Evidence based physiotherapy treatment for PIVD: an alternative to painful surgery!


“Why to go for painful spinal surgery with number of side effects when there is a safer and proved alternative available?”, asks Dr Aneeta Verma, a physiotherapist and nutritionist with 11 years of experience in helping people with medical conditions to regain their normal life via adopting healthy life style and physical therapy. “One of PIVD patient came to me with problem of back pain which reappeared again even after spinal surgery. A proper and customized physiotherapy treatment was structured for the same person who regain the confidence and better life with almost no back pain.” Let’s explore what is PIVD and dig the details of the mentioned alternative approach for the same.

What is PIVD

PIVD refers to “prolapsed intervertebral disc”. It is the protrusion of inner soft gel like portion of spinal disc and is also called as “slipped disc”. Spinal disc are the circular structures present between successive vertebrae of the spine. These discs have semi fluid mass of cartilage and collagen fibers in the center which is surrounded by rings of the fibers collectively called as annulus fibrosus. The spinal nerves come out through the spinal disc to obtain the messages from different body parts. The discs also makes back to bend and flex while serving as shock absorber. PIVD occurs when the disc is stretched enough to return to its normal shape or there is prominent bulging of inner soft fibers or there is complete spillage of the inner soft jelly or there is sequestration. There is inflammation around the bulged disc and pressing of the any of the spinal nerves.

Causes of PIVD

PIVD can occur due to incorrect posture, obesity, manual labor, weakened trunk, long sitting hours and/or ageing.

Symptom and diagnosis of PIVD    

Symptoms of PIVD include severe lower back pain, pain in legs, feet and buttocks due to pressed spinal nerve, muscular spasm, and loss of control over bowel movement. Pressing of last few spinal nerves causes Cauda equina syndrome which includes numbness in area around the anus, weak leg muscles, lower back pain and loss of control over the bowel and bladder.

Diagnosis is based on the symptoms and include SLR, bowstring tests and femoral stretch test.

Need of surgery?

In most of the cases, the painful treatment of spinal surgery is recommended which becomes mandatory for Cauda equina syndrome. Some of the risk factors associated with spinal surgery include damage of nerve root, infection, bleeding, nerve damage, formation of blood clots and even reappearance of pain in time, as it occurs in many cases.

Physiotherapy: An alternative approach

Having said about risk factors of spinal surgery, it becomes necessary to talk about the alternative approach. Though, surgery seems to give a quick relief from back pain as compared to the physiotherapy, it is not beneficial in long term owing to its too many side effects and no assurance of permanent pain relief. The physiotherapy aims at pain relief, muscle strengthening and relaxation, relief from inflammation and prevention of any further complications. The structured exercise regime includes nerve mobility exercises, press ups in prone condition, simple spinal movements in different poses (prone, supine, half lying, standing etc) and isometric exercises. A regular routine of exercise under supervision of experienced physiotherapist gives visible results. The person is then motivated to do some aerobic exercises, walk etc. to increase the strength of the muscles further. A routine of exercises keep the person away from any pain and nullify the need of any spinal surgery at all.

Eva physiotherapy and wellness clinic aims to achieve sum of the physical and mental health of the person who are demoralized due to recommended need of risky spinal surgery.

Treating Diabetic Neuropathy with Physiotherapy and Nutrition Therapy

Treating Diabetic Neuropathy with Physiotherapy and Nutrition Therapy


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.


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


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).


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 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 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


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.


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


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.


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.


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.


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.


Treating Osteoarthritis of Knee: Surgery versus Physiotherapy


Osteoarthritis is a situation that involves the wear and tear of the cartilage / natural cushioning between joints. The shock-absorbing capacities of the cartilage are reduced and results in the bones at the joints rubbing against each other causing pain, swelling, stiffness, inability to move, and emergence of bone spurs.
Knee pain is a standout amongst the most well-known yet ignored musculoskeletal conditions. Osteoarthritis is one of the leading causes of knee pain. While it can happen even in youngsters, the possibility of osteoarthritis ascends after the age of 45. Women are more prone towards it. Cases of osteoarthritis are rapidly increasing in India due to the changing lifestyles and eating habits.


The most common causes for knee osteoarthritis include factors of age; weight gain; heredity factors; gender (women above 55); repetitive stress injuries such as kneeling, squatting, or lifting heavy weights (55 pounds or more); athletics involving soccer, tennis, or long-distance running; and other illness such as rheumatoid arthritis, metabolic disorders (iron overload) and excess growth hormones.

