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The human back is the largest structural part of the body. It helps us keep the body straight against the gravity and move in various directions.


The back has many supportive structures like the vertebral column (backbone), rib cage, muscles and other soft tissues.


The backbone is formed by 33 pieces of bones. In an adult, the 24 bones are movable and separated by cushioning discs. The remaining lower 9 pieces (sacrum and tailbone) are fused and attached to the pelvic bones.


Backbones also make protective canals for the spinal cord from the brain and that connect to the different organs and body parts.


The human back has three regions:

  • The upper back (neck and shoulder region)
  • The middle back (thoracic region)
  • The lower back (lumbar region and the tailbone area)

 

Among the three regions, the lower back is the most vulnerable for injuries, because of its flexibility and mobility.
Back pain is the most common symptom. Many of us must have experienced back pain several times in our lives. It can affect everyone from adolescents to adults, due to various reasons.
Recent studies indicate that a sedentary lifestyle and jobs performed sitting for a long time like computer work are the reasons for increase in the back pain cases.


Back pain based on its duration can be classified as:

  • Acute (recently started)
  • Chronic (exists for many weeks)

 

Back Pain Causes

 

There are many causes, but all have their origin in one of:
Musculoskeletal Origin

This is one of the most common causes of back pain that include:

  • Muscle strain and ligament sprains lead to muscle spasm and inflammation on the back
  • Trigger points and muscle spasm form on the muscles due to the prolonged use of back muscles and other     soft tissues
  • Myofacial tightness and fibromyalgia
  • Abnormal postures exert excess stress on the musculoskeletal systems
  • Dysfunction of the vertebral joints lead to the loss of synchronized movements of the vertebra and abnormal     opening and closing of the vertebral joints
  • Muscle weakness, especially of the muscles in the back, abdomen and pelvis due to prolonged inactivity or     pain.
  • Chest deformity and stress on the ribs or rib cage are a most common cause of upper and middle back     (thoracic) pain. Such traits are also a cause of pain in the back, chest and shoulder blade region. This cause is     also common in children.
  • Spondylitic changes wear and tear the process of the vertebra and its joint, leading to pain and nerve     irritation
  • Pregnancy
  • Spondylolisthesis and retrolisthesis
  • Sacroiliac joint dysfunction due to arthritis, pregnancy or muscle spasm can lead to lumbar back pain,     especially during movements of the back
  • Vertebral fusion anomalies like sacralization or lumbarization
  • Ankylosing spondylitis is a chronic inflammation of the spine that may gradually fuse the vertebras
  • Tumors, possibly cancerous, can be a source of skeletal pain
  • Bone spurs or osteophytes are new bone growths in the spine. Spinal stenosis occurs when the canal     holding the spinal cord becomes narrower, due to protrusion of the spurs into the canal.
  • Osteoporosis is a type of bone disorder that causes bones to become thin and weak because of calcium loss.

    Neurological Origin

  • Disc abnormalities like spondylosis or herniated (bulged) or prolapsed discs can compress the nerve at the     nerve root level, causing pain and inflammation.
  • Caudaequina syndrome compresses the spinal cord due to the massive compression of the discs. This     syndrome leads to serious medical problems like severe pain, loss of sensation, urinary incontinence or the     inability to begin urination.

 

Referred Pain from other Organs

  • Pain may radiate to the back due to pain in other parts of the body caused by the abnormalities of the organs in     the abdomen, pelvis, or chest.
  • Kidney problems and kidney stones
  • Pelvic infections
  • Ovarian disorders

 

Congenital Origin
Congenital abnormalities like spinabifda and scoliosis

 

Psychosomatic origins

  • Unresolved emotional problems may lead to chronic back pain
  • Suppressing sexual desires for a long time may cause back pain

 

Infections

  • Osteomyelitis, tuberculosis of spine, and other
  • Viral infections

 

Back Pain Symptoms
The symptoms of back pain vary from person-to-person and cause-to-cause. The general symptoms are:

