productivity.

In one case, an employer experienced a return of £34 for every £1 spent on providing in-house and discounted physiotherapy for staff.

Now the effectiveness of those services looks set to get official recognition. SEQOHS is the system for accrediting an OH service that complies with a rigorous set of standards. The professional network, the Association of Chartered Physiotherapists in Occupational Health and Ergonomics (ACPOHE), is working with SEQOHS to introduce a quality assurance system for OH physiotherapy. ACPOHE has recruited six organisations that represent the breadth of OH physiotherapy services, and a one-year pilot project began in November 2013. During the pilot period the sites will provide documentary evidence to demonstrate how their organisation meets the SEQOHS standards. The feedback from the pilot will feed into the Faculty of Occupational Medicine’s review of the SEQOHS standards. At the end of the pilot, all participating organisations will receive a written report with regards to their level of achievement against the standards and an action plan identifying where further evidence improvement is required.

Organisations that can successfully demonstrate compliance will also receive a letter from SEQOHS stating that the organisation meets the standards. These organisations will then be ready to apply for full accreditation in 2015 when the updated standards are issued.

This would make the UK the first place in the world where OH physiotherapists can receive a quality assurance standard for their practice.

OH physiotherapists now work in a diverse range of settings across all sectors. Whatever type of workplace they are in, however, the evidence shows the employer will see an average return of £3 for every £1 invested in the service. As the economy continues to struggle back to life, the importance of that statistic speaks for itself.



via-http://www.personneltoday.com/hr/physiotherapists-helping-reduce-sickness-absence-rates/

Thursday, July 31, 2014

Radial Tunnel Syndrome: Assessment and Management

Lateral elbow pain is a common complaint in many sports physiotherapy and physical therapy practices around the world. It is likely that this will surprise no-one. Lateral epicondylalgia, the most common cause of lateral elbow pain, has an annual prevalence of 1% to 2% in the general public (Shiri et al., 2006). Such a complaint is even more common in many groups of athletes (Hume et al., 2006; Mackay et al., 2003). However, this is not an article about tennis elbow. It is about radial tunnel syndrome, a condition which has been suggested to be the main aetiopathogenetic (what a word) element in 4% of lateral epicondylalgia cases (Jalovaara & Lindholm, 1989). Interestingly, it causes headaches for the therapist in 100% of cases. This is because whilst radial tunnel syndrome is rare, it is challenging to differentially diagnose and can be a monster to manage. If you have a recalcitrant case of tennis elbow then this post will interest you! This article discusses the best available evidence for assessment and management of this condition.

For detailed article, visit-
http://www.thesportsphysiotherapist.com/radial-tunnel-syndrome-evidence-based-assessment-management/ 

Snapping Scapula Syndrome (Scapulothoracic Bursitis): Assessment and Management

Whilst this condition is more common than we may think, it seems to be underappreciated within the world of physiotherapy. This is a disorder that ranges from inconvenience for some to truly disabling to others (Manske et al., 2004). Of even greater interest is that it is related to many sports including swimming, baseball pitching and weight-training. Thus, this article will discuss snapping scapula syndrome including what it is, why it occurs and what you need to do to fix it!

For the details on the topic, visit-
http://www.thesportsphysiotherapist.com/snapping-scapula-syndrome-scapulothoracic-bursitis-assessment-and-management/ 

Functional Performance Testing: An Assessment Necessity

As a sports physiotherapist, it is important that you not only rehabilitate athletes but ensure that they are fully fit to return to play. As many of you are fully aware, objective measures such us a full active range of motion does not determine an athlete’s readiness to RTP. Accordingly, a comprehensive assessment of an athlete’s function, via functional performance testing, becomes an absolute assessment necessity. This article will discuss current research on the the role and implementation of functional performance testing, as well as some tests that you may use in your own clinical practice.

For detailed article, visit-
http://www.thesportsphysiotherapist.com/functional-performance-testing/ 

Manual Therapy for Inversion Ankle Sprains

Ankle sprains are very common in the practice of sports physiotherapy. However, unfortunately many patients go on to have long term problems. This has lead to the development of many proposed treatments and rehabilitation programs. This article will discuss new research into the use of manual therapy techniques combined with exercises for the rehabilitation of inversion ankle sprains.


