Effective treatment of lymphedema of the extremities.

Ko DS1, Lerner R, Klose G, Cosimi AB.

Author information

Abstract

OBJECTIVE:

To define the immediate and long-term volumetric reduction following complete decongestive physiotherapy (CDP) for lymphedema.

DESIGN:

Prospective study of consecutively treated patients.

SETTING:

Freestanding outpatient referral centers.

PATIENTS:

Two hundred ninety-nine patients referred for evaluation of lymphedema of the upper (2% primary, 98% secondary) or lower (61.3% primary, 38.7% secondary) extremities were treated with CDP for an average duration of 15.7 days. Lymphedema reduction was measured following completion of treatment and at 6- and 12-month follow-up visits.

INTERVENTION:

Complete decongestive physiotherapy is a 2-phase noninvasive therapeutic regimen. The first phase consists of manual lymphatic massage, multilayered inelastic compression bandaging, remedial exercises, and meticulous skin care. Phase 2 focuses on self-care by means of daytime elastic sleeve or stocking compression, nocturnal wrapping, and continued exercises.

MAIN OUTCOME MEASURES:

Average limb volumes in milliliters were calculated prior to treatment, at the end of phase 1, and at 6- to 12-month intervals during phase 2 to assess percent volume reduction.

RESULTS:

Lymphedema reduction averaged 59.1% after upper-extremity CDP and 67.7% after lower-extremity treatment. With an average follow-up of 9 months, this improvement was maintained in compliant patients (86%) at 90% of the initial reduction for upper extremities and lower extremities. Noncompliant patients lost a part (33%) of their initial reduction. The incidence of infections decreased from 1.10 infections per patient per year to 0.65 infections per patient per year after a complete course of CDP.

CONCLUSIONS:

Complete decongestive physiotherapy is a highly effective treatment for both primary and secondary lymphedema. The initial reductions in volume achieved are maintained in the majority of the treated patients. These patients typically report a significant recovery from their previous cosmetic and functional impairments, and also from the psychosocial limitations they experienced from a physical stigma they felt was often trivialized by the medical and payor communities.

TO AVAIL LYMPHEDEMA TREATMENT CONTACT 919819559990 (MUMBAI)

PMID:

 

9565129

 

[PubMed - indexed for MEDLINE]

Foldi's Textbook of Lyphology, 2^nd Ed.
Position Statement of the National Lymphedema Network. Topic: Exercise.  http://www.lymphnotes.com/article.php/id/401/

OMG, you're texting your way to back pain (mobile causing neck and back pain)

Humans were designed to stand upright. And yet in this modern world, too many of us spend our days with our heads slumped over for a simple reason: we're staring at the tiny screen of a smartphone.
People spend an average of 2 to 4 hours each day with their neck bent at this unnatural angle while shooting off emails or texts. That's 700 to 1,400 hours a year. The success of social media is has led to an epidemic of bad smartphone posture. 

eople who have poorer posture often have poorer physical and emotional health. The researchers define bad posture as "the head in a tilted forward position and the shoulders dropping forward in a rounded position."

Bad posture has been linked to a host of medical problems, including headaches and other neurological problems, depression, constipation, and heart disease. At a minimum, constant slouching is likely to cause a lot of chronic pain.

This is why Hansraj said it's important to be mindful of your smartphone posture.
"While it is nearly impossible to avoid the technologies that cause these issues, individuals should make an effort to look at their phones with a neutral spine and to avoid spending hours each day hunched over," the authors write in their study.

Biofeedback & Electrical Stimulation Therapy for Urinary Incontinence

Electrical Stimulation for Urinary Incontinence

Electrical stimulation is used to treat urinary incontinence by sending a mild electric current to nerves in the lower back or the pelvic muscles that are involved in urination.

You may be able to provide electrical stimulation therapy at home using a unit with a vaginal or anal electrode. Timing and duration of therapy varies. For example, your treatment may consist of 12 weeks during which you have 15-minute stimulation sessions twice a day. This kind of stimulation has been used for both urge and stress incontinence.

How vaginal or anal electrical stimulation works is not well understood. The stimulation may make the muscles contract, producing an effect similar to Kegel exercises, which strengthen the muscles by contracting them frequently. The stimulation may also encourage the growth of nerve cells that cause the muscles to contract.

