Low back pain in older adults

While older adults can experience pain related to any of the conditions that also affect younger adults, individuals over age 60 are more likely to suffer from pain related to degeneration of the joints in the spine. Two of the most common causes of lower back pain in older adults include mainly osteoarthritis and stenosis of spine.

Symptoms: Lower back pain and stiffness that is the most pronounced in the morning and in the evening

Includes any combination of the below symptoms:

Pain that interrupts sleep

Pain that is most pronounced first thing in the morning and again toward the end of the day

Localized tenderness when the affected area of the spine is pressed

Aching, steady or intermittent pain in the lower back that is aggravated by extended activity

Stiffness or loss of flexibility in the back (for example, unable to bend comfortably at the waist)

Possible cause: Facet joint osteoarthritis

Facet joint osteoarthritis, also called degenerative arthritis or osteoarthritis of the spine, is a degenerative condition that develops gradually over time. The pain is caused by the breakdown of the cartilage between the facet joints in the spine. At first the symptoms may only be intermittent, but can later develop into steadier pain in the lower back, and may eventually cause sciatica in addition to lower back pain.

Symptom: Leg pain that occurs primarily when walking and standing upright

Includes any combination of the following:

Unable to walk far without developing leg pain

Lower back pain relief is achieved quickly after sitting down

Symptoms fluctuate between severe and mild/none

Symptoms develop gradually over time

Weakness, numbness, and tingling that radiates from the low back into the buttocks and legs

Likely causes: Lumbar spinal stenosis or degenerative spondylolisthesis

Both spinal stenosis and degenerative spondylolisthesis can place pressure on the nerves at the point where they exit the spine. Standing upright, such as in normal walking, increases pressure on the nerve and results in leg pain.

Symptoms: Sudden onset of back pain, limited flexibility, height loss

Includes any of the following:

• Sudden onset of back pain
• Standing or walking will usually make the pain worse
• Lying on one's back makes the pain less intense
• Height loss
• Limited spinal flexibility
• Deformity and disability

Possible cause: Spinal compression fracture

As a general rule, the possibility of compression fracture should be considered after any sudden onset of back pain in adults over age 50, especially in post-menopausal women with osteoporosis and in men or women after long-term corticosteroid use. In a person with osteoporosis, even a small amount of force put on the spine, as from a sneeze, may cause a compression fracture.

Less Common Causes of Lower Back Pain

While less common than the above listed conditions, a number of other conditions can cause low back pain as well, including but not limited to:

• Piriformis syndrome
• Infection
• Spinal tumour
• Fibromyalgia
• Snkylosing Spondylitis
• Coccydynia

Why runners with back pain is not getting better

All of us treat back pain in our practices.  It can easily be as much as 50% of our patient population, which has led to many schools of thought.  Do I manipulate?  Do I use the algorithms from McKenzie?  Should I strengthen the core?  All of these have their time and place and are each incredibly valuable for the right patient!

For years, I used these schools of thoughts, but still often struggled with a specific population – RUNNERS. Runners are supposed to come in with aching knees, IT Band Syndrome, Achilles Tendon pain, but back pain?  Yes, more often than you might think, they complain of back pain.  It’s not that manipulating a runner’s back is not helpful and plenty of us could benefit from a few extra planks, but there’s something more.  If you don’t address this, the likelihood of the back pain returning is high because you haven’t addressed the activity provoking the pain.

Many runners adopt a hyperlordotic position when they are running and even worse, they hinge in a specific segment of their lumbar spine.   They run very upright and may even show excessive vertical oscillation (bounce when they run).

Once you determine that this may be a contributing factor, you need to look at what may be the cause. Typically, it is one of 3 things:

1. Habit: The runner is just too upright and needs to work on a forward lean.  You can cue the the runner to fall through their ankles when they run.  Let them stand still with their feet together and begin to fall forward at their ankles.  They then naturally step forward to keep from actually falling. This is will promote the natural forward lean we are looking for.
2. Hip PROM: Inadequate extension PROM is present, resulting in a compensatory anterior pelvic tilt and hyperlordosis during late stance.
3. Lumbopelvic and Hip Motor Control: Instead of extending the hips through the gluteals, extension occurs through the lumbar spine and no hip extension PROM deficit is present.

You can quickly determine whether this is a problem with PROM or motor control by performing both active and passive hip extension in prone.  I often find a PROM restriction exists, but not always.  Once you treat the passive restriction you need to retrain the new motion with motor control drills.  A simple prone hip extension exercise or quadruped hip extension will often do the trick, but you must focus on promoting hip extension and not anterior pelvic tilting.  Finally, retraining running form to use the new ROM and motor control completes the cycle.  You can use your falling drill at this point.