For detailed research, visit-
 http://www.thesportsphysiotherapist.com/manual-therapy-for-inversion-ankle-sprains/

University of Calgary scientist finds physiotherapy can speed up concussion recovery

Before Jon Cornish’s head hit the ground and the Calgary Stampeders running back was left motionless on the McMahon Stadium turf, there was a terrifying moment when his neck snapped back.

The concussion that followed has kept the Stamps star sidelined ever since.

While common medical practice suggests the best way for athletes to recover from similar injuries is rest and a gradual build-up of physical exertion, a new study from the University of Calgary suggests hands-on physiotherapy could speed up the road to recovery.

The study was conducted by Kathryn Schneider, a researcher and physiotherapist at U of C’s Faculty of Kinesiology and Sport Injury Prevention Research Center.

Its findings could change the way concussions are treated, as they suggest that people suffering from prolonged post-concussion symptoms could have their recovery times decreased through a combined physiotherapy treatment of the vestibular (balance) system, the cervical spine and vertebrae in the neck.
“We specifically targeted the individuals who had dizziness, neck pain and/or headaches following concussions,” said Schneider, whose study was published in the British Journal of Sport Medicine.
“The general consensus is an initial period of rest is of benefit, and the majority of people do recover in that initial seven-to-10 day period, so it would be following that initial time period where if individuals still had symptoms that persisted this would be a treatment that would be of benefit.”

The study focused on 31 patients who were still suffering from symptoms after the initial seven-to-10 day recovery period. They were divided into two groups: One that went through a standard vestibular rehabilitation, and another that combined the vestibular rehabilitation with cervical spine physiotherapy.
The findings were striking.
The group that went through the combined treatment saw 73% of participants medically cleared within eight weeks, compared with just 7% of the standard group.
“I started to see a lot of athletes in the clinic and could see some positive results within a clinical environment but there’s no research currently evaluating the response to forms of physiotherapy treatment following concussions,” Schneider said. “We weren’t sure of the magnitude of the effect we might see.
“We did see a large difference between the groups — it was greater than what we had initially hypothesized it might be.”

Despite the clear difference between the two groups, there’s still lots of research that’s needed. After all, 31 people is a small sample size, and Schneider says future studies will need to examine how variables like age and gender might have on outcomes, as well as the ideal timing and dosage.

Concussions are also highly individual-specific, so no one at the U of C is suggesting they’ve stumbled on a one-size-fits-all treatment.

One major variable that can affect recovery time is whether a patient’s had a history of concussions, as symptoms often get worse and recoveries take longer when a patient’s been concussed before.
The U of C research, however, seemed to work just as well on those with a concussion history as those who were suffering through the injury for the first time.
“We don’t have the numbers to really understand the effects that a previous concussion has on the effects of this study, but in the treatment group everybody that recorded a previous history of concussion was medically cleared to return to sport,” Schneider said.



via- http://www.calgarysun.com/2014/07/30/university-of-calgary-scientist-finds-physiotherapy-can-speed-up-concussion-recovery

Saturday, July 26, 2014

Physiotherapists have a vital part to play in combatting the burden of noncommunicable diseases

The burden of noncommunicable diseases (NCDs) has been described as “a public health emergency in slow motion” by the United Nations (UN) Secretary General Ban Ki-moon and the World Economic Forum considers chronic diseases in both high and low resource countries to be a major risk to the global economy. However, all NCDs can either be prevented or, if identified early, treated and managed in a way that significantly reduces disability, financial and societal costs, and prolongs healthy years of life.

For the detailed report, kindly go to-
http://www.physiotherapyjournal.com/article/S0031-9406(14)00030-3/pdf 