Electrical stimulation of the bladder can also be done by placing electrodes under your skin, either through your leg or into your lower back. This is usually done for severe urge incontinence or overactive bladder that hasn't been helped by other treatment.

Posterior tibial nerve stimulation (PTNS) is done by inserting a very small electrode through the skin of your lower leg. The electrode is connected to an electrical stimulator (pulse generator) outside your body. The stimulator sends pulses to the electrode, which stimulates the tibial nerve in your leg. That electrical current then affects the nerve in your lower back that controls bladder and pelvic floor function.

Sacral nerve stimulation (SNS) is done by putting an electrical stimulator under your skin above your buttocks. This stimulator looks like a pacemaker. It is attached to electrodes that send pulses to a nerve in your lower back (sacrum). The sacral nerve plays a role in bladder storage and emptying.

Why It Is Done

Electrical stimulation may be used to treat:

• Overactive bladder.
• Stress incontinence.
• Urge incontinence.
• Mixed stress and urge incontinence.

How Well It Works

Vaginal or anal electrical stimulation has been tried mostly in women who have urge, stress, and mixed incontinence. There is some research that it can help reduce how often women have incontinence.1

In men with urinary incontinence after prostate surgery, pelvic floor exercises and anal electrical stimulation did not improve incontinence any more than pelvic floor exercises alone after 8 weeks.2

Posterior tibial nerve stimulation may help about half of the people who get it. In one study, about 5 out of 10 people who had the treatment were better after 12 weeks.3

Sacral nerve stimulation has been studied for urge urinary incontinence that hasn't gotten better with other treatments. Most of the studies have only included a small number of women. In those studies, about half of women had some improvement in urinary incontinence after treatment.4

Risks

Vaginal or anal electrical stimulation can cause pain, tenderness, and bleeding.

The risks of sacral nerve stimulation include:

• Pain where the device is implanted under your skin.
• Movement of the implanted device from its original spot.
• Infection.

What To Think About

Before trying electrical stimulation for urinary incontinence, talk to your doctor about the following:

• Can my incontinence be treated with behavioral or exercisetherapy before trying medicine? Behavioral or exercise therapy, such as bladder training or pelvic floor (Kegel) exercises, is noninvasive, can be done at home, is inexpensive, has no side effects, and does not limit future therapy options if it is not successful.
• How much experience does the doctor have in treating incontinence? Some doctors do not realize the impact that urinary incontinence can have on a person's life and may disregard your concerns.
• Could any medicines I am taking for another condition be causing my incontinence? Some medicines (especially diuretics) cause the body to produce greater amounts of urine, which may contribute to incontinence problems. Take them when you will easily be able to get to a restroom.

Complete the special treatment information form (PDF) to help you understand this treatment.

Citations

1. Onwude JL (2009). Stress incontinence, search date June 2008. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
2. Goode PS, et al. (2011). Behavioral therapy with or without biofeedback and pelvic floor electrical stimulation for persistent postprostatectomy incontinence. JAMA, 305(2): 151–159.
3. Peters KM, et al. (2010). Randomized trail of percutaneous tibial nerve stimulation versus s efficacy in the treatment of overactive bladder syndrome: Results from the SUmiT trial.Journal of Urology, 183(4): 1438–1443.
4. Groen J, et al. (2011). Sacral neuromodulation as treatment for refractory idiopathic urge urinary incontinence: 5-year results of a longitudinal study in 60 women. Journal of Urology, 186(3): 954–959.

