Assistant Physiotherapist Vacancies in Trans Nzoia County Public Service Board

 Assistant Physiotherapist Vacancies in Trans Nzoia County Public Service Board.

For more information about the vacancy kindly visit the following link-

https://cpsbtransnzoia.co.ke/jobDetails?id=TCPSB%2FEX%2F25%2F2026

Disclaimer-

The post is only with the intention to help others. We don't take any responsibility for the same. Kindly check first and then go ahead.

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

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/

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/ 

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

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 

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

The Nordic Hamstring Exercise

Here in this video, the Nordic Hamstring Exercise is explained. This is a hamstring strain prevention protocol for those involved in sprinting sports (soccer, football, rugby etc).

 http://www.youtube.com/watch?v=IbmuE4clhg4

Proud to be a Physiotherapist

Role of Physiotherapy in Diabetes

  Physiotherapy is an ancient science, which involves physical treatment techniques, such as massage, and the use of electrotherapeutic and mechanical agents – rather than drug therapy – for the management of a condition.

Physiotherapists play an important role in helping people to overcome disability and pain related to orthopedic, musculoskeletal, neurological and rheumatologic illnesses.

Any person with diabetes whose aching legs have experienced relief after a massage, or whose painful feet have been relaxed after a soak in cool water will testify to the importance of physiotherapy in relieving their symptoms.

Preventing diabetes-

The Diabetes Prevention Project demonstrated that lifestyle modification, including intensive exercise, is more effective in preventing diabetes than pharmacological therapy, and highlighted the role of trained professionals in motivating people to follow lifestyle interventions. Similar results have been reported by the Malmö Study, the Da Qing Study, the Finnish Diabetes Prevention Study and the Wenying Study. Physiotherapists are able to help people, to plan an individualized exercise programme in order to maintain good blood glucose control and achieve optimal weight. Furthermore, physiotherapy leads to metabolic improvements even in the absence of weight loss, reducing the frequency of cardiovascular events and improving life expectancy. Effective exercise counseling ensures both cardio respiratory and musculoskeletal fitness. This helps people with diabetes improve their quality of life, and contributes to overall control of blood glucose. The use of alternative therapies, such as yoga, can contribute to the achievement of optimal cardio-respiratory health.

Physiotherapists can help people to maintain good blood glucose control and achieve optimal weight. Physiotherapists, with their knowledge of physiology and anatomy, can suggest specific exercises for people with coexisting complications, cautioning against certain movements that might be detrimental to their health. For example, an isotonic exercise like jogging will benefit a person with high blood pressure and diabetes, but the repeated foot trauma associated with jogging may harm someone with peripheral sensory neuropathy or Charcot foot.

Beyond exercise counseling-

Most people with diabetes suffer from musculoskeletal complications, which might include frozen shoulder, back pain or osteoarthritis. Many people with poorly managed type 1 diabetes develop a syndrome of limited joint mobility. Diabetic amyotrophy is a type of neuropathy that involves muscle wasting and weakening, especially in the thighs. Carpal tunnel syndrome and sciatica are other neurological conditions that are commonly suffered by people with diabetes. In all these conditions, physiotherapy plays a pivotal role in returning people to normal levels of health and wellbeing. The physiotherapist uses a combination of active and passive exercises, and mechanical and electrical aids to

improve musculoskeletal and neurological functions.

Pain relief-

Physiotherapy offers various effective non-pharmacological approaches for pain relief. Transcutaneous electrical nerve stimulation (TENS) involves electrical nerve stimulation through the skin, sending a painless current to specific nerves. The mild electrical current generates heat that serves to relieve stiffness, improve mobility, and relieve pain.

Interferential therapy (IFT) uses the strong physiological effects of low frequency electrical stimulation of nerves.

TENS and IFT are considered gold-standard therapies for the relief of neuropathic pain, and have proven benefits in the management of painful diabetic neuropathy, edema (build-up of fluid in tissue) and resistant foot ulcers. TENS has been shown to be most effective against burning and stabbing pain, but comparatively less efficient for the relief of painfully sensitive skin and restless legs syndrome. Other modalities, such as ultrasonic therapy and hot wax, are useful for specific conditions in both people with diabetes and people without the condition. In spite of the benefits – safety, lack of drug interactions, efficacy, cost – associated with these methods, few centers’ have adopted TENS/IFT as primary treatments for painful neuropathy. Perhaps this underscores the need to create specialized diabetes physiotherapy units, staffed by qualified physiotherapists specializing in the care of

people with diabetes.

Physiotherapy can play an important role in preventing and managing foot problems.