Risk factors for groin/hip injuries in field-based sports

Groin/hip injuries occur frequently in the athletic population, particularly in sports requiring kicking, twisting, turning and rapid acceleration and deceleration. Chronic hip, buttock and groin pain make up 10% of all attendances to sports medicine centres. Understanding risk factors for field-based sports (FBS) players is important in developing preventive measures for injury. The objective of this systematic review was to identify and examine the evidence for groin/hip injury risk factors in FBS. 14 electronic databases were searched using keywords. Studies were included if they met the inclusion criteria and investigated one or more risk factors with relation to the incidence of groin/hip injuries in FBS. Studies were accumulated and independently analysed by two reviewers under a 12-point quality assessment scale (modified CASP (for cohort study design) assessment scale). Because of the heterogeneity of studies and measures used, a meta-analysis could not be conducted. As a result risk factors were pooled for analysis and discussion. Of the 5842 potentially relevant studies, 7 high-quality studies were included in this review. Results demonstrated that previous groin/hip injury was the most prominent risk factor, identified across four studies (OR range from 2.6 (95% CI 1.1 to 6.11) to 7.3, (p=0.001)), followed by older age (OR 0.9, p=0.05) and weak adductor muscles (OR 4.28, 95% CI 1.31 to 14.0, p=0.02) each identified in two studies. Eight other significant risk factors were identified once across the included studies.

This study identified 11 significant risk factors for groin/hip injury for FBS players. The most prominent risk factor observed was previous groin/hip injury. Future research should include a prospective study of a group of FBS players to confirm a connection between the risk factors identified and development of groin/hip injuries.


For detailed study, kindly visit-
http://www.ncbi.nlm.nih.gov/pubmed/24795341

Attentional focus of feedback for improving performance of reach-to-grasp after stroke: a randomised crossover study

Objective

To investigate whether feedback inducing an external focus (EF) of attention (about movement effects) was more effective for retraining reach-to-grasp after stroke compared with feedback inducing an internal focus (IF) of attention (about body movement). It was predicted that inducing an EF of attention would be more beneficial to motor performance.

Design

Crossover trial where participants were assigned at random to two feedback order groups: IF followed by EF or EF followed by IF.

Setting

Research laboratory.

Participants

Forty-two people with upper limb impairment after stroke.

Intervention

Participants performed three reaching tasks: (A) reaching to grasp a jar; (B) placing a jar forwards on to a table; and (C) placing a jar on to a shelf. Ninety-six reaches were performed in total over one training session.

Main outcome measures

Kinematic measures were collected using motion analysis. Primary outcome measures were movement duration, peak velocity of the wrist, size of peak aperture and peak elbow extension.

Results

Feedback inducing an EF of attention produced shorter movement durations {first feedback order group: IF mean 2.53 seconds [standard deviation (SD) 1.85]; EF mean 2.12 seconds (SD 1.63), mean difference 0.41 seconds; 95% confidence interval -0.68 to 1.5; P = 0.008}, an increased percentage time to peak deceleration (P = 0.01) when performing Task B, and an increased percentage time to peak velocity (P  = 0.039) when performing Task A compared with feedback inducing an IF of attention. However, an order effect was present whereby performance was improved if an EF of attention was preceded by an IF of attention.

Conclusions

Feedback inducing an EF of attention may be of some benefit for improving motor performance of reaching in people with stroke in the short term; however, these results should be interpreted with caution. Further research using a randomised design is recommended to enable effects on motor learning to be assessed.


For more detailed study, kindly visit-
http://www.physiotherapyjournal.com/article/S0031-9406(13)00050-3/pdf 

Thursday, July 24, 2014

Physiotherapist Vacancies in Govt. of Odisha


Name of Post- Physiotherapist


No. of Posts- 8 (Eight)


Pay Scale- Rs. 20,000/- + P.I.


Educational Qualifications- Graduate in Physiotherapy from a recognized Institution / University (minimum 50% marks) with 3 years’ post qualification experience.


Last Date- 31st July, 2014


How to Apply- 

·  Eligible candidates can download the application form from its official site. http://www.nrhmorissa.gov.in/. Online application will be available till 26 July 2014.

·  Generated Application duly signed by the candidate along with self attested copies of all supportive documents shall however be sent to the “Mission Directorate (NHM), Annex Building of SIH&FW, Nayapalli, Unit-8, Bhubaneswar-751012, District-Khurda (Odisha)” so as to reach on or before 31 July 2014.



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This post is purely for helping other Physiotherapists. This site doesn't take any responsibility about the jobs. One should do proper inquiry before joining.