Mirror Therapy for Pain relief

“Twice a day, ten minutes per session, for five weeks and the phantom pain will go away” – Stephen Sumner’s recipe for mirror therapy. This story is of Stephen Sumner who lost his left leg that had been amputated six inches above the knee and his phantom pain. Stephen used the mirror for two weeks, then stopped because the pain had not returned. About a year and a half later, he felt the pain again, and this time he stayed the course for the full five weeks. He hasn’t had phantom pain for over four years. “It’s gone now,” he says. “It’s gone because I treated myself with a mirror.” Stephen is now on a mission to alleviate pain of people suffering from Phantom pain using mirrors. He meets people with amputation, learns about their story and shares his too. He gives a mirror to people with phantom limb pain, teaches them the use of it and thereby alleviates their pain. He is “Mirror Man”; a mirror therapist who first targetted Cambodia, place where landmines and unexploded ordnance killed around 20,000 people and injured 44,000 more between 1979 and 2011. Stephen has travelled around Asia with mirrors on the back of his bicycle to help many amputees suffering from phantom pain.  Stephen offers a simplified explanation of the brain reorganisation theory. Pointing to his head, he says, “You have a commander here that controls the body. The commander has a map of the whole body. When the map doesn’t match the body, the commander panics and you feel pain. This mirror is to trick the commander into thinking the leg still exists, so he stops panicking and the pain goes away.” Mirror therapy is a well know techniques used by therapists all over the world.  Graded Motor Imagery (GMI) offers a novel three stage synaptic exercise process for neuropathic pain involving left/right discrimination, imagined movements and mirror therapy. With patience, persistence and often lots of hard work, GMI gives new hope for treatment outcomes. The “Mirror Man” is dedicated towards helping people to overcome from phantom pain using mirrors, read his full story. -

 See more at:
http://www.physiospot.com/2014/08/23/the-mirror-man/?utm_source=September+2014&utm_campaign=The+Latest+September&utm_medium=email#sthash.oFkwsCvA.dpuf

Aromatherapy & physiotherapy Exercise to Relieve Pain

Medical condition characterized by muscle pain and the presence of “tender points.” Tender points (points in the body that are especially painful when touched) may occur in the arms, legs, neck, shoulders, and back, and are detected at specific locations for the diagnosis of names, including chronic muscle pain syndrome, fibrositis, psychogenic rheumatism, and tension myalgia, fibromyalgia.

People with Pain often experience other symptoms, including fatigue, insomnia, headaches, constipation, diarrhea, abdominal pain, bloating, and a heightened sensitivity to light, sound, and odors.

How is Aromatherapy with Essential Oils Used to Pain?

Aromatherapy is used to treat pain because of the ability of essential oils to bring about desired changes in one’s physical and mental states. Specifically, some essential oils appear to increase one’s tolerance of pain, improve one’s general overall emotional state, improve circulation, and, in general, elevate one’s mood. These changes appear to relieve the pain, sensitivity to outside stimuli, and fatigue that are associated with pain.
The essential oils used in treating fibromyalgia are chosen because they have one or more of these properties. For example, some of the essential oils used to relieve sore muscles and joints include black pepper (Piper nigrum), eucalyptus (Eucalyptus globulus), juniper (Juniperus communis), and peppermint (Mentha piperita). Essential oils helpful in calming one down include chamomile (Matricaria chamomilla), jasmine (Jasminum officinalis), and lavender (Lavendula officinalis). Essential oils used to increase one’s energy are geranium (Pelargonium graveolens), grapefruit (Citrus paradisi), and lemon (Citrus limon).

How Exercise helps relieve to Pain?

 Low-impact exercise reduces pain and fatigue – and increases your ability to function.

Recent research shows that exercise can help. A 2007 study in the Archives of Internal Medicine found that person with pain in a four-month exercise program reported significant improvements in physical function, fatigue, and depression. 

 

Understanding Your Pain is Understanding Your Body

The source of your pain likely confuses or eludes you. You know where you feel it but you don’t understand why you constantly feel it and why it won’t go away. No physician or Doctor is explaining the reason source of pain. The source of your pain is often hard to determine and, as such, you feel you can’t control the pain and its effects. However, you are still in control of your body and the way it functions. @ physioconsultation the physiotherapist will teach you about the biological, psychological and social factors related to your condition and how these factors can contribute to pain. These invaluable pain management skills will empower your pain relief and give you tools to use for a lifetime. Our holistic approach and advance pain management tool will give you relief with time.

Conditions commonly treated include:

• Spine-related pain (e.g. neck and low back pain)
• Myofascial pain
• Fibromyalgia
• Neuropathic pain (e.g. diabetes mellitus, shingles)
• Pelvic pain
• Complex Regional Pain Syndrome (formerly Reflex Sympathetic Dystrophy [RSD])
• Post-surgical and post-traumatic pain
• Headache
• radiculopathy pain
• meralgia pain
• nerve compression
• posture correction

to avail services in mumbai contact 9819559990

Biofeedback in Mumbai , India

How Does Biofeedback Therapy Work?

Researchers aren't exactly sure how or why biofeedback works. They do know that biofeedback promotes relaxation, which can help relieve a number of conditions that are related to stress.

