Jaahnavi Sriperambuduru Cupping Old Wine in a New Bottle

Volume 9, Issue 1 Reg.No.gujeng/2009/30341 ISSN NO.: 0976 -1993 July-Aug’2017 `150

Art in Social Physiotherapy Support The need and importance The key to rehabilitation adherence Tendon Rehabilitation Dry Key Management Tactics Needling Beneﬁts in conditions which have no deﬁned Treatment approach

An interview with the Mysterious Mountain Girl Jaahnavi Sriperambuduru Cupping Old wine in a new bottle

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She created a world record on Prof. Satyen Bhattacharyya has July 31, 2015 by climbing the presented a detailed account of the highest mountain peak in history and origin of Cupping along Europe - Mt. Elbrus at the age with 13 different types of Cupping of 13. She climbed Mount Methods. He shall discuss more in the Kosciuszko in Australia (7,310 next article in the forthcoming issue ft) in Dec 2015 and most on the conditions treated with recently Alaska’s own Mt. cupping, various cupping equipments Denali (20,308 ft) which she etc. summited on July 10th 2016 to Bhavsan Bhavsar has given a brief become the youngest Person summary on the importance of visual from India to accomplish this communication and art in physio- feat. therapy. Smruti Dash & Anshuman In this issue, we bring to you Rath have shed light on how Mobile an exclusive interview with apps can help physiotherapists in this mysterious mountain girl their practice. Poonam Botadara has and what makes her take up shared her experiences of home such a challenging sport at this health care and what needs to be age. What are the kind of taken care while you are at a home preparations required, how is visit. Also presented are the current to scale all 'Seven Summits' in her training schedule and affairs on the latest in physiotherapy Dear Readers the world. The highest peak on most importantly, what is the from across the globe. each continent - Asia Mt. role of physiotherapy in her “Adventure without risk is 8th Sept 2017 was the World Physio- Everest, Australia Mt. journey. Disneyland”. Sounds therapy Day. You all must have Kosciuszko, South America Mt. interesting when you hear Apart from the cover feature, celebrated the day with various Aconcagua, Antarctica Mt. writes on the activities. Send us a brief write up Vinson Massif, North America Devdeep Ahuja so when you learn that the importance of social support with photographs about your this for the �irst time. More Mt. Denali, Europe Mt. Elbrus statement comes from a 15 in rehabilitation adherence in celebration and we shall publish it in and Africa Mt. Kilimanjaro - are year old. Yes, this is what the continuation to his previous the next issue. Last but not the least, part of Misson7Summit. home page of her website article. Also covered is the from this issue onwards, we are says. This is what her email By the age of 14 years, Jaahnavi second part of the article re-introducing your favourite section signature reads. This single has completed Phase IV of her latest in Tendon Rehabilitation Word-Maze. So make sure you statement portrays her life Mission. Out of the 7 continent by Parivesh Kumar, where he participate and win the prize. philosophy of how taking peaks, she has completed discusses tendinopathy I hope this issue would help you in risks is what adventure is all Africa, Europe, Australia and treatments. Diana Pinto & gaining more clinically relevant about. North America and is all set to team presents a collection of a information and knowledge to help complete the rest 3 continents. few case studies to show the Yes! I am talking about the you in your professional pursuit. 15-year-old mountaineering Her mission started with Mt. sensation, Jaahnavi Sriper- Kilimanjaro in Africa (5,895 mt) about six different conditions, To your good health and comfort, on October 2, 2014, where she bene�its of dry needling in ambuduru from Hyderabad, Mukesh Nayak was the youngest girl from treatment approach. which have no de�ined and youngest girl from India India to achieve this feat. who aims to become the �irst

04 PHYSIOTIMES Vol. 9, Issue 1, July 2017 PT

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Spotlight Quintessential Special Article Cupping: An Old wine in a new The Latest in Tendon bottle - Satyen Bhattacharyya Rehabilitation: Key Home Snapshot Healthcare: Management Tactics Art in 28 Best practices Parivesh Kumar Physiotherapy Poonam Bhavan Botadara Cover Feature Bhavsar An interview 20 38 with Jaahnavi Sriperambuduru: The mysterious mountain girl 10 32

26 42 Current Affairs Case in point The Latest Dry Needling - Physiotherapy Benefits in Research & conditions which 34 16 Techvantage Updates Feature article have no definite across the globe treatment Gen-X: The Social Support: healthoid way The key to Best of web Diana Pinto, 46 rehabilitation Smruti Dash & Book Review Saachi, Simoni adherence Anshuman Rath Event Calendar Devdeep Ahuja 47 Word Maze

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Jaahnavi Sriperambuduru (The Mysterious Mountain Girl - Himaputri) is a 15 year old from Hyderabad, Telangana, probably the youngest girl in the world to have started her adventure career at an early age of 10 months, when her parents took her into wilderness in a specially designed backpack to give her the ﬁrst taste of outdoor.

She is on a Mission to climb the highest peaks of the 7 continents known as the #Mission7Summit and reach the farthest point of An Interview with the globe “The North Pole” and the “The South Pole” (The Grand Slam) to become the world’s Jaahnavi youngest girl to do so. Till date she has completed Sriperambuduru 4 continents highest peaks namely: 1) Mt. Kilimanjaro The mysetious (Africa), 2) Mt.Elbrus (Europe), 3) Mt.Kosciusko mountain girl (Australia), 4) Mt.Denali (North America). She became the world’s youngest girl to summit Mt.Elbrus at the age of 13 yrs in 2015.

In July’2016, she also became ﬁrst Indian born Telugu girl to be invited to the white house to take part in National South Asian symposium. Apart from Mountaineering she practices classical dance and attends drawing classes.

Jaahnavi is also a motivational speaker and works towards “Empowering the girl child” which she started by not only

3810PHYSIOPHYSIOTIMESTIMES Vol. Vol. 8, Issue9, Issue 4, Jan’1, July 2017 2017 Cover Feature PT educating the girls but also providing them with life skills under “JanJay Foundation”. Jaahnavi is one of the youngest TEDx Hyderabad speakers and also travels the globe for educating girls about “The Importance of Education”and want to give an exposure into the wilderness through which, she feels one can understand their own potential and develop it. She gives commer- cials related to girl empowerment and send messages for girl stereotypes for gender equality. Her recent campaign #Am Pretty Tough through one of the leading cosmetic company of India, Dabur Gulabari, has brought about a major change in the process of “Don’t Judge a Book by its cover”. In an exclusive chat with Mukesh Nayak, Director, PHYSIOTIMES, Jaahnavi shares her story of triumph and challenges she faces in her quest to complete the Mission7Summit. . Presented here are the excerpts.

