Treating Diabetic Neuropathy with Physiotherapy and Nutrition Therapy

Treating Diabetic Neuropathy with Physiotherapy and Nutrition Therapy

Introduction

Diabetes, a metabolism disorder, is mostly attributed to unhealthy eating habits and a generally unhealthy lifestyle. Various complications can arise in the human body due to its overbearing and elongated presence. Diabetic neuropathy is one such complication where diabetes for a long period results in nerve damage, usually affecting the patient’s leg and feet. Patients with type 1 or type 2 diabetes often run the risk of developing diabetic neuropathy.

Causes

There may be several causes that lead to diabetic neuropathy. However, all of those causes circle back to diabetes being the core issue. As a direct result of diabetes, high levels of blood sugar in the blood for long periods injure nerves in every portion of the body, and kidneys damaged by diabetes send toxins into the blood that in turn cause nerve damage. Additionally, usage of Metformin drugs to manage diabetes can lead to a Vitamin B12 deficiency and this in turn can cause nerve damage. Apart from this, a diabetic patient may develop diabetic neuropathy if his blood vessels are damaged by high levels of cholesterol, mechanical injuries (such as carpal tunnel syndrome), and unhealthy lifestyle factors including overweight, alcohol consumption and smoking.

Symptoms and Types

The common symptoms for diabetic neuropathy include sensitivity to or loss of feeling of touch, trouble with coordination when walking, numbness or pain in the extremities, muscle weakness, nausea and indigestion, diarrhoea or constipation, unsteadiness upon standing, intemperate sweating, vaginal dryness in women and erectile dysfunction in men, to name a few. These symptoms may, however, vary depending on the type of diabetic neuropathy.

Diabetic neuropathy is of four kinds – peripheral, autonomic, proximal, and focal.

  • Peripheral neuropathy is the most common of all that affects the legs, hands and arms, necessarily in that order.
  • Autonomic neuropathy occurs when diabetes affects the autonomic nervous system that controls the heart, bladder, stomach, intestines, sex organs and eyes.
  • Proximal / radiculoplexus / femoral neuropathy, also known as diabetic amyotrophy, affects the nerves in the thighs, hips, buttocks or legs, commonly observed in type 2 diabetes and older patients.
  • Focal neuropathy / mononeuropathy is when a specific nerve in the face or torso or leg is damaged, usually in older patients.

Diagnosis and Treatment: Physiotherapy and Nutrition Therapy

Diabetic neuropathy can be effectively managed through the holistic and therapeutic non-intrusive alternative treatment of physiotherapy. The physiotherapist uses methods such as gross light touch and pinprick sensation to conduct a comprehensive physical test to check the core and muscles strength, sensitivity, reflexes, etc., in order to diagnose and assess the diabetic neuropathy condition. Other tests include filament test, quantitative sensory testing, nerve conduction studies, electromyography (EMG) and autonomic testing.

Techniques such as transcutaneous nerve stimulation (TENS), static magnetic field therapy, low-intensive laser therapy, and monochromatic infrared light therapy, have been shown to have positive effects in the management of diabetic neuropathy, by slowing down the condition, relieving the patient of pain, manage further or associated complications and restore the functionality of the affected regions. There is also an exercise regimen particularly for patients with peripheral and proximal neuropathy, such as aerobic exercise, flexibility exercise, strength training exercise and balance exercise, and generally to manage weight. In addition, nutrition therapy becomes pertinent in order to manage diabetic neuropathy because diabetic conditions call for a massive alteration in food intake. There might be certain nutritional deficiencies that are best managed through food intake. In addition, it also aids in weight loss and maintaining a generally healthy lifestyle.

We at Eva Physiocare have developed an integrated wellness programme comprising of physiotherapy and nutrition therapy in order to effectively manage diabetic neuropathy in our patients.

Anterior Cruciate Ligament (ACL) Injuries & Effective Treatment Through Physiotherapy

Anterior Cruciate Ligament (ACL) Injuries & Effective Treatment Through Physiotherapy

Introduction

The anterior cruciate ligament is a diagonal ligament running through the knee’s middle, preventing the tibia (shinbone) from sliding out before the femur (thighbone) whilst providing the knee with complete rotational stability. ACL injury occurs when there is a tear or a sprain in the anterior cruciate ligament of the knee. There may be a Grade 1 (mildly damaged ligament but stable joint) or Grade 2 (partial tear, which is rare) or Grade 3 sprain (complete or near complete tear).