Biofeedback is the process of gaining greater awareness of many physiological functions primarily using instruments that provide information on the activity of those same systems, with a goal of being able to manipulate them at will.  Some of the processes that can be controlled include brainwaves, muscle tone, skin conductance, heart rate and pain perception.

Different types of biofeedback are used to monitor different body functions:

Electromyogram (EMG). This measures muscle activity and tension. It may be used for back pain, headaches, anxiety disorders, muscle retraining after injury, and incontinence.

Neurofeedback or electroencephalography (EEG). This measures brain waves. It may be used for attention deficit hyperactivity disorder (ADHD), epilepsy and other seizure disorders.

EMG triggered NeuroMuscular Electrical Stimulators (EMG-triggered NMES) : EMG triggered NeuroMuscular Electrical Stimulation is a technology to detect the extremely small electrical ElectroMyoGraphic (EMG) signals still measurable in paralyzed muscles after stroke and use these signals to initiate electrical muscle stimulation impulses to those same muscles resulting in actual muscle movement. This form of stroke rehab is used to re-learn and re-develop spontaneous muscle control, which cannot be done by electrical muscle stimulation alone

to avail services in Mumbai contact 9819559990

INPP in Mumbai, India

What is INPP method?

The INPP method of Neuro-Developmental Therapy (developed by the Institute for Neuro-Physiological Psychology) helps address difficulties associated with Neuro Develomental Immaturity (or Neuro Developmental Delay).  A clinical assessment process is used to determine an individualised movement and therapy programme designed to meet the developmental profile of the child or adult seeking assistance.  Regular assessments inform the INPP practitioner who will modify and adapt the programme over a period of time ensuring continued customisation as the patient progresses.

What is Neuro Developmental Immaturity?

Neuro Developmental Immaturity can occur when the primitive reflexes are not fully integrated and the postural reflexes are not fully developed.  This can result in children experiencing difficulty sitting still, developing co-ordination and body control, developing fine motor skills, developing adequate eye control and visual function to assist learning tasks including reading, writing and comprehension.  This physiological basis for learning difficulty can cause frustration and an inability to comply with many of the requirements of a standard schooling experience.  It can interfere with concentration, memory and perception of information.  Some children may be hypersensitive to sound or visual stimulation, unable to exclude irrelevant data and information and are therefore easily distracted.

Physio Consultation  looks behind and treats the symptoms of Neuro-Motor Immaturity (NMI), or Neuro-Developmental Delay (NDD), by identifying the roots of the problem using an assessment and screening programme developed and successfully used by Dr Peter Blythe and the Institute for Neuro Physiological Psychology since 1969, the INPP programme.

Integrating Thinking helps address:

• Reading and writing difficulties
• Educational underachievement eg. Consistently being told “you can do better”
• Dyslexia (reading difficulties)
• Dyspraxia (DCD) (clumsy child syndrome)
• Dysgraphia (writing problems)
• Co-ordination difficulties
• Attention Deficit Disorder (ADD)
• Concentration problems
• Asperger’s Syndrome
• Auditory processing difficulties
• Visual processing difficulties

The neuro-motor development programmes include clinical assessments and supervision of remedial programmes using specific developmental movement methods devised at the Institute for Neuro-Physiological Psychology in the UK. (www.inpp.org.uk)

Clinical assessments include standardised neurological tests to identify underlying developmental and physiological factors that may be contributing to learning difficulties.

The INPP program is drug free and non-invasive and is designed to match the developmental profile of the child or adult assessed.

The INPP method of addressing neuro-motor immaturity is a home-based programme supported by a trained neuro-developmental therapist. Implementing the programme requires approximately 10 minutes of daily activity.

No equipment is necessary for conducting the therapy programme at home. Regular follow up assessments are scheduled on a 6 – 8 week basis with ongoing support available between visits.

Six steps to the Integrating Thinking INPP program:

1. Screening questionnaire (Free online Questionnaire);
2. Initial consultation to determine program suitability (1 — 1.5hours);
3. Diagnostic assessment and exercise programme development (2 – 3 hours);
4. Report reading and exercise programme establishment;
5. Implementing the programme (5—10 minutes/day @ home);
6. Follow up reviews at 6 weekly intervals

   vardhman jain has completed 1 year training program of INPP (www.inpp.org.uk)

To avail service in Mumbai contact 919819559990 

Hydrotherapy / Aquatic Therapy in Mumbai

Hydrotherapy

What is Hydrotherapy?