1. Please tell us in brief 3. Tell us about your first mission. A. When I have my expeditions and dinner. So, we are about your early life and coming up, my father and I start used to variety of dishes A. My first mission of mountain- family background. planning for it 3-4 months for each meal. But, eering as I said was 16000 ft. in ahead depending upon which during expeditions we A. I was introduced to this Uttrakand known as Roopkund climb I am going for (sometimes do not have those kinds sport at a very early age of 10 Trek and my first mission of even 6 months ahead). So the of options. We must months, by the guidance of #Mission7Summit was Mt. main thing which differs here manage with the food my coach, mentor, My father. Kilimanjaro (Africa) which is one from my routine training is that He wanted to give me the of the most memorable one as I hardly get rest after my Physiotherapy exposure to wilderness and Mt. Kilimanjaro is world’s single practice, we are on roads in has really helped nature. My father always standing mountain with 4 search of Sponsors me during my last wanted to make me some- different terrain to cross and (Mountaineering is a very 2 expeditions in thing different for which my reach the summit. expensive sport!!). I must pack making myself mother supported every time. 4. How do you go about training my equipment, weigh the bags, more flexible and My father is Dr. S. Krishna and preparation on a day to day set up my electronics, purchase for strengthening Rao, my mother S.Saraswathi, basis? (Fitness, diet and other my personal essentials, take my muscles. I have a younger brother who regimen that you follow) care of my health, I shouldn’t we are served. On the is 14 years S.Jayavardhan and be having any injuries (so I mountains, we won’t I also have two dogs (I am a A. My day starts at 5:00 am. Like should be very careful while feel hungry but, we must pet lover!). From my other sports, training for my training which Ramesh sir is eat. We won’t feel thirsty childhood, I was always in the expeditions takes vigorous and very particular) and more over I but we need to keep field of adventure, going for intense workout. For this I train should also focus on Recovery ourselves hydrated. We extracurricular activities. under the able guidance of my stage. won’t feel sleepy but, we fitness coach a Dronachaya 2. At what age did you start need to give our mind Awardee Nagapuri Ramesh Sir. 6. What are the key challenges mountaineering & what and body rest. So, I train twice a day morning for you face while mountaineer- inspired you to get into it? 4 hours and in the evening 2 ing? 7. What are the health A. My professional climbing hours for which my younger problems that a moun- A. The list of challenges we face started when I was 9 years. brother accompanies me. I run 20 taineer can suffer during on the mountains has no full My first exposure to high kms on alternate days in a week. I a mission? stop. The major challenge altitude was in Uttrakand for do 60-65 kms cycling on alternate which I have faced is the The basic problem a a trek to Rookpkund (16000 days in a week also. My practice unpredictable weather. We do mountaineer suffers is Ft). My father has been the schedule keeps on changing. I also not know when the weather AMS (Altitude Mountain inspiration for me to get into put on 25 kgs of weight on my would change. I say - ‘Expect Sickness). It can happen this sport. Later I came to back and then climb on some hilly the Unexpected’. The other to anybody. If you are know about the mission areas. I keep travelling to different challenge is communication. In not well acclimatized known as 7 summits! My parts of India for practice. For this few countries guides do not then AMS can come. This father said why we don’t try type of vigorous training I intake speak English, so it is very can happen to world's this challenge. I always had 4000 calories a day, for which I difficult for us to ask for our best mountaineer also. the answer ‘Yes’. So before must follow a very strict diet. requirements or to even say Second is Pulmonary taking up with this mission, I 5. How do you prepare just something and the other major Edema. In this case, went for a practice climb to before a specific mission. How one is food. We as Indians have excess fluid develops in Ladakh. From here on I have does it differ from your routine a vast variety of dishes for the lungs, either in the started my Mission7Summit. training? breakfast, lunch, evening snacks lung tissue itself.

PHYSIOTIMES Vol. 9, Issue 1, July’ 2017 11 PT Cover Feature

This will happen only when 10. What role has physio- you are going above 7000 therapy played in helping metres. After 7000 metres, the you manage your injuries body and mind connection and maintain your general goes off. You will not have fitness levels? much control on your mind. A. Yes, Physiotherapy plays a You may pull off your gloves, major role for any sports hat, socks etc. People have person and particularly when died due to this. That is why it comes to Mountaineering we are totally fit - mentally and we should protect more from physically. the injuries as we always are After 8000 metres, the "Death prone for accidents. For me Zone" starts. The problem of physiotherapy has really "High Altitude Cerebral helped me during my last 2 Edema" starts. In this case, expeditions in making myself your brain starts expanding. more flexible and for This happens because of lack strengthening my muscles, of oxygen circulation in your but to be very honest, I could body. As a result, the person not afford to have a full time dies. There is one more thing physiotherapist as we are still called – frostbite which is also on the mercy of sponsors for known as Ice Burn. This our all climbs. 13. What are the top three It has taught me one big happens only if we are not qualities required to be a lesson that life gives you 11. Who are your role properly geared or covered. successful mountaineer? many opportunities and models when it comes to chance, but it all depends Due to this, the body part will A. What I believe - ‘A mountain- mountaineering? upon us when we grab the first turn blue, then red and eer will be successful not when opportunity and make the then black. That body part will A. My first role model is my he or she climbs a mountain or best use of it. It also taught have to be cut off from your father and the other role accomplishes a mission, but me that one mistake will be body. model is Late Malli Mastan when they conquer them- sir, as he is a Guinness record your last mistake, so it taught 8. What are the most common selves!’ But then the three holder who has climbed all me to be focused, alert, and injuries that you have encoun- qualities would be: the 7 mountains of the seven conscious of what I am doing. tered while mountaineering? 1. When they believe in continents in just 172 days, themselves that ‘Yes I can do it’ 15. When was the first time A. Till date I have not encoun- who left all of his education 2. Discipline within ourselves your achievements were tered any major injuries, but to be in the mountains. first. noticed by the world and the few minor ones I have experi- 12. What is the best thing 3. To know one’s weakness and media? enced, like the ankle sprains or about mountaineering? accept it for a better change. twist or some bruises when we climb the rocks or slip down A. Mountaineering is such a I could not afford to have a full during the steep climbs. sport where you be yourself, time physiotherapist as we are which is one of the best 9. Have you heard of physio- still on the mercy of sponsors for thing. When you can be therapy? If yes, when and yourself you will know your our all climbs. how? strengths and weaknesses. A. Yes, I have my own physio- The other best thing is that 14. Please share some life A. My first achievement was therapist, whom I visit you will know how much you lessons mountaineering has noticed when I climbed the occasionally before my can motivate yourself when taught you. highest trekable peak in Ladakh Stok Kangri, as I was practice sessions of an you are alone, and how much A. Mountaineering has taught the youngest girl to climb at expedition and she gives me you can pull yourself when me to believe in me that I am the age of 12 yrs. the list of exercise and precau- you are exhausted, tired and capable of anything. It has tions for my practice and other cannot put that one last step. taught me to fight back my own 16. Off late, you have been necessary information to This sport helps you build problems. It has made me receiving a lot of media follow, which really helps me your confidence and trans- realize that I was headstrong for coverage and attention. to prevent major injuries. forms the overall personality what I believe in and for what I of a person. go for.