Tuesday, July 22, 2014

Chronic Fatigue Syndrome


Introduction:
Severe fatigue is a common complaint among patients. Often, the fatigue is transient or can be attributed to a definable organic illness. Some patients present with persistent and disabling fatigue, but show no abnormalities on physical examination or screening laboratory tests. In these cases, the diagnosis of chronic fatigue syndrome (CFS) should be considered.

According to Centers for Disease Control and Prevention (CDC, USA) Chronic fatigue syndrome (CFS) currently is defined as:
(1) fatigue of at least 6 months' duration, seriously interfering with the patient's life; and (2) without evidence of various organic or psychiatric illnesses that can produce chronic fatigue.

The World Health Organization classifies myalgic encephalomyelitis/chronic fatigue syndrome (ME/cfs) as a nervous system disease. Together with other diseases under the G93 heading, ME/cfs shares a triad of abnormalities involving elevated oxidative and nitrosative stress (O&NS), activation of immuno-inflammatory pathways, and mitochondrial dysfunctions with depleted levels of adenosine triphosphate (ATP) synthesis.


Clinical features:
Elaborately CFS is characterized by debilitating fatigue with associated myalgias, tender lymph nodes, arthralgias, chills, feverish feelings, and postexertional malaise. According to Komaroff there may be abrupt onset with an 'infectious-like' illness, intermittent unexplained fevers, arthralgias and 'gelling' (stiffness), sore throats, cough, photophobia, night sweats, and post-exertional malaise with systemic symptoms.

According to Clauw 4 of the following criteria need to be present: sore throat, impaired memory or cognition, unrefreshing sleep, postexertional fatigue, tender glands, aching stiff muscles, joint pain, and headaches.


Prevalence:
While chronic, debilitating fatigue is common in medical outpatients, CFS is relatively uncommon. Prevalence depends substantially on the case definition used.


Etiology:
It is known that CFS is a heterogeneous disorder possibly involving an interaction of biologic systems. Medical research continues to examine the many possible etiologic agents for CFS (infectious, immunologic, neurologic, and psychiatric), but the answer remains elusive.


Diagnosis:
Diagnosis of CFS is primarily by exclusion with no definitive laboratory test or physical findings.

Differential diagnosis should be considered carefully as similarities with fibromyalgia & teperomadibular joint disorder exist and concomitant illnesses include irritable bowel syndrome, depression, and headaches.
Course of CFS:

According to Komaroff the illness can last for years and is associated with marked impairment of functional health status.


Treatment:
Therefore, treatment of CFS may be variable and should be tailored to each patient. Therapy should include graded exercise (SF-36 is useful in assessing functional status), diet, good sleep hygiene, antidepressants, and other medications, depending on the patient's presentation.

It is noteworthy that for graded exercises to be implemented one need to assess the exercise capacity of the individual.

Tuesday, July 15, 2014

Physiotherapist Vacancies in National Rural Health Mission, Madhya Pradesh


Post- Physiotherapist

No. of Vacancies- 7

Qualifications- B.PT.

Experience- Minimum 3 years of related experience of working in government/ non government hospitals any where in India.

Salary- 25000/- per month

Apply Online here-

Last Date:  July 18, 2014



Disclaimer-
This post is purely for helping other Physiotherapists. This site doesn't take any responsibility about the jobs. One should do proper inquiry before joining.

Physiotherapist Job in Ministry of Defence, United Kingdom (Permanent)


Department- Ministry of Defence

Business Area- Joint Forces Command

Number of Jobs Available- 1

Location: City/Town- Winchester

Post Type- Permanent

Qualification(s)-
Degree in Physiotherapy plus additional specialist training or experience to post graduate diploma level or equivalent.

Licence(s)-
HCPC Registered Physiotherapist

Membership(s)-
Chartered Society of Physiotherapy

Salary Minimum- £25,783

Salary Maximum- £34,530
  
Grade Entry Qualifications Required
Degree in Physiotherapy plus additional specialist training or experience to post graduate diploma level or equivalent. Memberships: Chartered Society of Physiotherapy and/or Health Professions Council.