Physiotherapy intervention for Tennis Elbow:

What is Tennis elbow?

Tennis elbow is a condition caused by inflammation of the tendons that attach the extensor carpi radialis brevis to the outer bony prominence (lateral epicondyle) of the elbow. Certain repetitive movements of the wrist can cause this condition. Tennis elbow can occur in anyone who strains the tendons of the forearm and is not limited to tennis players. Tennis elbow is also called lateral epicondylitis.

Why tennis players getting tennis elbow?

Any activity, including playing tennis, that involves repetitive use of the extensor muscles of the forearm can cause acute or chronic tendinitis of the tendinous insertion of these muscles at the lateral epicondyle of the elbow, while attempting One-handed backhand with poor form or technique

Other game players can get tennis elbow?

Yes, You know Sachin Tendulkar, a famous cricketer from India. In 2004, it was happened to him. It was actually a small tear in the origin of muscles at the elbow that runs through to the wrist. In effect, wrist movement caused pain at the elbow. It could happen acutely and immediately, need not have to be over a period of time."

Tennis players what can do to avoid tennis elbow? 

Hold your injured arm out straight, palm down.Use your other hand to hold the back of your injured arm's hand.Press down so your fingers point to the ground.You should feel a light stretch on the top of your forearm. Do not stretch to the point of pain.

Symptoms:

tenderness over the outside of elbow.

Morning stiffness of elbow or persistent aching

Soreness of Forearm muscles

Elbow pain is severe, while holding or grasping the hand.

Call your health care professional or physiotherapist, if the following conditions develop:

• Pain that limits your daily activity
• Pain that lasts despite ice, resting, and over-the-counter anti-inflammatory pain relievers
• Any weakness or numbness in the hand, which may mean you have another type of injury in the wrist or elbow

Are There Home Remedies for Tennis Elbow?

• Home remedies include icing the area for 20 minutes twice a day to help to decrease inflammation and relieve pain. Freezing water in a paper cup and tearing away the top rim as the ice melts is an easy way to use ice. Do not put ice directly on the skin. Wrap it in a towel.
• Rest the sore area to prevent further injury and decrease pain.
• Over-the-counter anti-inflammatory medications such as ibuprofen, asprin or naproxen may help decrease the pain and swelling and help the healing. 

Physiotherapy intervention:

The first steps in treating tennis elbow are reducing inflammation and resting the irritated muscles and tendons. Ice and compression may also help reduce inflammation and pain. Once inflammation subsides, you can begin gentle exercises to strengthen the muscles of the forearm and prevent recurrence.

Most cases of tennis elbow respond to rest, ice, rehab exercises, pain medicine, and counterforce braces. This injury does take from 6 months to 12 months to heal. Patience helps. Surgery is considered as a last resort when all other nonsurgical treatments have failed.

Treatment for Tennis elbow:

• Icing the elbow to reduce pain and swelling. Experts recommend doing it for 20 to 30 minutes every 3 to 4 hours for 2 to 3 days or until the pain is gone.
• Using an elbow strap to protect the injured tendon from further strain.
• Taking nonsteroidal anti-inflammatory (NSAID's), such as ibuprofen, naproxen, or aspirin, to help with pain and swelling. However, these drugs can cause side effects, such as bleeding and ulcers. You should only use them occasionally, unless your doctor says otherwise, since they may delay healing.
• Performing range of motion exercises to reduce stiffness and increase flexibility. Your doctor may recommend that you do them three to five times a day.
• Getting physiotherapy to strengthen and stretch the muscles. 

  Strengthening Exercises for Tennis Elbow:

      Ball or sock squeeze

     Hold a tennis ball (or a rolled-up sock) in your hand.

Make a fist around the ball (or sock) and squeeze.

Hold for about 6 seconds, then relax for up to 10 seconds.

Repeat 8 to 12 times.

Switch the ball (or sock) to your other hand and do 8 to 12 times.

Wrist deviation

1. Sit so that your arm is supported but your hand hangs off the edge of a flat surface, such as a table.
2. Hold your hand out like you are shaking hands with someone.
3. Move your hand up and down.
4. Repeat this motion 8 to 12 times.
5. Switch arms.
6. Try to do this exercise twice with each hand.