12 PHYSIOTIMES Vol. 9, Issue 1, July’2017 Cover Feature PT

How do you handle this The main message behind fame at such a young age? climbing all these peaks is very simple. As a mountain- A. Yes, I have been receiving eer we would like to know a lot of media coverage and how much we have attention, but I never like conquered ourselves and this anyone calling me a celebrity challenge is the ultimate for or a superstar. I just like to any human being to take up. be treated the way I am treated normally. My father 18. How do you manage your always tells me “the day you studies and mountaineering feel proud about yourself together? that you are great, than your With her father Dr. Krishna Rao A. I have recently graduated downfall starts.” A. I talk about my main eyes and believing in you. Yes, 10th class. Studies have never mission ‘Girl Empowerment’ we all dream in our sleep but, Even when I was Invited by been a barrier for anything I which I am working for and dreaming our life’s goal and The White House and after have done. While travelling I what Indian girls can achieve achieving is what makes us that I became the youngest would carry my books along if we are given proper different. TEDx speaker also, I felt that with me, revise during my guidance, encouragement and I am doing what I like, so I journey and whenever I get 21. Your message to the support. generally see things as they chance I study my subjects physiotherapy fraternity. come, so even as a young online. The key message is about my A. Firstly, I salute all the girl I feel like the same as tagline which is basically my 19. What are your current physiotherapists as they are other Teenagers and even life’s mantra ‘Adventure engagements and activities one of our backbone, without want to be like them. without Risk is Disneyland’, I apart from mountaineering? whose support no sports give the example of the ECG I feel very happy to meet person can be safe and fit. A. Apart from Mountaineer- reading for my tagline children and people from Secondly, if physiotherapy ing, I generally take care of because it has a lot of age groups and learn from becomes a part of every the Training part for children meaning behind it and them when they come to person’s life, then injury levels in Adventure sports and explains it to them to the congratulate me or even to will come down. It should be Fitness, so I have a unique point. When the readings go take selfies whenever I visit introduced from the school program known as “FitVen- up and down that is when it is a program as a special guest. level, so that the students who ture”, which is a combination I always like to meet people are planning to take up sports of Fitness and Adventure If physiotherapy because of their blessings in their coming future can under the brand JanJay which is the only thing that becomes a part understand the importance of Adventures. I also work for works on the Top of the of every person’s physiotherapy and take its Girls empowerment and see Mountains for my safety. My support for becoming a better that not only every girl child life, then injury father is always behind me sportsperson. is being educated but also levels will come to take care about my given proper life skills for down. Jai Hind. activities. them so that they can stand the indication that the person Jaahnavi Signing out 17. What is Mission7 on their own and live for is alive. If the reading is a summit and what is the what they want to be under straight line it indicates no life message behind this JanJay Foundation. I regularly in the person. Even our lives mission? visit some orphanages nearby go the same way. If we have and spend time whenever I A. Climbing all the highest ups and down we know am in the city and try to peaks of 7 continents is where we stand, how much explain their studies or play known as Mission7 Summit, hard we are working. If we with them and chit chat. and to add to that I am also don’t face any problem then attempting for Grand Slam 20. You deliver talks and we are doing nothing and we record in which I will be motivational lectures on haven’t got any sharp vision reaching the farthest points several forums. What is your of what we are doing. of the globe “The North key message when you The other key message is Pole” and “The South Pole”. speak? about dreaming with open

PHYSIOTIMES Vol. 9, Issue 1, July’2017 13 JSS Mahavidyapeetha, JSS College Of Physiotherapy JSS Hospital Campus, M.G.Road, Mysuru, Karnataka, India PG CON 2017 [3-4 Dec, 2017] www.jssphysiotherapy.edu.in I. Clinical reasoning: The art of listening and seeing Clinical reasoning process Informative II. Outcome measurement: What numbers say, Patient centric measures-the art of healing. Sessions III. Movement for function:Laban movement analysis, measuring movement IV. Research methods: Are we right? Numbers speak. Is it important? What do patients think? Who can participate : Practitioners and PG students of Modern Medicine (Allopathy), Nursing, Ayurveda, Rehabili- tation (PT,OT,SLP), Psychology, Biomedical Engineering

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The key to Rehabilitation Adherence During the last 30 years, (such as receiving love and attendance and Grade I Rehabilitation adherence researchers have shown great empathy) and instrumental evidence of positive relation- is an outcome of a interest in the phenomena of (practical help such as gifts ship with home exercise complex interaction of social support, particularly in of money or assistance with adherence. the context of health. Social child care) components. physical, social, therapeu- My research project included support has been described as tic and psychological For the purpose of my an initial mixed methods “support accessible to an elements. In a previous research, social support synthesis of qualitative and individual through social ties to article, I had discussed the included both the structural quantitative studies explor- other individuals, groups, and central role of therapeutic elements (e.g. did the ing determinants of atten- the larger community.” relationship in facilitating patient have any family or dance, in-clinic adherence rehabilitation adherence. It has also been described as “a friend who could provide and home exercise adher- This second article, based network of family, friends, support if required or the ence in outpatient musculo- on the ﬁndings of my neighbors, and community level of social obligations) skeletal physiotherapy doctoral research, centres members that is available in and functional element (e.g. clinics. This was followed by on the role of social times of need to give psychologi- the level of positive a prospective cohort study support and other social cal, physical, and �inancial help”. reinforcement or feedback and then a qualitative study inﬂuences as a determi- available or does the incorporating focus groups Theoretical models of social nant of rehabilitation patient have anyone to and interviews with support specify the following adherence. patients, reception staff, two important dimensions: physiotherapists and clinical Devdeep (1) a structural dimension, fromprovide my �inancial mixed methods support if managers to discuss and Ahuja which includes network size researchrequired). indicated The �indings that PhD, MCSP, and frequency of social interac- greater social support had a Finally, a triangulation Co-founder tions, and (2) a functional HEducate, UK Grade II evidence of a protocolelaborate was upon used the to �indings. dimension with emotional positive relationship with