Improving feet-

Physiotherapy centers’ can play an important role in preventing and managing foot problems. Teaching the importance of correct gait and posture, along with the basic principles of off-loading when required, can prevent or stabilize a number of foot complications. In people with tropic ulcers, for example, which are typical in people with diabetes-related foot problems, the effective use of crutches or foot splints can ensure off-loading and early healing. In people who are unfortunate enough to undergo an amputation, the physiotherapist helps with post-operative pain relief, rehabilitation, limitation of disability, and the optimum use of prostheses. Similar rehabilitative measures, exercises and therapeutic aids are available for people who are recovering from heart attack, stroke, peripheral

vascular surgery, or other traumas or surgical interventions.

Wider benefits-

Physiotherapeutic interventions, usually delivered on a one-to-one basis are patient-centered, in line with the contemporary approach that all providers of chronic medical care, including endocrinologists, try to provide to people in their care. The time spent with the physiotherapist during the course of treatment can strengthen patient provider bonding and enhance communication.

As the number of people with diabetes continues to rise, and as the existing diabetes population ages, the need for efficient physiotherapy services will continue to grow. Including specialized physiotherapists as equal members of the diabetes care team will help us to utilize their services effectively in order to improve the health and well-being of all people with diabetes.

Treatment of Osteitis Pubis

Osteitis Pubis is a condition that many consider rare, however, it is probably more common than you may think. The incidence of groin pain, in some sports, is as high as 13% (Ekstrand and Ringbord, 2001). Thus, it is highly likely that as a sports physiotherapist you will encounter may athletes with a diagnosis of osteitis pubis. Therefore, as is frequently stated on this site, you need to be aware of the current research and evidence based practice, even in a world with limited research

OVERVIEW
Osteitis pubis is defined as a painful inflammatory process involving the pubic symphysis and surrounding structures including the pubic rami, cartilage, musculotendinous and ligamentous pelvic structures (Batt et al, 1995). It is suggested that this is caused by repetitive stresses of the pubic symphysis during strenuous physical activity, most commonly secondary to reduced hip range of motion (LeBlanc and LeBlanc, 2003).

TREATMENT
The following discussion regarding treatment decisions is guided by the systematic review by Choi et al (2011). Whilst they searched for the best available evidence, they were unable to identify any RCTs regarding treatment decisions for osteitis pubis. Therefore, the following recommendations are based on clinical experience and case studies/series. Hint, hint… not a lot of rock solid evidence going around.

CONSERVATIVE MANAGEMENT
This generally involves the three mainstays of an inflammatory musculoskeletal condition: relative rest, NSAIDs, and physiotherapy!
Physiotherapy treatment, as always, should be based on the individual athlete and their assessment findings. Thus, as stated above, you should assess for biomechanical and functional impairments and treat accordingly. The components of a successful conservative rehabilitation program included (Wollin and Lovell, 2006):

*.Manual techniques to restore full range of motion in the lumbar, sacral and hip joints. This included soft tissue, MET, mobilisation and manipulative techniques
.*.Core Control Exercises (TrA and Pelvic Floor Training)
*.Adductor Strengthening (Progression of gentle isometric through to loaded isotonic strengthening)
*.Gluteal Strengthening
*.PNF patterns
*.Stationary Bike
*.Return to running program
*.Graduated and progressive return to play

Whilst this is by no means a recipe for your patients, it should serve as an indicator of the components of a successful rehabilitation program. In this small case series (n=4) all players returned to play at a mean timeof 13 weeks.The results of this study mirrored the overall findings of Choi et al (2011) who found that the mean return toplay for all patients undergoing conservative management was 9.55 weeks.

INJECTIONAL THERAPY
The studies examined two types of injectional therapy corticosteroid or prolotherapy.

*.Corticosteroid Injections: Overall 58.6% of patients RTP in 8 weeks, whilst there was no response in approximately 20% of patients.
*.Prolotherapy Injections: Topol et al (2005) examined prolotherapy injections in patients with chronic groin pain and found much more promising than the corticosteroid injections! 91.7% of the athletes RTP in 9 weeks, and there was a 8.3% no response rate.

SURGICAL MANAGEMENT
As you may expect surgical management should only be considered as a last resort. Dependant on the choice of surgery, which is widely variable in clinical practice, it can be a season ending operation. Therefore, it is not a decision to make lightly. The case series literature describes three surgical techniques (Choi et al, 2011).

These are discussed below:
1.Curettage of Pubic Symphysis: 72% RTP at an average of 5.6 months
2.Arthrodesis of the Pubic Symphysis: 87% RTP at an average of 6.6 months, with a 25% complication rate.
3.Polypropylene Mesh Placement into the Preperitoneal Retropubic Space: 92.3% RTP at an average of7.2 weeks.