Treatment: Surgery Versus Physiotherapy

Surgery is said to be the last resort for treatment of osteoarthritis of the knee. This is because in a revolutionary study on meniscal tears and the treatment of Osteoarthritis by the New England Journal of Medicine, it was resolved that there were no irrelevant contrasts between patients settling on surgery over an escalated regiment of non-intrusive treatment / physiotherapy.

The differences between the two procedures include:

  1. While surgical procedures involve arthroscopy, osteotomy, and arthroplasty; physiotherapy includes hamstring stretches, calf stretches, standing quadriceps stretches, seated leg raises, step-ups, straight-leg lifts, single-leg dips, hamstring curls, wall squats, half squats, knee stabilization series, static hamstring contractions, sit/stands, heel cord stretches, leg extensions, hip abductions and adductions and leg presses with resistance bands, in accordance to the physiotherapist’s guidance.
  2. The underlying problem with surgery is the possibility of adverse effects / risks due to intrusive procedures. Due to this, physiotherapy being a non-intrusive technique is considered safer.
  3. Surgery focuses on realignment of bones in joints, artificially, by the addition of artificial parts, cutting of excess bone, and general realignment. Physiotherapy, however, focuses on restoration of mobility and strengthening of muscles, in addition to weight management. Stretching, strengthening, and flexibility exercises, along with proprioception and balance exercises, and joint mobilization and manipulation, are effective in pain management, lowering inflammation, and restoring optimal balance after an injury.
  4. Most patients can administer to themselves and resume typical everyday exercises inside 6 weeks and drive inside 4 to 6 weeks. It might take 3 months to a whole year to completely recoup and acknowledge the advantages of knee surgery. Physiotherapy, on the other hand, needs no special recovery time and it spans over a period of 6 to 12 weeks only.
  5. In addition to all of this, it is to be acknowledged that surgeries are costly unlike physiotherapy.


Despite the problems posed by surgery, it is a definite tool in the treatment of osteoarthritis of knee, but only recommended in extreme conditions. Physiotherapy is in every way the best procedure to go about it. Physiotherapy is aimed toward biomechanical corrections of the affected knee, thereby preventing the osteoarthritis from taking a serious shape. It’s therapeutic nature and capacity to provide relief often postpones the need for surgery or dismisses it altogether. We at Eva Physiocare are working on preventive care that includes diet management in the integrated wellness programme.


Spinal Issues Attributing to Heel Pain and Physiotherapy as a Treatment

Heel pain can be caused due to a multitude of factors. Often the heel pain is localised and is caused due to shoes misfitting, overuse of feet, and so on. At other times, it is caused by underlying problems such as spinal issues. However, here we will focus on spinal issues often being the direct cause of heel pain.


Spinal issues attributing to heel pain include – cervical spondolysis, sciatica, spondylolisthesis, lumbar degenerative disc disease, spinal stenosis, and herniated disc. They are generally a result of postural problems, muscle tightness / weakness, nutritional deficiencies and ageing.


Common symptoms of heel pain caused due to spinal problems include restricted ability to bring the foot up, foot heaviness and difficulty walking on tiptoes, difficulty in completing everyday functions such as walking and driving, and is usually accompanied by redness, tenderness, thickened skin, or swelling.


It is crucial that the particular reason for foot pain be precisely analysed by a properly prepared doctor. On the off chance that the foot pain might be caused by an issue in one’s lower back it is prudent to see a spine specialist for an entire analysis of potential lower back conditions that might cause the leg pain and foot pain. The diagnosis is done by examination of medical history, taking X-rays, etc.

Treatment: Physiotherapy

Heel pain often lands a patient in surgery and we at Eva Physiocare can prevent that. We are working on preventive care for heel pain caused due to spinal issues as well as non-spinal ones.

Physiotherapy is a non-intrusive treatment process, therapeutic in nature, and is shown to grant quick relief to patients. At the same time physiotherapy helps in preventing heel pain by curbing it before it takes a serious shape. Physiotherapists efficiently make manual assessment by way of clinical reasoning and without having to refer to any kind of imaging such as X-rays, etc. in order to diagnose the causes of the heel pain.

Physiotherapy treatment procedure focuses on biomechanical corrections through heel and foot exercises like stretching and strengthening exercise, etc., to ensure strength and flexibility. In this case the physiotherapist will not just focus on the heel pain but also on the underlying spinal problems that are attributing to it, thereby, treating the spinal issue by means of physiotherapy as well. Physiotherapy for the spine includes controlled, gradual and progressive exercises that induces the free movement of nutrients to the spine, and have healthier discs, muscles and ligaments.

The systematic treatment of physiotherapy allows the patient to avoid surgery altogether and it is considered a good thing by many given its intrusive nature, high costs and associated risks. Additionally, if the patient has to undergo or has already undergone surgery, physiotherapy helps in quick and effective rehabilitation, and enhancement flexibility and mobility.