  • Pain and stiffness on the back
  • Severe pain while coughing or sneezing
  • Pain while moving
  • Pain around the lower-back and upper-buttocks
  • Pain radiation with or without numbness, tingling sensation and muscle weakness felt toward the leg

 

Occupational Back Pain
Sitting in an awkward position, using a poorly designed workstation or performing jobs that require the frequent use of back muscles injure the soft tissues and stress the muscles. Such tissue and muscles cause pain and inflammation.
These traits activate the spinal reflex mechanism, resulting in protective muscular contraction (spasm), fatigue, accumulation of pain-stimulating chemicals like lactic acid and the formation of trigger points on the muscles.
Because of the pain and inflammation, the patient, over a period of time, involuntarily ignores using proper muscles or avoids the pain-generating positions. All these, in turn, further increase the stress on the spine and other back muscles, leading to spinal deformity and malfunction of the spinal joints.
Further the pressure on the discs also increases, making way for early degenerative bone and disc changes.
Eventually the pain starts spreading toward the other parts of the body, especially sides of the back, stomach, buttocks, hip joint region and legs, with or without other neurological deficits.

 

Impact of Chronic Back Pain

  • Difficulty in sitting for a extended time
  • Experiencing pain while sleeping
  • Difficulty performing normal activities
  • Lack of productivity and concentration in work
  • Emotional stress
  • Difficulty to socialize
  • Difficulty to have sex
  • Side effects due to the frequent use of medicines

 

Conventional Treatment for Back Pain
Most of the conventional back pain treatment focuses on treating the symptoms and not the causes.
Although your pain may subside through pain-relieving medicines, muscle relaxants or by other means, the causes of back pain remain. In fact, the pain may become severe and require surgery.
Further, there is no medicine to correct your posture and release the muscle tightness and trigger points.


Physio Holistic Therapy (PFT) for Back Pain

  • PHT effectively treats back pain that has a musculoskeletal or neurological origin. The back pain specialist of     our clinic focus on the symptoms and causes and give complete remedies.
  • PHT stages of hands-on solutions will relieve your back pain and help avoid surgery in many cases.
  • Advantages of PFT treatment for Back Pain
  • Treatment focused on root causes of the problem
  • Speedier recovery
  • No dugs for treatment
  • Absolutely no side effect
  • Activates bodies natural healing mechanism
  • No diet restrictions
  • No activity restriction
  • You can avoid spinal surgeries
  • Chances of pain recurrence is very low

 

Slip Intervertebral Disc



 

The prevalence of a slip disc mainly relates to jobs like computer work, which are performed sitting for a long time. A slipped disc is a common problem. It has become a fad to say, “I have a slip disc”. Even for any kind of spine-related pain, the disc is suspected as the main cause. Recommending surgery for correcting the disc is also very common.


Our back bone is made of 33 bone segments. Of these 24 are free to move, while others are fixed. A cushioning disc exists between all the movable bones, except the upper cervical C1 and C2. The disc helps each segment freely move over the disc, making the spine flexible to move in different directions.


Thoracic (upper-back) areas are stiffer because of the rib cage and have very limited motion. So a disc prolapse is very rare in thoracic region.


The disc acts as a shock absorber to the backbone and is made of jelly-like water content called nucleus pulposus and fibrous tissues called annulus fibrosis.


The nucleus is at the center of the disc contained by the tight bands of annulus. The upper- and lower-end of the disc is made of end-plate cartilage to house the vertebras.


Disc Disorders
A prolapsed disc doesn’t mean that it has slipped off from its normal position. Instead, the nucleus pulposus in the disc bulges through the weak covering portion (herniation).
Sometimes, the position of the disc changes (prolapse) slightly due to excess pressure, resulting in the inflammation and irritation of the nerve roots from the spinal cord.
The ruptured annulus fibrosis balloons out the nucleus pulposus (extrusion) and spills it around. Such a disc is known as the Sequestered Disc. It is a most serious condition.
This disc displacement can happen in any direction of the spine. Based on the site and side of displacement, neurological deficits like sensory or motor dysfunction and radiating pain with pin-pricking or tingling sensation occur.