combine the �indings from

16 PHYSIOTIMES Vol. 9, Issue 1, July’ 2017 Feature Article PT the previous three stages activities and sometimes exercises into their daily to develop conceptual attending physiotherapy models and levels of did not seem important times for exercises and being determinantIn itself, social of obligations adherence. may evidence tables for each of routine, developing �ixed appear to be an unmodi�iable the 136 determinants against other obligations. organisational ability if the demonstrated that: a) if the explored. enough when weighed disciplined, greater level of - “Physiotherapy is time However, my research has ered to be possible facilita- Social obligations consuming and that the exercise programme is torstime of is exerciselimited were adherence. consid patients need to alter their perceivedpatient-centred need is high, and i.e. b) Patients and physiothera- daily routine or take time takes into account pists both concurred that a completed as a part of off from work, family or Patients and their social recreationalExercises which activities can be social obligations to attend physiotherapists both obligations regular schedule and or other activities of the department for treat- concurred that a con�lict and con�lict with a patient’s daily routine may ment which may be dif�icult with a patient’s regular exercises the most important factors promote adher- for some patients” (Second schedule and commitments was commitments was one of ence. The physio- one of the most important into the decision to not attend an therapists should factors which in�luence their can be �it which in�luence their and McLean 2010) daily routine appointment. These order) (Marwaha, Horabin also respect the decision to not attend an obligations included Society perceives time as a schedule of patients appointment. then patients inability to take time off commodity and prioritising of the patient, time for rehabilitation and “ . .. So I’ve been setting time to prioritise their family members and exercises is one of the main when planning exercises. limits, as you stated [name], physiotherapyare programmore willing over work, needing to care for considerations in achieving in my daily planner about their social obligations and commitments. adherence to the exercise when to make it a priority, - children, or other social program. Willingness and Participants felt that they when I can put it in, trying to mendations. ability to accommodate had to prioritise their work my life around it.” (patient, adhere with exercise recom �irst order) (Wilcox et al. 2006) STOP THE PAIN. FEEL THE BURN. TARGETED PAIN RELIEF COMFORTABLE TO WEAR STAYS ON IN WATER

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PHYSIOTIMES Vol. 9, Issue 1, July’ 2017 17 PT Feature Article

exercises into their daily information, it also provided routine and thus overcome - the barrier of managing ionship while exercising, exercises while they still thussocial making bene�its it ofmore compan enjoy- - able and acceptable. tions. ful�il their social obliga Exercising in groups also Support from family, facilitated competition and friends, peers and exer- drive in some participants cise partners who wanted to do better than their peers. Patients Many patients are depen- also tend to be motivated by dent on the material, hearing the success stories emotional and practical from other patients who support from their family have undergone similar members. Encouragement treatment. from family members and friends provides a stimulus “I meet a lot of different to continue with the people … and it’s amazing exercise program. External how quick you can form a cues and reminders to relationship with people that exercise along with an you have never met before. acknowledgement of the And it’s a great way to share Thus a discussion between patients’ physical limita- time with other friends.” the physiotherapist and tions, facilitates adherence patient at an early stage to to the exercise program. A et al. 2006) identify the interests of lack of such support acts as (patient, �irst order) (Wilcox Support provided by coaches patients, short and long term a barrier to the continued in the form of understanding goals and tailoring of the engagement of participants the athletes’ injury, recovery Beyond the intervention to attain those with the rehabilitation and rehabilitation process immediate goals may facilitate prioritisa- process. tion of their physiotherapy was considered vital to their family and program over their social “Oh, the support I got from engagement in exercise friends, obligations. An example of my family and friends was programs. If a coach consid- such intervention is the Brief great. My husband has been ered the recommendations patients also Advice which is being fantastic watching over me of physiotherapist to be enhance provided as a part of making sure I don't do worthless, then there was anything I shouldn't. My best little chance of the athlete’s their support Scotland’s new physical activity pathway. Brief Advice friend sometimes came to continued participation. the rehab centre with me structure consists of a short (~3 Conversely, if the coach was which I really appreciated” further by minute), structured conversa- also included as a part of the tion with the patient aimed at multidisciplinary team who forging rela- raising awareness of the al. 2009) (Carol, �irst order) (Levy et understood and encouraged tionships Beyond the immediate rehabilitation, this promoted with their exploring barriers and family and friends, patients adherence to rehabilitation. identifyingbene�its of physicalsome solutions. activity, also enhance their support The coaches’ understanding, peers or Similar approach may be structure further by forging approval and support for the exercise developed and tested for relationships with their treatment program recom- partners. therapeutic exercise as well. peers or exercise partners. mended by the therapists’ Frequency of sessions, Having an exercise partner was considered to be an duration and number of with similar abilities important factor in whether exercises need to be allowed them to share their athletes adhered to their optimised to ensure that anxieties and goals and exercise regimen. patients can stay motivated discuss disease related by results, are able to adapt issues. Apart from sharing