Physiotherapy: An Effective Treatment for Supraspinatus Tendinopathy


Supraspinatus tendinopathy is a typical and debilitating condition that turns out to be more pervasive after middle age and is a typical reason for shoulder pain. The supraspinatus tendon of the shoulder’s rotator cuff is affected and these affected tendons of the musculoskeletal framework proceed toward degeneration.


Supraspinatus Tendinopathy is generally attributed to resistive overuse and repetitive stress of the shoulder and its surrounding regions during certain occupational activities or sports. Broadly speaking, the causes of this condition can be summarised under two heads – extrinsic and intrinsic factors.

  1. The extrinsic factors can be further subdivided into two areas – primary and secondary impingement.
  2. Primary impingement includes factors such as increased subacromial loading, trauma (direct or repetitive), and overhead activities.
  3. Secondary impingement includes factors such as rotator cuff overload or soft tissue imbalance, eccentric muscle overload, glenohumeral laxity, bicep tendon laxity, glenoid labral lesions, muscle imbalance, scapular dyskinesia, posterior capsular tightness and trapezius paralysis.
  4. The intrinsic factors, on the other hand, include acromial morphology, acromioclavicular arthrosis, coracoacromial ligament hypertrophy, coracoid impingement, subacromial bursal thickening and fibrosis, prominent humeral greater tuberosity, impaired cuff vascularity, ageing, primary tendinopathy, intratendinous issues, articular side partial-thickness tears, and calcific tendinopathy.

Physiotherapy Treatment

The treatment of supraspinatus tendinopathy comprises of various progressive exercises. There are three phases of treatment: Immobilization, passive/assisted range of motion, progressive resistance exercises; in the acute and the recovery stages.

1.  Acute Phase

The objectives of the acute phase are to alleviate torment and irritation, avert muscle decay without compounding the torment, restore non-painful scope of movement, and standardize the arthrokinematics of the shoulder complex. This incorporates a time of dynamic rest, dispensing with any movement that may cause an expansion in side effects.

Range-of-motion exercises may incorporate pendulum activities and indication constrained, dynamic helped scope of-movement works out. Joint preparation might be incorporated with substandard, front, and back floats in the scapular plane. Fortifying activities ought to be isometric in nature and work on the outside rotators, interior rotators, biceps, deltoid, and scapular stabilizers. Neuromuscular control practices additionally might be started. Three different PNF patterns can be used. Further, stretching exercises must be incorporated which will involve a 3-time repetition for a period of 30 seconds each.

In addition, therapeutic Kinesio taping and exercises; ultrasonic laser therapy; have shown to be effective in treating Supraspinatus Tendinopathy patients. They have advantageous impact in diminishing pain intensity, reducing the disability and improving shoulder ROM in chronic subacromial impingement syndrome of shoulder.

Modalities that likewise might be utilized as an aide incorporate cryotherapy, hyperthermia, transcutaneous electrical nerve incitement and ultrasound. Concentrated ultrasound treatment has been appeared to build calcium resorption, but this requires frequent visit treatment that may not generally be viable.

2.  Recovery Phase

Additionally, the physiotherapist may recommend self-exercise during the recovery phase. These may include isotonic resistance exercises involving the supraspinatus, internal rotators, external rotators, prone extension, horizontal abduction, forward flexion to 90°, upright abduction to 90°, shoulder shrugs, rows, push-ups, press-ups, pull-downs, upper extremity ergometry exercises, trunk exercises, and general cardiovascular conditioning for endurance. This aims at standardize scope of movement and shoulder arthrokinematics, perform manifestation free exercises of day by day living, and enhance neuromuscular control and muscle quality.


Physiotherapy has been proven to be the most effective for the purposes of rehabilitation. But this does not mean that the other procedures are to be foregone entirely. One should consult their doctor for proper treatment. Physiotherapy including laser therapy and Kinesio taping works as a complementary treatment to other forms of treatments which generally include medicines and surgeries.

Please note that Evaphysiocare has been recommended as the best physiotherapy clinic in Noida by many Supraspinatus Tendinopathy patients in Delhi NCR.


Physiotherapy- A Solution for Backache

Backache: An Introduction

Backache is the pain caused in any region of the back. Human back can be divided into four regions: Cervical segment, Thoracic cavity, lumbar and tailbone (sacral spine). The pain in any of these four regions is called backache. The most sensitive part of the back, which is prone to back pain is lumbar, as it supports most of our body weight. Back pain can originate from muscles, joints, nerves or bones in the spine. Also internal organs like gall bladder, pancreas or kidneys may also cause ‘referred pain’ in the back. It may be acute or chronic pain and can easily radiate into upper or lower parts of the body.