Slip Disc Causes


Stress: The vertebral column structure helps it perform various kinds of motions that include forward and lateral flexion, extension and axial rotation.
During our day-to-day activities, we use one of or a combination of the above motions. This generates different stress forces on the disc:

  • Compressive stress because of bending forward (flexion), backward (extension) or to the side (lateral flexion)
  • Shear stress because of rotation

Excessive, different or prolonged stress can cause a slip disc.


Bad posture and altered vertebral alignment: These unevenly distribute the stress forces through the disc, leading to a distorted disc.
When people do their job with their spine in an awkward position for a long time, the spinal motion generates different stress forces on the abnormally aligned vertebrae and their discs. The stress ruptures the annulus fibrosis.
These result in shortening of the muscles, trigger point formation and muscle spasm, causing severe ache and radiating pain like the discogenic pain.


Prolonged sitting: The effects of that are increased mechanical stress and axial load on the spine. So, the compressive force exerts pressure on the disc, causing it to distort. The shear force during rotation, and the compressive force, ruptures the end-plate cartilage.


Sudden activities: Lifting heavy weight or lifting weight with rotation can cause more compressive and shear force, resulting in a teared or prolapsed disc.


During and after Pregnancy: This timeframe causes changes in the body, including structural and hormonal changes. The extra weight of the body adds additional weight on the spine. This changes the line of gravitational force, which may increase the curvature of the spine.


Hormones like relaxin lose all the ligaments attached to the joints, including the spine. Therefore, the disc may receive less support, resulting in its displacement. With relaxin, action pressure during delivery also imposes pressure on the disc at the lower-back. So, pregnancy back pain isn’t uncommon.


Aging: Degenerative changes of the disc due to aging.


Increased body weight: It can create excess pressure on the disc.


Sex in a bad posture: It may cause the disc to prolapse, especially in people who have hyper-flexible joints.


Sedentary life style
Slip / Herniated Disc Symptoms
A herniated disc can produce various symptoms, depending on the site and extent of the prolapse:

  • Localized pain on the neck or back
  • Pain numbness, which might radiate down to the limbs (sciatica, if prolapse is at the lower-back)
  • Pain might get worse during coughing, sneezing and by the application of pressure while defecating, sitting or     walking.
  • Decreased ability to raise the leg straight. This symptom, however, could also be associated with other     conditions like pyriformis syndrome, back muscle spasm and others.
  • Spinal deformities like side bending of spine(scoliosis) or straightening of neck or back curvature
  • Stiff neck or back
  • Weakness of single muscle or group of muscles in the limbs, loss of sensation, bladder and bowel dysfunction

 

Conventional Treatment for Slip / Herniated Discs
It includes taking rest, pain relieving medicine(s), muscle relaxant(s) or anti-inflammatory drugs or corticosteroid injection. Surgery may be performed if the pain does not respond to medicines.
Non-drug treatments include short wave, IFT, traction and exercise strengthening and deformity correction (if it exists). Wearing a cervical collar or a back-support belt is also a part of the non-drug therapy.


Do you still have Pain after the Conventional Treatment?
Many times even after disc replacement, the pain might remain or the chances of pain reoccurrence are very high. This is because the conventional treatment is focused on pain reduction and disc replacement.
The treatment doesn’t solve the further effects of your disc prolapse like the muscle spasm, trigger points, myofacial tightness and others.


As part of bodies protective reflex function, the muscles of surrounding the area of problem will go or strong protective spasm, if it is stays for longer time gradually develops many trigger points this will give terrible pain and stiffness Until all the pain causes are treated, your spinal deformity never gets corrected, and you will have frequent pain. Also, spasmotic muscles attached to the vertebras will further squeeze your vertebrae, leading to excess pressure on the disc again.


Still have Pain after Disc Surgery?
If you have a disc prolapse with serious neurological deficit like bladder and bowel dysfunction, weakness and losing muscle bulk and other, you may need to have a surgery.
If you experience pain even after surgery, it may be because of persisting effects of the disc prolapse and trigger points on your neck, back or your limbs. Treating these effects will relieve you from pain.
Physio therapy has excellent releasing methods to give you relief from the pain.