18 PHYSIOTIMES Vol. 9, Issue 1, July’ 2017 Feature Article PT

“Sometimes you will get a coach who will come in with the athlete and that’s of patients are also strongly fantastic because you can in�luenced by their family discuss everything with the and friends (Sher et al. coach and athlete and get 2014). Physiotherapists agreement on what he can should therefore endeavour do. Its good to have coach to identify the important on your side and to work as people in patient’s life, a team.” (Physiotherapist, examine their role in patient’s beliefs and attitudes and evaluate their extent of �irst order) (Niven 2007) support for maintaining - patient’s HEA (Lanoutte et al. It has also been shown that 2009). This may also facili providing social support to tate a discussion about a others may result in health - patient’s social obligations, bene�its to the individual priorities and conse providing support as quent need for well. Peer support Many patients are prioritising HEP among patients same within the with the dependent on the Exercising in groups dailyThere routine. may health material, emotional be also facilitated problemchronic and practical support clinical practice. This - competition and drive has been attributed to from their family in some participants occasions lack of adequate train who wanted to do ofcombines both members. where ing of the psychosocial- the bene�its despite best issues within entry level better than their peers. as well as post qualify intentions, a Summary: receiving and patient may not ing programs (Foster providing social be able to attend the and DeLitto 2011) as support. Previous appointment due to social well as following the research indicates that obligations or other urgent traditional biomedical The �indings regarding the impact peer support may lead to priorities. In such situations, model of care in clinical of social support on rehabilitation- improved adherence for it may be useful to provide practice, which then adherence from my study have medication diet, and more accessible rescheduling in�luences their clinical emphasised the need for physio exercise. and cancellation procedures reasoning and decision therapists to be cognisant of and which may include use of making as well as the work within the bio-psychosocial The success of peer - text messages or emails, explanations provided paradigm and consider not only support appears to be due online calendars or social to the patient. the patient and their presenting in part to the non - media websites such as problem, but also the social hierarchical, reciprocal - Foster and DeLitto Facebook or Twitter. Promot environment within which they relationship created (2011) have suggested ing cancellation of appoint live and function to ensure that the- through the sharing of several strategies which ments within a timeframe rehabilitation programs are similar experiences with can be utilised within which allows physiotherapy designed with their social obliga others undergoing the the entry level programs- departments to re-allocate tions in mind, additional support, same medical and/or to facilitate greater the appointments may be encouragement and education is behavioural tasks and focus on the psychoso useful to ensure appropriate provided to patients and their challenges. Physiotherapy cial elements within utilisation of resources. signi�icant social in�luencers to departments should physiotherapy practice facilitate adherence to the exercise Acknowledgement: consider promoting such Recent evidence has including a speci�ic programs. peer support or ‘buddy’ suggested that while there is focus on integrated The above article is systems to facilitate recognition of contribution biopsychosocial models based on the �indings of my PhD study- support amongst patients of the psychosocial elements within entry level titled ‘Determinants of Rehabilitation education and greater Adherence in musculoskeletal physio and thereby facilitate HEA. to a patient’s experience, it is therapy: a mixed methods project’ funded not regularly addressed by inter-professional Personal health beliefs and by Shef�ield Hallam University, United the physiotherapists in education. Kingdom (2011-2015) cultural exercising norms

PHYSIOTIMES Vol. 9, Issue 1, July’ 2017 19 PT Quintessential

The latest in TENDON REHABILITATION In the previous Management aim needs to endure in their edition I have covered the early stages (reactive day-to-day life. An argument for high tendon the basics of the tendinopathyIf the injury is or identi�ied early in load as one of the key compo- Heavy-load eccentric calf tendon including the tendon disrepair) then load nents of a successful tendon muscle training for the biomechanics, management/reduction will rehabilitation program has treatment of chronic Achilles patho-mechanics and allow the tendon time to always been raised. tendinosis - Over time the the continuum of adapt and recover. tendinopathy, its time One of the key goals of Use of NSAIDs may be eccentric training program now to shed some rehabilitation should be to hasbene�it been of attributed Alfredson’s to the light on tendinopathy increase tendon stiffness, as their ability to impede mode of contraction (i.e. treatments. this will increase the tendons healingbene�icial can at reduce this stage, abnor as- eccentric) rather than the ability to withstand repeated mal adaptation. load. stretch-shortening cycle loading and overuse injury. In degenerative stages When performing eccentric exercise appears to be a training with bodyweight it It seems to be a clear sugges- positive stimulus for tendon is more of a muscle stretch tion that high load is probably restructuring. - more likely than bodyweight vention, and this may be Exercise is the most Parivesh Kumar PT exercise to increase tendon than tendon speci�ic inter evidence based treatment PGDip Musk stiffness. There is some (perhaps those that are very for tendinopathy - tendons (Melbourne), BPT evidence that tendon tight).suf�icient for some patients Senior Clinician, responds more to heavy need to be loaded progres- Gippsland Lakes rather than lighter rehabilita- sively so that they can If we apply heavy load Community Health tion loads. develop greater tolerance to slowly, as in a heavy slow Australia the loads that an individual resistance regime, or heavy

20 PHYSIOTIMES Vol. 9, Issue 1, July’ 2017 Quintessential PT isometric load over a number of weeks the tendon will adapt. This is Stress shielded mostly measured by Optimised looking at tendon stiffness Optimised Load Unloaded Load under load. The tendon becomes stiffer, i.e. it Normal or Normal Tendon strains less under a given Excessive Adaptation Load +/- load. individual factors Excessive Appropriate Eccentric rehab may well Load +/- modified Strengthen individual load still have a role but isomet- factors ric exercise has been introduced to reduce pain and Heavy Slow Resistance Reactive Tendinopathy training is arguably the building strength and load capacity.�irst choice at present for Tendon dysrepair The current evidence suggest that slow and heavy loading is good for tendons – especially the big, strong, powerful Degenerative Tendinopathy tendons of the lower limb. Tendon is a constantly evolving structure with its strength predominantly TENDINOPATHY REHAB PROGRESSION coming from collagen molecules. When you Phase of perform exercise (such as rehab Aim Treatments running/jumping) the collagen in the tendon Isometrics in mid range 1 Reduce pain undergoes a process of Reduce Compressive load and use of SSC both breakdown and Ibuprofen (if reactive) regeneration. 2 Improve strength Heavy slow Resistance Training in non- compressive position after a bout of exercise thereOver the is an �irst overall 24-36 loss hours of 3 Build functional strength Progress strength work into more functional collagen. Less collagen tasks. Treat movement dysfunction means less tendon strength, hence leaving the 4 Increase Power Reduce reps but increase speed of muscle tendon vulnerable to contraction to build power however (if no further 5 Develop Stretch- introduce plyometrics +/- graded return to exercisedamage. hasAfter taken 48 hours place) Shortening-cycle (SSC) running there is an overall gain in collagen and therefore 6 Sport specific strength. This is one of the Add drills specific to requirements of sport reasons that physiothera- Maintenance Maintain optical Continue stregth work, gradual increase hours rest between loading tendon health in loading. Avoid training error. exercisepists would sessions. suggest 48