Hydrotherapy is a physiotherapy treatment or an exercise program consisting of a variety of water based exercises that are carried out in water or by use of water. It is popularly also know as Pool Therapy , Aqua Therapy, Aquatic Therapy and many more. It is especially helpful in cases where a land-based exercise program is not possible due to the intensity of pain, decreased bone density, disability or other factors. The water temperature is usually 33 –37ºC.

How does it differ from swimming?

Usually we refer to swimming as a sport or as a recreational activity. While swimming is very beneficial, not all patients are at this level.

Hydrotherapy is a form of medical treatment of diseases through the use of water. Water based exercises for musculoskeletal conditions are usually less painful than land based

What are the benefits of hydrotherapy?

The warm temperature and sensory input from the water pressure allows your muscles to relax and eases the pain in your joints. This makes it easier to exercise and desired exercise intensity can be  achieved.

The water buoyancy supports your body weight. This reduces stress on joints and muscles that helps to exercise with an increased range of movements. By pushing your arms and legs against the water you can also improve your muscle strength, co-ordination and balance.

Who benefits most from hydrotherapy?

• Arthritis in several joints, fibromyalgia, Rheumatoid arthritis
• Sports injuries; muscle strain or tears, Acute/chronic
• Acute or chronic back and neck pain
• Poor  trunk stability, Poor Balance and stability
• Neurological disorders  e.g. Stroke, Brain Injury, Multiple Sclerosis
• Post-operative conditions e.g. joint replacement, spinal surgery, rotator cuff repair. Immobility following fracture healing
• Obesity

To avail service in Mumbai contact 919819559990 

Dry needling

Intra Muscular Dry Needling (IMDN)

What is Intra Muscular Dry Needling (IMDN) ?

Dry needling is an invasive procedure whereby solid filament (acupuncture) needles are inserted into the skin and muscle directly at a myofascial trigger point, which are related to the production and maintenance of the pain cycle.

The approach is based on Western anatomical & neurophysiological principles which are not to be confused with the Traditional Chinese Medicine (TCM) technique of acupuncture (Travell & Simons 1999).

What can Intra Muscular Dry Needling (IMDN) help?

Dry needling can be used for a variety of Chronic / Acute musculoskeletal problems. Muscles are thought to be a primary contributing factor to the symptoms. Conditions which respond to dry needling include, but are not limited to:

• Headaches

• Frozen Shoulder

• Tennis elbow

• Carpal tunnel syndrome

• Golfer's elbow

• Buttock pain

• Leg pain

• Hamstring strains

• Shin splints

• Muscle Spasms

• Fibromyalgia

• Sciatic Pain

• Hip Pain

• Knee Pain

• Repetitive Strain Injuries

How does Intra Muscular Dry Needling (IMDN) work?

There are mechanical and biomechanical can cause favorable biochemical changes which assist in reducing pain. It is essential to elicit a Local Twitch Response which is a spinal cord reflex and is the first step in breaking the pain cycle.

How does Intra Muscular Dry Needling (IMDN) stop this cycle?

A spasmed muscle becomes a damaged muscle. Spasm reduces blood flow in the muscle. This means less oxygen and nutrients to the muscle. Muscle fibres die off and get replaced by fibrous scar tissue. This in turn holds the muscle tight, prevents muscle metabolites from leaving the muscle and causes continued spasm and pain.

Putting a needle into a spasmed muscle causes the muscle to relax, this can be seen with an electromyogram (EMG).

Where does Intra Muscular Dry Needling (IMDN) fit in the entire rehabilitation programme?

More frequently, dry needling is needed at the beginning to help break the pain cycle  or change instantaneous muscle tension then other treatment modalities are introduced.

To avail service in Mumbai contact 919819559990 

Chronic Pain Management

What is Chronic pain?

Chronic pain is defined as pain that has lasted longer than three to six months.

How Can we help?

Complete and sustained remission of many neuropathies and most idiopathic chronic pain (pain that extends beyond the expected period of healing, or chronic pain that has no known underlying pathology) is rarely achieved, but much can be done to reduce suffering and improve quality of life via our Pain Management  Method.

To avail service in Mumbai @ home 

contact 9819559990