Have you decided to opt for Disc Surgery?
Many time trigger points, prolonged spasm or soft-tissue injuries due to various reasons can generate severe pain and is normally confused with discogenic pain.
MRI is very accurate - even small changes of the disc can be detected.
Such changes, however, aren’t always the cause of the pain. It may be due to pre-existing trigger points or activated by disc changes.Many times if you treat those you can be freed from pain.



 

SCIATICA

 

 

The term sciatica commonly used for any kind of pain radiating down to the back side of the leg along the pathway of sciatic nerve. Many time diagnosis is focused on sciatic nerve irritation but it many not be the causes always, trigger point formation on muscles also can generate sciatica kind of pain.

 

Causes of Sciatica

Disc prolapse: sciatic nerve is longest nerve formed by union of five nerve roots from back and it runs behind the leg from back to feet. Herniated disc some time irritate the nerve root and creates severe radiating pain. Area of pain distribution depends on extent and area of disc prolapse.


Spondylitis changes of the spine: narrowing of nerve foramens or degenerative changes of vertebras some time irritates the nerve root results radiating pain.


Trigger point formation: Activation of hiding trigger points of back muscles, thigh and lower leg muscles creates severe referred pain which is similar to neurological deficit.


Muscle spasm and tightness:During sciatic nerve courses it branches and piers through muscles at different areas. Spasm and tightness some time compress the branches of sciatic nerve and causes pain at different areas of leg it is also known as pseudo sciatica.


Weak muscles: some time weak muscles unable to maintain the posture which results in to excess strain on the back. Weak abdominal muscles exaggerate the spinal curvature, some time slipping of vertebra on over another known as spondylolisthesis which results undue pressure at nerve root and generate radiating pain.


Piriformis syndrome:piriformis is a muscle which present deep at buttocks. 15% population sciatic nerve passes through the muscles. Any contracture or spasm on this muscles due to various reasons, compress the sciatic nerve results severe radiating pain and neurological deficits.


Tumors: any abnormal growth either benign or cancerous can generate sciatic pain

Symptoms of Sciatica

Pain any where in the back side of the leg or buttocks.Some time numbness, tingling sensation or muscle weakness along with pain.

 

 

PHT treatment for Sciatica

PHT has developed effective treatment for sciatica which may be acute or very chronic. Sciatic pain treatment depends on the causative factors responsible for the sciatica pain. PFT has its own method of treatment without drug administration for each causative factor.

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Core Stability

Core stability trains abdominal and back muscles to support the spine, fundamental to physiotherapy & treatment of spinal pain and pelvic disorders.

What is Core Stability?

Core stability is the training of the abdominal and back muscles which act to support the spine. Core stability is the corner stone on which exercise is based and is fundamental to the physiotherapy treatment of spinal pain, and pelvic disorders.


Recent research has identified the specific roles of the abdominal muscles which can be divided into 2 groups – superficial and deep. The top layer of muscle under the skin (rectus abdominus and external/internal obliques) is responsible for moving the spine (bending forwards and twisting), these muscles provide power, speed and strength to the body during functional and sporting activities. The deepest layer (transversusabdominus) has been shown to be an important stability and support muscle of the spine. When working normally, this muscle wraps around the trunk like a muscular corset controlling movement and protecting the spine. Studies have identified that this muscle is susceptible to weakness and deactivation as a result of pain and injury. This can compromise the stability of the spine and predispose to further injury.


The signs of instability are:

  • Sudden sharp jolts of pain with small movements or for no apparent reason.
  • Difficultly rising back up to an upright position after forward bending.
  • Having to walk your hands up the thighs/ fronts of your legs or use support to straighten up after bending.
  • An unexpected catch of pain having almost returned to the vertical position from bent over.
  • Feeling wary about your spine, not trusting it.
  • A sudden dart of pain when turning over in bed, often sharp enough to wake you up.

What are the benefits of good Core Stability?

  • Relieve pain
  • Significantly reduce the likelihood of recurring low back and pelvic pain.
  • Enhance your postural control
  • Increase your freedom to move normally.