PHYSIOTIMES Vol. 9, Issue 1, July’ 2017 21 PT Quintessential

The latest concept Low-level laser therapy is Tendon Neuro- (LLLT) plastic Training or There is no consensus about TNT… the use of low-level laser It builds on current treatment for tendinopathies. thinking to improve And a number of questions motor control as well as remain unanswered, like improving tendon load LLLT’s role when used in capacity. It’s developed combination with other by Ebonie Rio and a interventions, and especially great team of tendon exercises, in the remodelling experts. phase of the tendon repair. Cortical inhibition has Iontophoresis and been reported to be a Phonophoresis feature of tendinopathy. Iontophoresis and phonopho- In simple terms this resis involve using ionizing means the area of the current or ultrasound to brain that controls the deliver medications locally. muscle (the motor Corticosteroids and NSAIDS cortex) isn't functioning What else is being used Extracorporeal Shock are commonly used with to manage tendinopathy? Wave Therapy: these modalities. Both are a balance between There are other old and new The use of extracorpo- widely used and anecdotally properly. It needs to �ind excitation and inhibition interventions / modalities in real shock wave effective, but well-designed and in tendinopathy this practice but none of them have therapy to address the RCTs are lacking to permit balance is thought to be come out with strong evidence to failed healing response reliable recommendations. altered. be recommended in the manage- of a tendon is a new Friction massage TNT adds external ment of tendinopathies. Few of concept. The rationale pacing to tendon them are mentioned below along for the clinical use of rehabilitation exercises with their current level of extracorporeal shock accurately delivered penetrat- using a metronome to evidence. wave therapy is ingFriction pressure is de�ined applied as through“an improve motor control stimulation of Corticosteroid Injections: and help restore this soft-tissue healing and currently little evidence balance. Current knowledge suggests that inhibition of pain available�ingertips”. to But support there the is use of receptors. Proposed it in the treatment of tendi- A contraction speed of 3 a role in tendinopathy than mechanism of action is nopathy. A Cochrane review seconds for the concen- originallyin�lammation thought. plays One much hypoth less of- disruption of evaluating deep friction tric component, neo-neuralization followed by 3 seconds that the degenerative change found in tendinopathic with deep friction massage for the eccentric has seenesis for within their affected proposed tendons ef�icacy is tissue that may be overmassage other found treatments. no bene�it been used successfully linked to symptomatic Therapeutic Ultrasound in tendon rehab. response in the surrounding pain. tissuecauses that an in�lammatory may contribute to Therapeutic ultrasound is Conclusion - Tendon There is no consensus pain and swelling seen in cases commonly used in the Neuroplastic Training on the use of repetitive of tendinopathy. treatment of tendinopathy. (TNT) is an exciting new low-energy extracorpo- concept that builds on Despite this, there is little In this setting, steroids would- real shock wave clinical research documenting previous tendon serve to offer symptomatic relief. therapy, which does not research. It involves Recent literature seems to require local anaesthe- using a metronome to treating tendinopathy or support the above, with the sia, versus the use of promotingthe ef�icacy tendon of ultrasound healing. in externally pace rehab literature often showing short- high-energy extracor- exercises and can be In the era of evidence-based term improvements only in poreal shock wave practice, further studies, used as part of an active symptoms with few long-term therapy, which requires self-management especially randomized control local or regional trials are essential in programme. anaesthesia. bene�its.

22 PHYSIOTIMES Vol. 9, Issue 1, July’ 2017 Quintessential PT HANDS ON WORKSHOP ON DRY NEEDLING Learn Pick up Get FREE First 25 Needling SDN, DVD, participants for DDN, practice get free analgesia, Periosteal needles and electrodes healing Pecking, amazing to apply and trigger PENS insights on needling point. skills. myofacia. with TENS. therapeutic ultrasound in elucidating the ef�icacy of Alternative injections, such as PRP, have shown short- promoting tendon healing term ef�icacy for tendinopa- andPlatelet treating rich tendinopathy. plasma (PRP) thy sufferers. – Blood injections –

Operative management Growth factors in PRP are seems to offer some bene�it tionin symptomatic rate than other relief treat but thought to promote tendon carries a higher complica- healing. Factors in platelets reserved only for patients’- have been found to play vital ment options and should be Membership of Physilife Therapy Universe: roles in stimulating processes Continous Online Support for cases & doubts in the maintenance and recalcitrant to other more conservative options. from experts. it’srepair unclear of tendon whether tissue. this PRP is level to avoid constant stimulates tendon cells and Reduce load to a tolerable positive, healing is not symptom exacerbation. supported by evidence. Then gradually increase it A recent systematic review again as symptoms, and found there was strong rehabilitation, allow. evidence to suggest PRP is no forTarget the rehabilitationtendon to tolerate to qualitybetter than studies placebo/control it does NOT loadgradually in the build functional up the ability in tennis elbow. In good seem to perform better than aggravating activities. This placebo. Further study with may also include range of additional high-quality movement exercises in randomized, controlled trials addition to the obvious Overall Conclusion: is necessary. strength/loadingMy favorite one liner exercises. for all the clinicians – “Trust it, Load it and the body will shouldA reasonable include �irst a course line of of adapt” treatment for tendinopathy Clinicians can contact the author for Principal and references or any further details or NSAIDs and eccentric questions on [email protected] exercise-based physical Special thanks to: www.physilife.in therapy.Corticosteroid injections

• running-physio.com, seem to offer excellent • physio-pedia.com, short-term pain relief but • tendinopathyrehab.com, lack long term ef�icacy. • markgibsonphysio.com

PHYSIOTIMES Vol. 9, Issue 1, July’ 2017 23

PT Case in point

DRY NEEDLINGBy: Saachi Varyani, Simoni Shah, Diana Pinto Benefits in conditions which have no defined Treatment approach