Wrist curls

1. Place your forearm on a table with your hand hanging over the edge of the table, palm up.
2. Place a 1- to 2-pound weight in your hand. This may be a dumbbell, a can of food, or a filled water bottle.
3. Slowly raise and lower the weight while keeping your forearm on the table and palm facing up.
4. Repeat this motion 8 to 12 times.
5. Switch arms, and do steps 1 through 4.
6. Repeat with your hand facing down toward the floor. Switch arms.

Biceps curls

1. Sit leaning forward with your legs slightly spread and your left hand on your left thigh.
2. Place your right elbow on your right thigh, and hold the weight with your forearm horizontal.
3. Slowly curl the weight up and toward your chest.
4. Repeat this motion 8 to 12 times.
5. Switch arms, and do steps 1 through 4.

useful physiotherapy videos for Tennis Elbow:

Physiotherapy role in depression:

One of the biggest things a physical therapist can do for their patients is to be aware of the signs and symptoms of depression and some of the common disorders associated with depression. If the therapist is sensitive to the signs and symptoms of depression they can document it in the plan of care and then notify the physician so the patient can get the appropriate medical treatment, if necessary. Also, because patients with depression may be emotionally unstable, recognizing the signs and symptoms of depression can help you in approaching different situations and then redirecting the patient toward other activities, instructions or more positive topics of conversation.

Exercise has been shown to benefit patients with mild to moderate mood disorders, especially anxiety and depression. When performing aerobic exercise your body releases endorphins from the pituitary gland which are responsible for relieving pain and improving mood. These endorphins can also lower cortisol levels which have been shown to be elevated in patients with depression. Additionally, exercise increases the sensitivity of serotonin in the same way antidepressants work, allowing for more serotonin to remain in the nerve synapse. Exercise can be aerobic or resistive in nature, as both have been shown to be beneficial in a variety of patient types. Anyone with depression can participate in an exercise program no matter how old or young they are, as long as proper supervision is provided. Exercise is an excellent option for treatment when taking anti-depressants is not an option due to their side effects. Depression symptoms can be decreased significantly after just one session but the effects are temporary. An exercise program must be continued on a daily basis to see continued effects. As a person continues to exercise they may experiences changes in their body type which can help to improve self esteem and body image issues they may have been having. Some other benefits of regular physical exercise include:

• reduces/prevents functional declines associated with aging
• maintains/improves cardiovascular function
• aids in weight loss and weight control
• improves function of hormonal, metabolic, neurologic, respiratory, and hemodynamic systems
• alteration of carbohydrate/lipid metabolism results in favorable increase in high-density lipoproteins
• strength training helps to maintain muscle mass and strength
• reduces age-related bone loss; reduction in risk for osteoporosis
• improves flexibility, postural stability, and balance; reduction in risk of falling and associated injuries
• psychological benefits (preserves cognitive function, alleviates symptoms/behaviors of depression, improves self awareness, promotes sense of well-being)
• reduces disease risk factors
• improves functional capacity
• improves immune function
• reduces age-related insulin resistance
• reduces incidence of some cancers
• contributes to social integration
• improves sleep pattern

Rehabilitative exercises for Ankle sprain:

Introduction

Ankle sprains are common injuries that can result in lifelong problems. Some people with repeated or severe sprains can develop long-term joint pain and weakness. Treating a sprained ankle can help prevent ongoing ankle problems.

Rehabilitation (rehab) exercises are critical to ensure that the ankle heals completely and re-injury does not occur.

• You can begin healing by walking or bearing some weight, while using crutches if needed, if you can do so without too much pain.
• Start rehab with range-of-motion exercises in the first 72 hours after your injury. Continue with further rehab, including stretching, strength training, and balance exercises, over the next several weeks to months.
• You can do rehab exercises at home or even at the office to strengthen your ankle.

How to do rehabilitation exercises for an ankle sprain

Start each exercise slowly and use your pain level to guide you in doing these exercises. Ease off the exercise if you have more than mild pain. Following are some examples of typical rehabilitation (rehab) exercises.

Keep in mind that the timing and type of rehab exercises recommended for you may vary according to your doctor's or physical therapist's preferences.

Range-of-motion exercises

Range-of-motion exercises begin right after your injury. Try doing these exercises then putting ice on your ankle, up to 5 times a day. These are easy to do while you are at a desk or watching TV.

Try the following simple Range of motion exercises:

• Trace the alphabet with your toe, which encourages ankle movement in all directions. Trace the alphabet 1 to 3 times.
• Sit in a chair with your foot flat on the floor. Slowly move your knee side to side while keeping your foot pressed flat. Continue for 2 to 3 minutes.