Causes of Backache:

Causes of backache include Strains (Muscles or ligaments or muscular spasm), Structural problems (Disc problems, Arthritis, etc.), infections and autoimmune diseases, obesity, etc.  Muscle weakness is fast becoming one of the major causes for backache. It is also called reduced muscle strength or weak muscles and occurs when the full effort does not produce a normal muscle contraction or movement. It is generally a symptom of a variety of skeletal muscle diseases like chronic fatigue syndrome, muscular dystrophies, hypnotia, polio, rheumatic fever, etc. It can be both, short term and long term.

Prolonged Sitting Linked to Serious Health Risks:

Sitting for prolonged periods of time can be a major cause of muscle weakness which further results in back pain or worsen an existing back problem. It causes increased stress of the back, neck, arms and legs and can add a tremendous amount of pressure to the back muscles and spinal discs. Additionally, sitting in a slouched position can overstretch the spinal ligaments and strain the spinal discs leading to damaged spinal structure in the long run.

Role of Physiotherapy:

If the above condition persists, it is advisable to visit a physiotherapist, who after determining the cause and intensity of the problem, may recommend the patient to undergo physiotherapy treatment. Dr. Aneeta Verma, a renowned physiotherapist in Noida, in her entire career so far, has found that most the backache problems are caused due to muscles weakness and tightness.

Under physiotherapy, a lot of techniques are followed to help relieve the pain. Application of heat/ice pads and electrical simulations may help alleviate the initial pain. Massage therapy, a part of the physical therapy also gives short term relief. As the pain subsides, the therapist introduces some flexibility and stretching exercises for the back and abdominal muscles. These exercises are performed gently first, thereby increasing the intensity to improve the muscle strength. Evaphysiocare, one of the best physiotherapy clinics in Noida, has recorded that patients suffering from backache problems, mostly belong to IT sector, who work tirelessly in their offices. The prolonged sitting in the office leads to muscles weakness and tightness, resulting in the problem of backache.

Then techniques on improving posture are focused upon. Wrong posture is one of the major culprits behind backaches, and correcting the posture will go a long way in avoiding and reducing the misery. Regular physical activity and exercise are the only ways through which long term outcomes can be achieved, so that even after the pain is gone, it should not reoccur.


Frozen Shoulder: Symptoms, Causes and Treatment

Feeling a stiff shoulder accompanied by pain and inability to move your arm? Well, you might be suffering from ‘Frozen Shoulder’ that affects your shoulder joint. Also called Adhesive Capsulitis, it causes the tissues surrounding the shoulder joint, to thicken and tighten, thereby making it difficult for the arm to move. The condition is often confused with arthritis, but the two are not related. It can affect one or both of the shoulders.

The human shoulder comprises of three bones that resemble a ball and socket joint. They are your upper arm called humerus, shoulder blade called scapula, and collarbone called clavicle. These bones are held together by tissues called the shoulder capsule. When these tissues become hard, scar tissues develop over time, resulting in pain and restriction of arm movement. This is what is referred to as a frozen shoulder.

Symptoms of this condition can be easily detected. They could be:

  • Acute pain and stiffness that restrict and obstructs shoulder and arm movement
  • Dull pain in one or both shoulders
  • Pain in the shoulder muscles that wrap the top of your arm

The symptoms develop in three stages. The first stage is the freezing stage where shoulder movement causes pain and the range of movement becomes limited. As the condition advances to second stage called frozen stage, the pain may diminish, but shoulder becomes stiffer and it using it becomes more difficult.  At the last stage, called the thawing stage, the range of motion starts to go back to normal and the pain reduces to a large extent. All this can take place from a year to three years.


Hormonal imbalance, diabetes and a weakened immune system might make a person vulnerable to joint inflammation. Long period of inactivity due to an injury or illness might also make shoulder tissues prone to the condition. Frozen tissue affects adults over 40 years and is more common in women.


Medications such as anti-inflammatory drugs or steroidal injections are normally administered to reduce the inflammation in the tissues. But these are often not beneficial in the long run and might cause side-effects. What comes to the rescue of patients suffering from this condition is the physical therapy or physiotherapy. Physiotherapy is most useful in restoring the full and unrestricted movement of shoulders. It can help to reduce the pain and stiffness and if caught early enough can prevent full onset of the condition. Various stretching and strengthening exercises can help release a frozen shoulder. Appropriate exercise programs done under the supervision of a trained physiotherapist can go a long way in relieving the patients of their pain. However, if the frozen shoulder does not respond to non-surgical treatment, then surgery to release or stretch the scar tissue is also resorted to in some cases.