itis itis elitis ndin urs nee My s Te nger llar B itis K erse natu er Fi ate enia rthr ansv aspi Tigg prap teop teoa Tr Supr Su Os Os Dry Needling is an 1. TRANSVERSE MYELITIS Rx aimed at: Correcting SIJ Rx: Dry needling to Supraspina- invasive form of 2. CALCIFIC SUPRASPINATUS TENDINITIS dysfunction, Left Dry Needling tus, Deltoid, Biceps, Triceps, treatment useful for Quadriceps & Left Tibialis coracohumeral ligament, treating Neuromuscu- 3. TRIGGER FINGER Anterior/ Peronei – Following Subdeltoid Bursa, Pectoralis loskeletal and Fascial 4. SUPRAPATELLAR BURSITIS which Strengthening to Gluteals Minor, Coracobrachialis, conditions. Much has 5. OSTEOPENIA was initiated. OSSUR Brace given Infraspinatus, Subscapularis, been said about Dry 6. OSTEOARTHRITIS KNEE to left knee, Talarmade Orthotics Teres Minor, Rhomboids, Needling to help given to both feet according to Latissimus Dorsi, Scalenes, improve Myofascial 1. TRANSVERSE MYELITIS evaluation. Patient treated once a Upper Trapezius. Periosteal Pain syndromes Female, 52 patient using walker week for 6 months. pecking of the Greater Tubercle through the release of came to our facility with H/o also done. Post 6 Myofascial Trigger transverse myelitis since 14 Clinical Findings: Upon return of Shoulder ROM, points (MTrP’s). years at L1 level and complaints inches. Left Quadriceps Strength shoulder strengthening program However Dry Needling of Left limb disability. months, Left Thigh girth is at 20 was initiated. Patient treated can be used to improve H/o: Bilateral lower limb Quadriceps muscle recruit during twice a week for 4 months. a multitude of other paralysis with pain/ stiffness in Contraction.is 2+. Patient No can buttock feel her pain, Left SIJ conditions that have lower back, loss of bowel and dysfunction persists. Patient now Findings in USG Shoulder: Along with the reduction in size/ bladder sensation. Medication walks with a stick independently. approaches to normalized her bowel/bladder treatment.less de�ined sensation and Right lower limb 2. SHOULDER ROTATOR CUFF/ Increaseresolution in of Supraspinatus calci�ic deposits, There are a multitude function, but not her Left lower SUPRASPINATUS CALCIFIC muscleother USG bulk, �indings Improved included Swing - & of conditions where in limb function. TENDINOPATHY It is a condition that causes Fibrillar pattern of Supraspina- Dry Needling has not C/o: Severe pain in left buttock, formation of calcium deposits tus tendon (In Dynamic evalua- been attempted as yet. inability to walk without walker, within the tendons of the rotator tion). Clinically, patients are pain This article attempts dependent on husband to move cuff. In addition to irritation and free with full range of shoulder to shed light on around, dragging of Left foot. pain, the calcium deposits reduce movement and return to conditions that could Patient unwilling to start the space between the rotator strength. treatment since she was aware cuff and acromion, affecting Dry Needling. Current that transverse myelitis has no normal shoulder motion & 3. TRIGGER FINGER researchpossibly bene�itis underway from (STENOSING TENOSYNOVITIS) cure. causing subacromial impinge- at our clinic to O/e: 1. ment. - determine the effect of novium narrows the space Dry Needling on a host C/o: Right Dorsi�lexors 3 +, withinIn�lammation the tendon of the sheath tenosy of the of other conditions. Left knee extensors 0, Left leg years with Pain in terminal range 5 patients between 30 - 50 The conditions 2.dorsi�lexors Right thigh 1, girth Left leg22 inches,knee - abduction), Pain and severe Left�lexors thigh 1 girth was 17 inches af�licted �inger. This painful restrictionof shoulder in motion shoulder (�lexion internal and Needling mentioned in in�lammatory condition there rotation. thisbene�iting article fromare: Dry patella) fore causes the �inger or thumb (At 10 inches above upper to catch or lock when �lexed.

26 PHYSIOTIMES Vol. 9, Issue 1, July’ 2017 Case in point PT

Repeated and strong gripping movements treatment. All previous progressively improved, - treatmentsof �luid collection to treat at this the bursitisstart of patientAs pain/stiffness was requested levels to get a tion process. accelerate the in�lamma Female patient, 55 C/o: had failed. hadBone no Scan. change Core in Strengthening diet during years old presented with was initiated thereafter. Patient severe pain and inability Calcium or Vitamin D supple- to bend her Right middle mentationthis time. Patient during did this not period take despite being recommended to and ring �inger. She felt do so. that her �inger got ‘locked Rx: Treatment included DEXA Scan and Clinical noin a Neural Spiderman complaints. position’ Findings: - during bending. She had Rx: Dry Needling to along with Needling to VMO, RectusCorrection Femoris, of SIJ Vastusdysfunction Latera - Patient had signi�i Fig.: Osteoarthritis Tibiofemoral and Patellofemoral joints before lis, Vastus Intermedius, cant improvement in his SIJ dysfunction with improvement and after Needling Tenosynovium of Right tendons along with in pain levels/strength/ Middle and Ring �inger research on the Improvement bursalHamstrings, swelling Adductors, started to Gluteals function of back and hips. and Palmaris Longus. • DEXA for Spine, Hip and Needling to Palmar fascia reduce,and Suprapatellar Gluteal and Bursa. Core As the strengthening program was -2.5.Distal forearm in April 2016 of Knee Joint Cartilage, but sessions. showed an overall T score of no study till date that focuses Patient was treated for 3 initiated. improvement. Our current Clinical �indings: on Knee Joint Space width Clinical �indings: Patient has shows:• DEXA Increasefor Spine, in Hip bone and mass atDistal the spineforearm and in the April hip 2017 with efforts are directed to handComplete grip reversalstrength of& with reduction in bone mass at Reversal of Osteoarthritis no pain in knee joint and no nocondition, symptomatic with no reoccur loss of- - distal radius (Note that No Dry and Improvement of Joint back stiffness. The bursal Space width in patients with swelling has reduced signi�i Distal Radius musculature). OAIN CONCLUSION:Knees. 4. SUPRAPATELLAR cantly. A Minor thickness above rence for 3 months. Needling was done for the The reasoning behind how BURSAL EFFUSION the knee joint remains, - evidence of the thickened mentT score at atwrist. Spine and Hip is above conditions is yet to be Prepatellar bursitis) bursal wall perhaps? USG currently -1 with no improve Dry Needling works in the - (Suprapatellar bursitis/ �indings5. INCREASED are awaited. BONE MASS IN 6. TIBIOFEMORAL AND A Bursa communicates OSTEOPENIA ment in the recruitment and PATELLOFEMORAL de�ined. However improve ARTHRITIS (KNEE OA): - Known C/o: Male, 45 years old muscle co-ordination seems logicallywith the distendedcavity of the with muscle control timing/ knee joint and is patho through Dry Needling in with a long standing SIJ issue Osteoarthritis,C/o: 20 cases of both Tibiofemoral Male and to be the bene�it obtained complained of constant back blood or synovial �luid and Patellofemoral Knee conditions. It is evident pain and stiffness. He also after a trauma. Patients which seemed to be getting age. throughmost Neuromusculoskeletal the limited literature complained of Left wrist pain complain of feeling of Female between 35 – 60 years on Dry Needling that it Rx: Dry Needling to Gluteals, swelling around the knee Core muscles, Lower limb, promotes Neuroplasticity progressively worse. Strength of Quadriceps, Adductors, bearing.joint, pain in bending the knee, pain during weight Gate Mechanism. Through Male patient, 62 Gluteals, Upper limb & Shoulder Tibialis Anterior, Peronei, IT C/o: ongoingthrough Closureresearch, of we the hope Pain to blade musculature was checked Hamstrings, Gastrosoleus, provide answers to why priorRx: Dry to Needlingstart of treatment. done to years old complained of Band, Gemelli/Obturators, Needling would help reverse Clinical/ Radiograph yearson and in off the Right prepatellar knee Iliopsoas, Quadratus Lumbo- Piriformis, Quadratus Femoris. swelling since past �ive Gluteals, Lumbar Multi�idi, - Findings: Patients showed conditions. region, accompanied some of the above mentioned mis, Tensor Fascia Lata, - Author can be contacted at Iliotibialrum, Latissimus tract, Rectus Dorsi, Femoris, Pirifor [email protected] on the medial side or by improved rates of Pain percep sometimes by knee pain (The authors are currently publishing Obliques, Rectus Abdominis. tion, improvement in ROM of MRI suggested suprapa- knee, Knee joint function as Dry Needling in the above mentioned back stiffness. PatientHamstrings, was seen External/ once orInternal twice journal articles for the Effectiveness of well as improvement in Knee conditions. All patients mentioned in tellar bursitis with 68 cc seen. There is extensive article have given prior consent to Joint Space width was also treatment.) a month for 12 months.