HOME MESSAGES
*.There is a dearth of quality research to guide treatment decisions for osteitis pubis.
*.Conservative management should always be the first line of treatment for osteitis pubis.
*.Optimal management is individualised and always looks “beyond the groin”!
*.Prolotherapy could be used if physiotherapy fails (but it hurts!).
*.Surgery is a last resort only

Source-
http://www.thesportsphysiotherapist.com/osteitis-pubis-treatment-decisions-in-a-world-with-limited-research/

Lumbar Canal Stenosis and Associated Deformities

Degenerative lumbar spinal stenosis results from pathological degeneration of the facet joints, disc herniation, hypertrophy and buckling of the ligamentum flavum, and spondylolisthesis. Degenerative changes in the three-joint complex (the intervertebral disc and two facet joints) explain the fluctuation in symptoms with alterations in posture, load, and duration of load. Lumbar intervertebral disc degeneration represents a cascade of events involving disc herniation, bulging of the disc and ligamentum flavum into the canal, and resulting chronic facet arthrosis, sclerosis, and osteophytic growth. Hypertrophy of the ligamentum flavum is also an important element in the development of spinal stenosis. Lumbar spinal encroachment induces ligamentum flavum hypertrophy, which further aggravates stenosis. Disease of the nerve roots and cord, however, does not typically result directly from compression of the nerves. Rather, the resulting stenosis causes decreased flow of cerebrospinal fluid, which represents approximately 60% of the nutritional supply to the cauda equina, and increased venous pressure. In such a scenario, any concurrent spinal deformities may critically compromise the nerve roots and cord, as well as exacerbate neurological symptoms of lumbar stenosis.

Spondylolisthesis can be caused by congenital, developmental, traumatic, neoplastic, or degenerative conditions. In degenerative spondylolisthesis, the most common type observed with lumbar stenosis, anterior/posterior displacement of a VB results from facet joint erosion and attenuation of the muscular, capsular, and ligamentous structures. Fourfold more common in females than in males, degenerative spondylolisthesis occurs most frequently at the L4-5 and L5-S1 levels.Disc degeneration causes spondylolisthesis with resulting segmental hypermobility, compounded by arthritis in sagittal facet joints.

There are many other spinal deformities associated with the LCS. For the detailed article visit-

http://www.medscape.com/viewarticle/448310_2

Vibration Exercise- A Relief for Fibromyalgia

Whole-body vibration exercise may reduce pain symptoms and improve aspects of quality of life in individuals diagnosed with fibromyalgia, research shows. Whole-body vibration exercise involves standing, sitting or lying on a machine with a vibrating platform that causes muscles to contract and relax as the machine vibrates. The machines primarily are used by researchers but have begun appearing in fitness centers and are sold commercially.

A pilot study by Indiana University researchers found that whole-body vibration exercise may reduce pain symptoms and improve aspects of quality of life in individuals diagnosed with fibromyalgia.

For the whole study, visit-

http://www.sciencedaily.com/releases/2014/05/140529154009.htm

Structured physical activity program can help maintain mobility in vulnerable older people

A carefully structured, moderate physical activity program can reduce risk of losing the ability to walk without assistance, perhaps the single most important factor in whether vulnerable older people can maintain their independence, a study has found.

Older people who lose their mobility have higher rates of disease, disability, and death. A substantial body of researchhas shown the benefits of regular physical activity for a variety of populations and health conditions. But none has identified a specific intervention to prevent mobility disability.

In this large clinical study, researchers found that a regular, balanced, and moderate physical activity program followed for an average of 2.6 years reduced the risk of major mobility disability by 18 percent in an elderly, vulnerable population. Participants receiving the intervention were better able to maintain their ability to walk without assistance for 400 meters, or about a quarter of a mile, the primary measure of the study. Results of the large clinical trial, conducted by researchers at the University of Florida, Gainesville and Jacksonville, and colleagues at seven other clinics across the country, were published online on May 27, 2014, in the Journal of the American Medical Association. The researchers were supported by the National Institute on Aging (NIA) and the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health.

