Yoga in Cardirespiratory Conditions

With the increased incidence of disorders of cardiorespiratory functions mostly due to altered life style, the time has come for us to address these without drug. Physiologically, it is understood that certain yoga postures with controlled breathing regulates the blood circulation and functioning of heart and lungs. If such yoga practices are performed for a long period of time, it will have therapeutic effect on functions of heart and lungs.

Almost none of us use the full capacity of our lungs. The primary question is how one can regulate breathing process. By training our body to breathe in a particular pattern, we can activate our autonomic system to use the new system of breathing. Yoga enhances relaxation to the bronchial functioning. Yoga also strengthens endurance, pain tolerance, and muscle tone. The asthmatics may be trained to relax their bronchus during an attack of asthma without using drugs. This procedure cuts the panic element in an attack so that one can turn the mind inwards to relax bronchus during an attack. In pranayama lungs are inflated to the maximum capacity and air pressure is increased in the lungs. This further leads to better oxygenation of the body which augments adequate release of chemicals in brain and endocrine glands. Heart beat also stabilizes because of breathing exercises mediated through autonomic nervous system.

Some of the Yoga practices recommended are;
Asanas:
1. Padmasana.
2. Bhujangasana.
3. Parvatasana
4. Sarvangasana.
5. Savasana.

Surya Namaskar: This exercise increases the antioxidant properties in the human body. It is effective in improving blood circulation.
Pranayama: Nadisuddhi pranayama by alternate nostril breathing is effective against disorders of cardio-respiratory functions. Other types of pranayama technique like Bhramari also show positive impact to this effect.
Yoga Nidra: Yoga Nidra is emerging as an excellent preventive and curative procedure in cardiovascular management. It induces a more relaxed mental attitude and emotional climate, enabling practitioners to successfully withstand the stresses of daily life. The deep muscular relaxation in Yoga Nidra has a significant and effective therapy producing both subjective and objective improvement in respiratory function disorders in asthma.

Special Yoga practices:
I.R.T. (Instant Relaxation Technique), Q.R.T. ( Quick Relaxation Technique ) and D.R.T. (Deep Relaxation Technique) have remarkable results in prevention of heart disease.

Difference between Upper and Lower motor neuron lesions

Key features of upper and lower motor neuron lesions

	Upper motor neuron	Lower motor neuron
Muscle tone	Increased	Decreased
Clonus	Present	Absent
Muscle fasciculation	Absent	Present
Tendon reflexes	Increased	Decreased or absent
Plantar reflex	Extensor (Babinski’s sign)	Flexor normal
Distribution	Extensor weakness and upper limb and flexor weakness in lower limb.	Weakness of muscle groups innervated by affected spinal segments/ root, plexus or peripheral nerve.

Mystery of Shouder Joint

Why it is difficult to diagnose shoulder cases ???

Shoulder joint may looks like a simple joint to normal individuals but I don’t think it is as simple as it looks like. Shoulder joint is like a” blue deep water pond” which looks simple and easy from outside but most difficult to stand if once you step inside.

Shoulder joint is a mystery because there are so many conditions in the shoulder joint that shows similar features and posses same symptoms. Because of this reason it is most difficult to conform the diagnosis.

This is not only the reason that makes shoulder joint different. There are so many other reasons that make a therapist or physician to misdiagnose and difficulties in diagnosis.

For example; Any patient complaining of decrease ROM in the shoulder joint and pain in the movement, may have problem in other joints likes SC (sternoclavicular) joint, AC (acromioclavicular) joint or ST (scapulothoracic) joint. Because for complete ROM of shoulder joint other joints (SC, AC and ST) movement should not be restricted. Therefore any pathological conditions related to these joints may decrease ROM of shoulder joint.

And any neurological problems like brachial plexus lesion or injury produce radiating pain to the shoulder joint and UL. And any problem in heart, gall bladder and liver may produce referred pain around shoulder region. So, this may be another reason that create problem while diagnosing shoulder cases.

Another reason for shoulder being difficult to diagnose; it is one of the common joint that is used in our most of ADL. We don’t use other joint like hip and knee while sitting and lying but we use shoulder joint. We use shoulder joint in activities of daily living (ADL) like combing, brushing, eating, etc. which makes it more prone to injury and thus difficult to diagnose. This is the joint that permit all movements in all planes. Like flexion/extension, med/lat rotation, abduction/adduction and circumduction. As it has global movements, it makes difficulties in diagnosing.  

Anatomy of shoulder joint is also another factor that makes it more prone to injury. Very large head of humerus articulate with comparatively small glenoid fossa because of which it is most common joint to dislocate.   

So, because of these reasons shoulder joint is difficult to diagnose as compared to other joints like knee, wrist or elbow joint. Therefore, it is very important to check all conditions and also important to assess peripheral joint while dealing with any shoulder cases.

Special Tests in Wrist and Hand

1. Finkelstein test

Test: tenosynovitis of abductor pollicis longus and extensor pollicis brevis tendon ( de Quervain’s tenosynovitis).

Procedure: patient makes a fist with thumb inside. Passively move wrist into ulnar deviation.

Positive sign: Reproduction of symptom.

  

2. Froment’s sign

Test: ulnar nerve paralysis.

Procedure: grip piece of paper between index finger and thumb. Pull paper away.

Positive sign: flexion of IP (interphalangeal) thumb joint as paper pulled away.

3. Ligamentous instability test for the fingers

Test: stability of collateral ligaments

Procedure: apply varus and valgus force to PIP (proximal interphalangeal) or DIP (distal interphalangeal) joint.

Positive sign: increased laxity.

4. Linburg’s sign

Test: tendon pathology at interconnection between flexor pollicis longus and flexor indicis.