Closing Date- 27 Jul 2014

Contact point for applicants-
Captain Michael Clarke
Telephone: Mil: 94275 4281 Civilian:01962 888 281
Email: DPHC(S)-WIN-PCRF-Physio-01@mod.uk  
  
Job Description-
Job Purpose:

• To provide a high standard of physiotherapy service to Service personnel including highly specialist work in the musculo-skeletal/sports and training injury area.
• To provide a positive caring environment, in which patients can expect a high quality professional service.
• To provide full support to the line manager in ensuring the provision of a comprehensive and professional physiotherapy/rehabilitation service for entitled personnel. This will include undertaking highly skilled and specialist work.

Principle Duties and Responsibilities:

Clinical

• To perform highly skilled physiotherapeutic assessment of patients referred by Medical Officers, Consultants, or other Healthcare Professionals with diverse presentations and complex and acute/chronic physical conditions and sports injuries. To use clinical reasoning skills to provide an accurate clinical diagnosis.
• To formulate, develop and deliver a specialised individualised treatment programme based upon evidence based practice, manual assessment and appropriate clinical reasoning.
• To communicate effectively with patients to ensure informed consent for assessment and treatment, good understanding of their conditions and maximise their rehabilitation potential. Patients may have barriers to communication e.g. English as their second language.
• To advise the Medical Officers with regard to specialist physiotherapy recommendations.
• To manage and prioritise own clinical caseload efficiently and effectively.
• The provision of clinical reports to supply clinical prognoses and comprehensive discharge planning for other medical professionals and, where appropriate the military CoC.
• Take an active role in monitoring clinical standards in the PCRF setting, through regular formal in-service training, watched assessments, review of complex patients, group practical sessions, tutorials and caseload reviews.
• To manage and prioritise own clinical caseload efficiently and effectively.

Professional:

• To have professional and legal accountability to the Chartered Society of Physiotherapy (CSP) ‘Standards of Practice, Health Care Professions Council Standards of Proficiency, Conduct, Performance and Ethics’, Ministry of Defence (MoD) local policies and tort law in all aspects of practice.
• Development and maintenance of your own personal, Service and Professional Standards at the highest attainable levels through continuing professional development activities and maintenance of a portfolio.
• Participate in the Knowledge Skills Framework (KSF) scheme and be responsible for complying with agreed development programmes, including attendance at appropriately planned and selected post-graduate courses.
• Use evidence-based practice, audit, outcome measures and published research to inform, measure and evaluate your own work and current practice.
• To take part in and support any relevant audit and research activity.
• To maintain a high standard of confidentiality at all times.
• To act as an ambassador for the physiotherapy profession at all times.
Evidence of Hepatitis B immunity is required.

Reserved / Non Reserved post(s)
This is a Non Reserved post and is therefore open to UK, British Commonwealth and European Economic Area (EEA) Nationals and certain non EEA members

What security level is required for this post?
Security Check

If you are a successful candidate you will be expected to undertake the following level of security check:
- Security Check
If you are a successful candidate you will be expected to undertake a Disclosure and Barring Security check
Working Pattern
This job/these jobs are full time and not suitable for part time or job share applicants
  
Minimum Expected Tour Length
2 Years

Employment Terms: Hours
37.5

Competence 1
Additional Competency

Competence 1 - Detail
NHS Core 1: Communication

Competence 2
Additional Competency

Competence 2 - Detail
NHS Core 3: Health Safety and Security.

Competence 3
Additional Competency

Competence 3 - Detail
NHS Core 4: Service Improvement

Competence 4
Additional Competency

Competence 4 - Detail
NHS Core 5: Quality

Competence 5
Additional Competency

Competence 5 - Detail
HWB1 Promotion of Health and Wellbeing

Competence 6
Additional Competency

Competence 6 - Detail
HWB6 Assessment and Treatment Planning

Competence 7
Additional Competency

Competence 7 - Detail
HWB7 Interventions and Treatment.


Disclaimer-
This post is purely for helping other Physiotherapists. This site doesn't take any responsibility about the jobs. One should do proper inquiry before joining.

In Association with Amazon.in

Sunday, July 13, 2014

Rehab for age-related loss of vision cuts depression risk in half

There is an associated risk of depression in people who experience loss of vision due to conditions such as age-related macular degeneration. New research suggests that a particular type of rehabilitation therapy called behavior activation could now reduce this risk by 50% .

A previous study published in JAMA Opthalmol. has reported that there is a significant association between vision loss and depression, but now new research has found that a form of rehabilitation therapy can reduce this risk in people with AMD by half.