For the whole study, visit-

http://www.nih.gov/news/health/may2014/nia-27.htm

The Effects of Virtual Reality-based Yoga on Physical Function in Middle-aged Female LBP Patients

The objective of this research was to determine the effects of a virtual reality-based yoga program on middle-aged female low back pain patients. Thirty middle-aged female patients who suffered from low back pain were assigned to either a physical therapy program or a virtual reality-based yoga program for a period of four weeks. Participants could check their posture and weight bearing on a monitor as they shifted their weight or changed their postures on a Wii balance board. There were a total of seven exercise programs. A 30-minute, three times per week, virtual reality-based Wii Fit yoga program or trunk stabilizing exercise was performed, respectively. Repeated-measures analysis of covariance revealed significant differences in between before and after VAS, algometer, Oswestry low-back pain disability index (ODI), Roland Morris disability questionnaire (RMDQ), and fear avoidance beliefs questionnaire (FBQ) scores. The VAS, algometer, ODI, RMDQ, and FBQ scores exhibited significant differences in groups. Regarding the effect of time-by-group interaction, there were significant differences in VAS, ODI, ODI, and FBQ scores.

The study concluded that for middle-aged female patients who have low back pain, a virtual reality-based yoga program was shown to have positive effects on physical improvements, and the program can be employed as a therapeutic medium for prevention and cure of low back pain.

For the full study, visit-

http://www.physiospot.com/research/the-effects-of-vr-based-wii-fit-yoga-on-physical-function-in-middle-aged-female-lbp-patients/

Physiotherapy Definitions- At Indian level & International level

1. World Health Organization (WHO): "Physiotherapists assess, plan and implement rehabilitative programs that improve or restore human motor functions, maximize movement ability, relieve pain syndromes, and treat or prevent physical challenges associated with injuries, diseases and other impairments. They apply a broad range of physical therapies and techniques such as movement, ultrasound, heating, laser and other techniques. They may develop and implement programmes for screening and prevention of common physical ailments and disorders" (Reference: http://www.who.int/hrh/statistics/Health_workers_classification.pdf )

2. The International Labour Organization (ILO ): Physiotherapists and related associate professionals treat disorders of bones, muscles and parts of the circulatory or the nervous system by manipulative methods, and ultrasound, heating, laser or similar techniques, or apply physiotherapy and related therapies as part of the treatment for the physically disabled, mentally ill or unbalanced. The International Labour Organization (ILO) is the international organization responsible for drawing up and overseeing international labour standards. It is the only 'tripartite' United Nations agency that brings together representatives of governments, employers and workers to jointly shape policies and programmes promoting Decent Work for all. (Reference: http://www.ilo.org/public/english/bureau/stat/isco/isco88/3226.htm )

3. International Standard Classification of Occupations (ISCO) is a tool for organizing jobs into a clearly defined set of groups according to the tasks and duties undertaken in the job. The World Health Organization (WHO) has classified physiotherapists in professional group (ISCO Code 2264) and paramedical professionals have been classified in a separate entity (ISCO code 2240). (Reference: http://www.who.int/hrh/statistics/Health_ workers_classification.pdf)

4. World Confederation of Physical Therapy (WCPT) : Physical therapists are qualified and professionally required to: -undertake a comprehensive examination/assessment of the patient/client or needs of a client group -evaluate the findings from the examination/assessment to make clinical judgments regarding patients/clients -formulate a diagnosis, prognosis and plan -provide consultation within their expertise and determine when patients/clients need to be referred to another healthcare professional -implement a physical therapist intervention/treatment programme -determine the outcomes of any interventions/treatments -make recommendations for self-management. (Reference: http://www.wcpt.org/what-is-physical-therapy)

5. Delhi Council for Physiotherapy & Occupational Therapy Bill 1997 : “Physiotherapy” means physiotherapeutic system of medicine which includes examination, treatment, advice and instructions to any persons preparatory to or for the purpose of or in connection with movement dysfunction, bodily malfunction, physical disorder, disability, healing and pain from trauma and disease, physical and mental conditions using physical agents including exercise, mobilization, manipulation, mechanical and electrotherapy, activity and devices or diagnosis, treatment and prevention. (Reference: http://delhiassembly.nic.in/aspfile/billspassed/141997.htm)

6. Maharashtra State OTPT Council: "Physiotherapy" means a branch of modern medical science which includes examination, assessment, interpretation, physical diagnosis, planning and execution of treatment and advice to any person for the purpose of preventing, correcting, alleviating and limiting dysfunction, acute and chronic bodily malfunction including life saving measures via chest physiotherapy in the intensive care units, curing physical disorders or disability, promoting physical fitness, facilitating healing and pain relief and treatment of physical and psychosomatic disorders through modulating physiological and physical response using physical agents, activities and devices including exercise, mobilization, manipulations, therapeutic ultrasound, electrical and thermal agents and electrotherapy for diagnosis , treatment and prevention. (Reference: http://www.msotptcouncil.com/OTPTActs.aspx )

Seronegative Spondyloarthropathies

Visit-

http://www.ncbi.nlm.nih.gov/books/NBK27224/

For the full information about seronegative spondyloarthropathies