Towel curls: While sitting, place your foot on a towel on the floor and scrunch the towel toward you with your toes. Then, also using your toes, push the towel away from you. Make this exercise more challenging by placing a weighted object, such as a soup can, on the other end of the towel.

Stretching exercises

Start exercises to stretch your Achilles Tendon as soon as you can do so without pain. The Achilles tendon connects the calf muscles on the back of the lower leg to the bone at the base of the heel. Try the towel stretch if you need to sit down, or try the calf stretch if you can stand.

• Towel stretch. Sit with your leg straight in front of you. Place a rolled towel under the ball of your foot, holding the towel at both ends. Gently pull the towel toward you while keeping your knee straight. Hold this position for 15 to 30 seconds, and repeat 2 to 4 times. In moderate to severe ankle sprains, it may be too painful at first to pull your toes far enough to feel a stretch in your calf. Use caution, and let pain be your guide.
• Calf stretch: Stand facing a wall with your hands on the wall at about eye level. Put the leg you want to stretch about a step behind your other leg. Keeping your back heel on the floor, bend your front knee until you feel a stretch in the back leg. Hold the stretch for 15 to 30 seconds. Repeat 2 to 4 times. Repeat the exercise with the back knee bent a little, still keeping your back heel on the floor. This will stretch a different part of the calf muscles.

Strengthening exercises

Talk to your doctor or physical therapist about the timing of strengthening exercises. Typically you can start them when you are able to stand without increased pain or swelling.

Do 8 to 12 repetitions of these exercises once or twice daily for 2 to 4 weeks, depending on the severity of your injury.

• Start by sitting with your foot flat on the floor and pushing it outward against an immovable object such as the wall or heavy furniture. Hold for about 6 seconds, then relax. After you feel comfortable with this, try using rubber tubing looped around the outside of your feet for resistance. Push your foot out to the side against the tubing, then count to 10 as you slowly bring your foot back to the middle.
• While still sitting, put your feet together flat on the floor. Press your injured foot inward against your other foot. Hold for about 6 seconds, then relax.
• Next, place the heel of your other foot on top of the injured one. Push down with the top heel while trying to push up with your injured foot. Hold for about 6 seconds, then relax.

Balance and control exercises

You can usually start balance and control exercises. when you are able to stand without pain. But talk to your doctor or physical therapist about the exact timing. Also, don't try these exercises if you could not have done them easily before your injury. If you think you would have felt unsteady doing these exercises when your ankle was healthy, you are at risk of falling when you try them with an injured ankle.

Practice your balance exercise at least once a day, repeating it about 6 times in each session.

1. Stand on just your injured foot while holding your arms out to your sides with your eyes open. If you feel unsteady, stand in a doorway so you can put your hands on the door frame to help you. Balance for a long as you can, working up to 60 seconds. When you can do this for 60 seconds, try exercise number 2.
2. Stand on your injured foot only and hold your arms across your chest with your eyes open. When you can do this for 60 seconds, try exercise number 3.
3. Stand on your injured foot only, hold your arms out to the sides, and close your eyes. If you feel unsteady, stand in a doorway so you can put your hands on the door frame to help you. When you can do this for 60 seconds, try exercise number 4.
4. Stand on your injured foot only, hold your arms across your chest, and close your eyes. Balance for a long as you can, working up to 60 seconds.

Stretching exercises should be continued on a daily basis and especially before and after physical activities to prevent reinjury. Even after your ankle feels better, continue with strengthening exercises and balance and control exercises several times a week to keep your ankles strong.

some of useful exercise videos:

Adult Neurogenesis ( new neurons generation)

What is adult neurogenesis?

"Adult neurogenesis" refers to the ability of the central nervous system (brain and spinal cord) to generate new neurons in adulthood called adult generated neurons. This is as differentiated from "neurogenesis" typically used to describe the processes of neuronal generation that occur during the prenatal (embryonic and fetal) period extending in to the early years of postnatal life.

Back in the 1800s and the first half of the 20th century, scientists and scholars believed that development of new neurons only occurred early in life and would cease at some point during development, so that no new neurons could be formed in the brain or spinal cord after this 'critical age'.  Some scientists back then disputed this as fact but had no means of disproving the widely accepted notion, the non-availability of advanced equipment back then and less advanced scientific investigation and laboratoty techniques meant this notion would go unchallenged for a very long time.

Definition:

Adult neurogenesis is the process of generating new neurons which integrate into existing circuits after fetal and early postnatal development has ceased. In most mammalian species, adult neurogenesis only appears to occur in the olfactory bulb and the hippocampus

What happen in neurological diseases?

