A 46-year-old woman approached with debilitating low back pain radiating to her right leg. She was not able to walk, stand or even sit unassisted. Even lying on bed & taking turn was troublesome. On standing, her hip was very much tilted to right side, she was not able to stand straight.
MRI revealed diffuse posterior bulge at L4-5 & L5-S1. She was advised surgery by one ortho and good form of physiotherapy by other. She didn’t want to opt for surgery so she decided to undergo physiotherapy for a month.
She was treated with few medications & Physiotherapy.
Her Physiotherapy treatment started with few positionings which would relieve pressure from her nerves. Meanwhile she was also given electrotherapy to manage the nerve pain. In 2 days, her pain improved and she was able to stand. But she was not allowed to do any movements at her spine. Unfortunately, to keep track of her dog, she bent down & ended up in trouble again. But this time it took a little longer for her to recover. Her leg raise was very much limited. She was not able to raise her leg beyond 10 degrees.
After a few days of positioning & electrotherapy, her muscles of abdomen & back were given facilitation to contract; without inducing any movement at spine. This helped her in turning & doing few transitions with less pain.
Gradually her Sciatic nerve was mobilised. Nerve mobilisations are done by experienced Physios and the frequency of mobilisations is decided on the basis of patient’s response. She responded very well to the mobilisations & was able to stand straight, sit unsupported & started walking with a stick
Gradually stability exercises were started for her low back. Within a month, she was able to do everything on her own without trouble.
During her entire treatment, she was prescribed gradual increments and no aggressive therapy was given at any point of time. Careful observation & detailed conversation with the patient were an important part of the therapy. To prevent recurrence, she was given customised home exercise plan which she followed with complete diligence.
We wish to cater more to such patients & put an end to their suffering. Trust, co-operation & complete understanding of what we are doing is important to help us help you.
If you or your knowns are suffering from similar issues, do let us know. We would be happy to help.
Stay Healthy! Stay Happy!!
40 year old female came after surgery of her elbow post fracture (Post Open Reduction Internal Fixation - ORIF for fracture around elbow). Surgery was done 15 days back. Her arm was immobilised in sling after surgery.
During her first visit , her arm was quite swollen. She had lot of pain, & was not bale to move her elbow beyond few degrees. We started postoperative physiotherapy which aimed at decreasing the swelling, decreasing her pain, mobilising the elbow, & increasing the muscle strength. Joint mobilisations are very important part of treatment post such surgeries. If not mobilised at the right time, they can lead to permanent stiffness & deformity. The process can be little painful, but if done by the expert in a right way with the right amount of force & skill, used at the right time, can yield extremely beneficial results.
Patient should not be living with any deformity until & unless expected by the surgeon. Sometimes after a major trauma, surgeons have to fix the fracture in a way that deformity is inevitable. Post surgery, a surgeons recommendation on when to start physiotherapy is very important. There might be certain limitations to be considered while mobilising the elbow, as advised by the surgeon.
Mobilisations for this patient were progressed gradually to obtain full arm bending & straightening.
After two months of therapy, her arm got straight. She was able to wear her clothes, wash her face, comb her hair with no difficulty. This patient achieved the results faster. It might take 2-3 months or more depending on the trauma, surgery, premorbid status & even age.
Muscle strengthening is also an important part of the treatment & is gradually progressed.
Such kind of post operative rehabilitation is extremely important to make the arm mobile & as strong as it was before the trauma.
Stay Strong! Stay mobile !
Have a wonderful 2023 !!
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