Causes

ACL injuries mostly occur during sports activities that require sudden slowdowns and direction changes, pivoting on a firmly planted foot, incorrect jump landings, sudden stop while running, and knee collision. They are the most common knee injuries among athletes in very high demanding sports such as football, basket-ball, etc., and even in sports such as cricket, badminton, etc.

As per various studies, female athletes are more prone to ACL injuries. This is due to contrasts in physical conditioning, muscular strength, and neuromuscular control, between male and female athletes. Further reasons may include contrasts in pelvis and leg alignment, increasingly loosened in ligaments, and the consequences of oestrogen on the ligament region.

Symptoms

Symptoms include hearing or feeling a “popping” noise in the knee, severe pain and swelling, loss of motion, tenderness, instability and inability to continue any activity.

Diagnosis

Diagnosis is mostly done through a physical exam, which is usually enough. The most common physical test is the Laxman Test. Other physical tests include pivot shift test, jerk test and anterior drawer test. If it’s unable to be diagnosed through physical tests, there may be a need to diagnose through X-rays, MRIs and ultrasounds.

Effective Treatment Through Physiotherapy

Physiotherapy, with its therapeutic nature, provides effective treatment in case of ACL Injuries, be it mildly damaged, partial tear, or a near complete tear. In most cases where a few weeks of rehabilitation therapy through physiotherapy is adopted, it is possible to avoid intrusive treatment procedures. This is because physiotherapy is capable of reducing these ACL injuries, provided there is stability in the knee. At the same time, physiotherapy also reduces risks of ACL injuries developing into knee osteoarthritis. Treatment of ACL injuries through physiotherapy are more effective in elderly patients, those with less levels of activity, and those who play sports with less stress on knees.

Normally, the physiotherapist provides an assessment of the injury with instructions and feedbacks. The rehabilitation therapy consists of machine based treatment followed  by an exercise protocol for biomechanical correction procedures to bring back motion and flexibility in the knee, and reduce the pain and inflammation. The exercise protocol is made by the physiotherapist based on the medical presentation of the condition. The exercises include – hamstring strengthening exercises to ensure general balance in the knee; exercise that strengthen the hips, pelvis and lower abdomen; training exercises to ensure proper jumping and landing; and training to improve sudden direction changes and pivoting. We at Eva Physiocare are developing rehabilitation therapy programme including diet therapy and an integrated wellness programme for ACL injury patients.

Anterior Cruciate Ligament (ACL) Injuries Surgery & Physiotherapy In Pre Post Rehab

Anterior Cruciate Ligament (ACL) Injuries Surgery & Physiotherapy In Pre Post Rehab

Introduction

Generally, a completely torn anterior cruciate ligament essentially requires surgical procedures for treatment. Surgeries are also usually recommended in cases where the patient is an athlete and wants to continue his / her high demanding sport, there is injury in more than one ligament, the patient is young and very active, and there is loss of stability in the knee due to the injury. However, pre and post-surgery rehabilitation therapy becomes pertinent. This is mainly because ACL injuries have a risk factor developing into knee osteoarthritis and a rehabilitation therapy programme negates that risk.

Pre-Surgery Rehabilitation Therapy

The significance of exercises in the pre-surgery period lie in the fact that they help in reducing the pain and inflammation after an ACL injury. Additionally, the exercises help regain motion and strength in the knee after the surgery, while negating the risks of knee osteoarthritis. It also helps prepare the patient mentally for the surgery.
Exercises generally include bridging, glute sets, hamstring curls, heel raises, heel slides, quad sets, shallow standing knee bends, straight-leg raise to the front, and straight-leg raise to the outside. These exercises are done under the thorough guidance of the physiotherapist, in a progressive manner, so that no stress is caused due to the exercises. Additionally, RICE (rest, ice, compression, elevation) and electrotherapy help reduce inflammation and pain, whilst ensuring one’s regain of motion range and joint flexibility.