The new study tested an approach called "behavior activation." According to study co-author Robin Casten, PhD, associate professor of psychiatry and human behavior at Thomas Jefferson University, Philadelphia, behavior activation is a method that involves helping people to recognize that the loss of enjoyed activities could lead to depression, and then helping them re-engage with those activities.


For more info, kindly visit : http://www.medicalnewstoday.com/articles/279366.php

Saturday, July 12, 2014

Physiotherapy in Wilson's Disease

Wilson's disease is an inherited condition in which copper is not excreted properly from the body. The excess copper can build up in the liver and/or brain causing liver damage and/or neurological problems. It can also collect in other parts of the body including the eyes and the kidneys. Copper begins to accumulate immediately after birth but the symptoms usually appear in the 2nd to 3rd decade. The first signs are hepatic (liver) in about 40% of cases, neurological (brain) in about 35% of cases and psychiatric, renal (kidney), haematological (blood), or endocrine (glands) in the remainder.


Neuropsychiatric symptoms-


About half the people with Wilson's disease have neurological or psychiatric symptoms. Most initially have mild cognitive deterioration and clumsiness, as well as changes in behavior. Specific neurological symptoms usually then follow, often in the form of parkinsonism with or without a typical hand tremor, masked facial expressions, slurred speech, ataxia or dystonia. Seizures and migraine appear to be more common in Wilson's disease. A characteristic tremor described as "wing-beating tremor" is encountered in many people with Wilson's; this is absent at rest but can be provoked by extending the arms. Cognition can also be affected in Wilson's disease. This comes in two, not mutually exclusive, categories: frontal lobe disorder (may present as impulsivity, impaired judgment, promiscuity, apathy and executive dysfunction with poor planning and decision making) and subcortical dementia (may present as slow thinking, memory loss and executive dysfunction, without signs of aphasia, apraxia or agnosia). It is suggested that these cognitive involvements are related and closely linked to psychiatric manifestations of the disease.


Psychiatric problems due to Wilson's disease may include behavioral changes, depression, anxiety and psychosis. Psychiatric symptoms are commonly seen in conjunction with neurological symptoms and are rarely manifested on their own. These symptoms are often poorly defined and can sometimes be attributed to other causes. Because of this, diagnosis of Wilson's disease is rarely made when only psychiatric symptoms are present. 


Physiotherapy-


Physiotherapy is beneficial for patients with the neurologic form of the disease. The copper chelating treatment may take up to six months to start working, and physical therapy can assist in coping with ataxia, dystonia, and tremors, as well as preventing the development of contractures that can result from dystonia.
Maintenance therapy is more important than rehab.

Relaxation technique is more important to maintain the position and posture.To reduce hyper-activeness use sedative otherwise due to hyper activeness rigidity will increase and result will be dislocation/fracture/injury of some joints/bones or muscle/ligament injury. To avoid torticollis maintain the position of neck and do the proper exercise and stretching.

Use cock-up splint to maintain hand position and use L-splint or night splint to maintain ankle position, proper positioning of spine to avoid scoliosis and kyphosis. Maintain sitting position 2-3 hours twice daily.




*Disclaimer*
The article is compiled, so ni copyright is claimed.

Friday, July 11, 2014

Importance of "pre-habilitation" to avoid knee injuries in young athletes

A 2014 article in the medical journal Pediatrics summarized the current research and has concluded that a specific exercise routine, known as neuromuscular training, greatly reduces the risk of knee injuries in young female athletes.

This neuromuscular training routine has been coined "Pre-habilitation" because it is performed before and throughout the sporting season. The comprehensive research results have shown a reduction in Anterior Cruciate Ligament (ACL) tears by 72 per cent, thereby avoiding surgery and/or a prolonged rehabilitation. The ACL is one of four major ligaments that stabilize the knee. There has been an increase in the number of ACL injuries over the past 20 years, with the rate being higher for females compared to males within similar sports. Interestingly, the majority of ACL injuries occur without any external contact by another player.