Immense interest has been generated around this area, now that adult neurogenesis is known to be a fact, focus has shifted towards determining the factors that affect adult neurogenesis (increase or decrease it rate of occurrence) and the functions of these adult generated neurons. Interestingly it has been shown that such factors as physical exercise, living in an environmentally enriched area and mentally challenging tasks among other things improve the rate of production of new neurons in the adult hippocampus as well as increase the longevity of these newly generated neurons. In the same vein, scientists have managed to demonstrate that laboratory animals in which the rates of neurogenesis had been increased by such means as physical exercise performed better at tasks such as learning a new skill or spatial navigation in a novel (new) environment. Incidentally, elevated levels of adult hippocampal neurogenesis have been observed in adults with neurological insults and diseases such as stroke (CVA), Alzheimer's disease, Parkinson's disease and dementia amongst others. These diseases are characterised by death and destruction of neurons and the elevated levels of neurogenesis are hypothesized to be the body's own way of trying to replace the neurons that would have been lost. 

Physiotherapist role in Adult neurogenesis:

Considering that physical exercise and environmental enrichment will improve the levels of adult neurogenesis, physiotherapists can augment the body's own regenerative capacities by working with patients with neurological diseases to promote activities that enhance hippocampal neurogenesis.

1. Promote a healthy lifestyle - eat healthy, avoid the use of drugs. The use of drugs such as methamphetamine(reduces the rate of neurogenesis) and decreases cognitive functions 

2. Develop an exercise regime as part of the treatment programme for neuro patients. 

So everyone come to know, physiotherapy helps in a lot of ways to rehabilitatate neurological patients in all ways( also in neurogenesis). 

Benefits of dance in Parkinson's disease

Parkinson Disease is a progressive neurodegenerative disease. Common symptoms of PD are resting tremor, bradykinesia, rigidity, mask face, and difficulties with gait. Gait difficulties include short and shuffling steps, festination and/or freezing of gait, difficulty turning or walking backward, and impaired ability to perform dual tasks when walking.  Individuals with PD are also at an increased risk of falls.

Dance address each of the previously mentioned key areas in the following ways, 

• The use of music to accompany dance movement can act as an external cue to facilitate movement.
• The use of specific movement strategies when teaching the dance steps.
• The need to control dynamic balance and respond to perturbations when interacting with other participants facilitates balance exercises.
• Dance helps enhance strength and flexibility. It may also improve cardiovascular functioning if done at a sufficient intensity

 Some of benefits are,

Motor benefits

Dance is shown to benefit individuals with Parkinson's disease by enhancing motor function through stretching, stepping and balance. Individuals who participated in a dance intervention ranging from 90 minutes of dance per week for 8 weeks, to 2 hours, two times per week for 2 years, showed improvements in various outcome measures, when compared to a regular exercise group. The motor improvements could be due to repetition, direction change, and step sequencing that are inherent in dance and transfer into effective, regular gait patterns.Furthermore, basal ganglia may be activated during rhythmic movements, and enhanced by the auditory cues in the music accompanying dance.

Cognitive benefits:

The changing visual and auditory stimuli, unique to dance, facilitate cognitive improvements when compared to regular exercise programs for PD patients. A dance class creates an environment where individuals must control continuously changing patterns of movement to match the instructor. Dance has been shown to reduce time taken to correctly complete the MRT (Mental Rotation Task) as dance aids in imagery formation and judgement. The attention required to anticipate movements, and respond to changes in music or instruction is unique to dance and can enhance the activity of the basal ganglia loops and frontal lobes. This is supported by greater improvement in FAB (frontal assessment battery). When compared to traditional rehabilitation (balance exercises, gait training) there were moderate improvements in cognitive test scores at the 8 week follow up, supporting dance therapy as being able to impact higher cortical functions in the long term.

Mental health benefits:

Mental health benefits for individuals with Parkinson's disease are exclusive to dance when compared to control and regular exercise treatment. Improvement shown in mood, motivation and enjoyment can be related to feelings of unity. There are improved AP (apathy scale) and SDS (self-rating depression scale) scores after dance intervention in patients with PD. It has been suggested that dance therapy can decrease fear of falling through practicing position changes in a controlled environment. Overall, health related quality of life and emotional well-being has been increased through dance for people living with PD.

Other benefits:

When compared to regular exercise and control groups, dance for PD yields greater gains in UPDRS (Unified Parkinson's Disease Rating Scale).  Personal, cultural, and social preference need to be considered to improve adherence to treatment program.