Post-Surgery Rehabilitation Therapy

After the surgery / the ACL reconstruction, the rehabilitation therapy needs to be resumed as it is critical for full recovery. At this stage, several comprehensive steps, including a wide range of exercises are used to attain full flexibility and motion in the knee while avoiding knee osteoarthritis. Exercises include open-kinetic-chain knee-extension, open-kinetic-chain knee-flexion, and closed-kinetic-chain knee exercises.
The therapy and exercises are easy at the beginning, aimed at removing blood clots and gradually are increased in intensity aimed at restoring knee strength and stability. Weight bearing exercises are added depending upon the patient. The final phase of the therapy increases stress on the knees to a bearable extent. This therapy may take 5-6 months to help the patient be free of any pain and regain complete motion range. Generally, after 12 months of rigorous post-surgery rehabilitation, athletes can return to their heavy demanding sport.

Conclusion

Generally, the orthopaedic surgeon of the patient works with or in coordination with the physiotherapist. An ACL injury treatment that includes surgery is a very long procedure. The treatment starts at the very beginning, right after the injury. It starts with rehabilitation, moves into surgery, and then again ends with rehabilitation. It is a very comprehensive treatment procedure and enables the complete and effective cure of the ACL injury while negating any risk factor at the same time. We at Eva Physiocare are developing rehabilitation therapy programme both before and after surgery, where we coordinate with the orthopaedic surgeon of the patient, including diet therapy and an integrated wellness programme for ACL injury patients and focus on their complete care and cure.

EFFECTIVE TREATMENT OF BURSITIS THROUGH PHYSIOTHERAPY

Effective Treatment of Bursitis Through Physiotherapy

Introduction

Bursitis or bursa inflammation is a condition where the bursa, which is a sac that contains a lubricating fluid situated in between the tissues of the bone, muscle, tendons, and skin, that helps in the decrease of rubbing, friction, and irritation in these areas, is inflamed and irritated. The incidence of bursitis is rapidly growing in India due to changing lifestyles and dietary habits.

Causes

While the most common factor in bursitis is ageing (commonly occurs in adults over 40 years of age), it is a condition that is also attributed to overweight, repetitive impact, sudden injury or trauma, overuse and stress at the workplace or during sports activities and incorrect posture at work or during exercise. Other factors may also induce or trigger bursitis, such as rheumatoid arthritis, gout, infection, psoriatic arthritis, thyroid disorders, and reaction to medicines.

Common Sites and Types

The most common sites of bursitis include – elbow, hips, shoulder, knee, and kneecap. The different types of bursitis include subacromial bursitis, prepatellar bursitis, infrapatellar bursitis, superficial infrapatellar bursitis, deep infrapatellar bursitis, suprapatellar bursitis, posterior and anterior Achilles tendon bursitis, Pes Anserine bursitis, medial collateral ligament bursitis, and iliotibial bursitis. In fact, many instances of bursitis are found around the knee joint.

Symptoms

The most common symptoms of bursitis include – pains, sudden or gradual and severe in the affected areas, particularly in case of calcium deposits; pains in case of pressure in the area or movement; stiffness; redness and swelling. One must seek medical help in case of these symptoms – the sudden loss of motion in the affected areas causing a joint to ‘freeze’; pain that disables a joint; excessive swelling, redness and rash in the affected regions; sharp shooting pains during movement; and fever.

Diagnosis

Bursitis is diagnosed by means of imaging (X-rays, ultrasounds and MRI scans) and laboratory tests (blood, fluid from the bursa, etc.).

Treatment: Physiotherapy

The therapeutic nature of physiotherapy affords the patient relief while healing the disorder and preventing it from becoming serious and/or recurrent. Physiotherapists assess the biomechanics of the patient and recommends specific stretching and strengthening exercises to increase the mobility and flexibility of the affected areas and reduce pain. In case the bursitis is caused by overweight or arthritis, physiotherapist recommends various exercises to manage the weight or the arthritis. Additionally, physiotherapy laser treatment and ultrasonic therapy play a very effective role in treating bursitis.

We at Eva Physiocare are working on effective preventive measures to treat bursitis. Our integrated wellness programme includes exercise therapy, diet therapy, physiotherapy laser treatment and ultrasonic therapy, designed and customised for each of our patients allowing both prevention and rehabilitation.