The risk of ACL injury in athletes sharply increases at adolescence (12-13 years old for girls; 14-15 years old for boys), with girls having a significantly higher risk until adulthood. This occurs because of what is called a 'motor-machine mismatch', where the body is growing faster then what the neuromuscular system can control it. Anatomical differences also contribute to increased risk for girls, and boys appear to be partially protected because of increased testosterone at puberty which accelerates muscle growth and strength.

An ACL injury, with or without surgery, will require many months of rehabilitation, and can be very disruptive to a young person due to time lost from school and sports. According to local Orthopaedic Surgeon, Dr. Stephen Sohmer, a young athlete with a complete ACL tear will almost certainly require surgery in order to return to sporting activity. An untreated ACL tear increases the risk of irreversible damage to other knee structures, and premature arthritis later in life. He supports pre-activity training programs for all young athletes in order to prevent an ACL tear in the first place.

Neuromuscular training works by preparing the body to perform sport specific movements in a way that reduces risk of injury during pivoting, landing, or unexpected loading of the knee. This is particularly relevant to any athlete that plays a sport requiring sprinting, pivoting, cutting, jumping, or landing (such as soccer, volleyball, lacrosse, football, baseball, or basketball).



via-http://www.courierislander.com/sports/local-sports/research-supports-pre-habilitation-to-avoid-knee-injuries-in-young-athletes-1.1202129

Thursday, July 10, 2014

Physiotherapist Vacancy in Ministry of Social Justice & Empowerment, Govt. of India


Name of the organization: PT. DEENDAYAL UPADHYAYA INSTITUTE FOR THE PHYSICALLY HANDICAPPED (Ministry of Social Justice & Empowerment, Govt. of India)

Name of Post: Physiotherapist

No. of posts: 01

Pay Scale: Rs.9300-34,800 Grade pay Rs.4200/-(PB-II)

Max Age limit: 28 yrs

Mode of recruitment: Director Recruitment

Qualifications:
i. Educational Qualification: Degree in Physiotherapy from recognized University & having good academic record;
ii. Desirable: Master in Physiotherapy;
iii. Experience: One year Teaching/Clinical/Research experience in recognized Institution/College/Government Hospital/ University/ Autonomous body.

How to apply: Online applications can be uploaded on http://www.iphnewdelhi.in OR http://www.iphnewdelhi.ac.in within 30 days from the date of publication of this advertisement

For more details, visit:



Disclaimer-
This post is purely for helping other Physiotherapists. This site doesn't take any responsibility about the jobs. One should do proper inquiry before joining.

Saturday, July 5, 2014

Physiotherapist Vacancy at Administration of Dadra & Nagar Haveli, U.T.

Physiotherapist Walk-in Interview for Rashtriya Bal Swasthya Karyakram at Administration of Dadra & Nagar Haveli, U.T.

A Walk-in Interview is fixed on 8/7/2014 10:00 AM in the  for filling up the below mentioned post in  on short term contract basis under National Rural Health Mission- District Early Intervention Center.


Post Name: Physiotherapist

No. of vacancy: 01

Job Type: Contractual

Qualification: Bachelor of Physiotherapy with 2 years experience in the field.

Consolidated salary: Rs.25000/-

Interview Date: 8th July, 2014 10:00 AM

To apply, eligible candidates may forward their applications to the Office of Mission Director, NRHM, Secretariat, Silvassa, Dadra and Nagar Haveli with one set of attested photocopy of educational qualification and experience certificates.



For more details visit- http://dnh.nic.in/tenders/1July2014/ADV1.pdf

Friday, July 4, 2014

Physiotherapy Vacancy in Trivandrum

Post- Physiotherapist

Job Type- Temporary

Eligibility:BPT with 3 year/MPT with 1 year

Salary:16,000/Month

Walk-In Interview:8 July 2014

Venue: Mini Conference Hall, 3rd Floor, 
          AMC Building,
          Sree Chitra Tirunal Institute for Medical Sciences and Technology,
          Medical College Campus, Trivandrum -11
 
 For more details,check;http://www.sctimst.ac.in/Recruitment/resources/PHYSIOTHERAPIST%20-%20TEMPORARY,%20DATE%20&%20TIME%2008.07.2014%20-%2009.30%20AM.pdf 


Disclaimer-
This post is purely for helping other Physiotherapists. This site doesn't take any responsibility about the jobs. One should do proper inquiry before joining.