Procedure: thumb flexion into hypothenar eminence and index finger extension.

Position sign: limited extension and reproduction of symptoms.

5. Lunotriquetral ballottement (Reagan’s) test

Test: stability of lunotriquetral ligaments.

Procedure: stabilize lunate and appy posterior and anterior glide to triquetrum and pisiform.

Positive sign: reproduction of symptoms, cripitus or laxity.

6. Watson (scaphoid shift) test

Test: stability of scaphoid.

Procedure: hold wrist in full ulnar deviation and slight extension. With other hand apply pressure to scaphoid tubercle(palmar aspect) and move wrist into radial deviation and slight flexion.

Positive sign: pain and/or subluxation of scaphoid.

7. Phalen’s (wrist flexion) test  

Test: median nerve pathology; carpel tunnel syndrome

Procedure: place dorsal aspect of hands together with wrists flexed. Hold for 1 minute.

Positive sign: tingling in distribution of median nerve.

8. Reverse phalen’s test

Test: median nerve pathology

Procedure: place palms of hands together with wrist extended. Hold for 1 minute.

Positive sign: tingling in distribution of median nerve.

9. Sweater finger sign

Test: rupture of flexor digitorum profundus tendion.

Procedure: patient makes a fist.

Positive sign: loss of DIP joint flexion of one of the fingers.

10. Tinel’s sign

Test: median nerve pathology; carpel tunnel syndrome

Procedure: tap over carpel tunnel

Positive sign: tingling or paraesthesia in median nerve distribution in hand. Furthest point at which abnormal sensation felt indicates point to which the nerve regenerated.

11. Triangular fibrocartilage complex (TFCC) load test

Test: triangular fibrocartilge complex integrity.

Procedure: hold forearm. With other hand hold wrist in ulnar deviation then move it through supination and pronation while applying a compressive force.

Positive sign: pain, clicking, crepitus.

Physiotherapy Treatment of Diabetic Ulcers

Physiotherapy Treatment of Diabetic Ulcer 

 Physiotherapy Aims

·        To relieve pain

·        To relieve edema

·        To prevent infection

·        To promote healing and improve circulation

·        To mobilize soft tissues at the edges and floor of the ulcer

·        To improve joint mobility and strengthen the weakened muscles

·        Prevent scar formation adhesions and other complications

·        To improve the condition of the skin in lower limb

Means of Physiotherapy Management

 1. Faradism under pressure

·        Faradism under pressure

·        Pneumatic compression bandages and elastic stockings

·        Elevation of the limb

·        Manual massage techniques

·        Ultrasound therapy (pulsed mode)

·        Soft tissue techniques

2. To control infection and promote healing

 a. Ultrasound therapy

 Uses:

·        Promote healing

·        Soften the indurations

·        Improve blood supply

·        Frequency: 3 MHz

·        Mode: Pulsed mode (acute ulcers) and continuous mode (chronic ulcers)

·          Intensity: 0.2 – 0.6 W/cm2

·        Duration: 2-6 mins

 b. Ultraviolet radiations

For infected wounds

·        It helps to destroy micro-organisms and improve circulation and promote skin growth

·        Kromayer lamp is commonly used

·        E4 dose or E4x2 dose for base of ulcer

·        E1 or E0 dose for edges of ulcer

·        For 2/3 times per week

 For healing ulcers

·        E1 dose (shallow ulcers)

·        E2 dose (for deep ulcers)

·        E1 or E0 dose for edges of ulcer

·        It helps to stimulate the growth of granulation tissue

 For indolent ulcers

·        E3 dose for the floor of ulcer

·        E1 or E2 dose for edges of ulcer

·        It helps to improve circulation and promote healing of ulcer

c. Pulsed electromagnetic energy: (PEME) It is the production of short bursts of high frequency current Pulse width: 65 us Frequency: 400 pulses/min Duration: 30 mins

Uses

·        Increased growth of epithelial and connective

·        Promote healing

·        Provides non-thermal effects

·        Improves circulation

d. Ionozone therapy It is the production of steam which is passed over a mercury arc and into a mixture of ionized water, ozone and O2 Distance: Applied 30 cms away from ulcer Duration: 10-2- mins

Uses:

·        Promotes healing

·        Prevents infection

·        If UVR treatment is not effective

·        Reduces pain

e. LASER (Light Amplification by Stimulated Emission of Radiation)

·        Visible red laser is used (600-950nm)

·        Promotes healing by proliferation of fibroblasts

·        Causes vasodilatation thus improves circulation

f. Infrared Rays (IRR)

·        For 20 mins at a distance of 50-70 cms

·        Promotes wound healing and improves circulation

  

3. To mobilize soft tissue structures

·        Manual massage techniques

·        Thumb and finger kneading from periphery up to location of ulcer

·        Modified petrissage, picking up and rolling

·        Moving the ulcer from side-side

·        These techniques are not given when the ulcer is infected

·        The limb should be elevated to 450 while giving manipulation techniques

Uses

·        Improves circulation

·        Drainage of exudate and tissue fluid

·        Improve skin texture

·        Reduce edema and congestion

4. To mobilize the joints and strengthening of muscles

·        Active exercises of the involved joint

·        Elastic bandages must be worn

·        Free exercise to maintain joint ROM

·        Walking and gait training exercises

·        Emphasizing on push off‖ while walking

·        Isometric exercises

·        Progressive resisted exercises

·        To improve functional training treadmill, cycling is done

5. General advice to the patient

·        Avoid exposure to infectious environment

·        Maintain personal hygiene

·        Sterile dressings are applied

·        Avoid standing for prolonged time

·        Elevate the limb with pillows while sitting or sleeping