PHYSIOTIMES Vol. 9, Issue 1, July’ 2017 27 PT Spotlight

An old wine in a new bottle

“That’s been the secret Origin - Cupping has been some parts of Africa to Three hundred years later, that I have had through this used in China and some parts another ancient classic, Susen year that keeps me healthy,” of the African countries for Liang Fang, recorded an said American gymnast several thousand years, it is replacedexpel poison by the from glass bites. cups, effective cure for chronic Alexander Naddour, USA When cattle horn was cough and successful treat- Today reports. “It’s been to create negative energy better than any money I’ve dif�icult to tell in which country �ire came into the picture (Chen spent on anything else.” was its origin. Cupping was not mentBin, Dr ofHe poisonousChong, personal snake communi bites- The earliest record of Cupping has become the earlier name, it was known and expel the air. usingcations, cupping 1995). therapy. cupping is in Bo Shu (an popular after Rio Olympic, as ‘horn therapy’ as it was About 500 years ago, a famous though it is an ancient mode applied with cattle horn. - surgeon called Wei Ke Zen of treatment. eredancient in anbook ancient written tomb on of Zong presented a detailed Micheal Phelps has made thesilk), Han which Dynasty was discov in 1973 record of the cupping methods Cupping common to recent used in surgical practice (Chen (Chen Bin, Dr He Chong, personal practitioners after his Bin, Dr He Chong, personal communications, 1995). Some Cupping marks came into 1 therapeutic cupping media in 2016 Olympic, - also developed a lot in Jin although it is a several communications,1995) . It thousand years old treat- Zouhoumethod Fangwere inalso about intro 28 ment. It was a media event Dynasty (265 – 420 AD) with ADduced in a book by this period cattle horn, (Chen Bin, Dr He Chong, evidence based practice. In when Phelps swam with Negative suction inside the personal communications, 1995). bamboo, different sized cups circular, eye-catching Cases of treatment of - bruises. The American Gymnastic team also used thenhorn replacedwas created by the by thebamboo recorded in Weitaimiyao were used as per the require cupping for their better cupping practitioner. It was tuberculosis were ments. In 1950s the clinical performance. Cattle horn are still in use in ef�icacy of cupping was and then by the glass cups. in 755 AD. con�irmed by further research

28 PHYSIOTIMES Vol. 9, Issue 1, July’ 2017 Spotlight PT in China and acupunctur- Types and Methods: Indications 4. MOVING CUPPING: ists from the former Soviet There are thirteen different This is also another draining Union, and was established Stress, Sports - Hotinjuries or cold and methods of application in method. It draws out more blood musculoskeletal‘Bi’ syndrome, Headache, pain, practice in hospitals all methods has been postu- as an of�icial1 therapy covers a larger area and patient over China. cupping. Most of these than �luid and Qi. Moving cupping Tremors and �its, Infertility should have a strong Qi before It became popular all over lated by ILKAY ZIHNI is the most painful form of CHIRALI in his career. cupping.being treated4 by this method. This the world. It was widely Previously there were dry used by army personnel of moving cupping, needle Indications: Acne, Skin lesion, (1796 – 1867) started cupping, �lash cupping, Egypt. William Marsden cupping, herbal cupping & conditions like post-stroke weak cupping, medium In�lammation, Neurological London,cupping therapywhere skilled in his cupping,water cupping. strong He cupping, added doctorsRoyal Free and hospital surgeons of used moxa cupping & Ice 3. STRONG CUPPING: &weakness, Tendon relaxation, Paralysis, Excess Sports heat - condition, Febrile disease, Muscle of the patients. This method is also known - program. cupping therapy for bene�it as draining method. Blood It is known as Hejama or cialcupping. Cupping Recently and Sports Physio injury, Cellulite, Weight loss and internal wind are the Hijama in the middle east Cupping.therapist are using Myofas target for strong cupping. - mad said, "Indeed the best 1. WEAK CUPPING: and Qi is manipulated from countries.of remedies Prophet you have Muham is thisSigni�icant method, amount so the ofpatient blood hijama, and if there was as light cupping, can be should be stable enough to something excellent to be appliedWeak cupping, in all parts also ofknown the used as a remedy then it is 2 4a. LIGHT-MOVING CUPPING: hijama” . In Arab coun- be treated by this method. tries, cupping was applied of cupping is to eliminate tonifyingbody. It increases method. Itthe can blood be This can be used with glass, in different locations and at theThe internal main aim pathogen. of this type Red applied�low and for is also30 minutes. known as different times as per the visible marks can be seen Slight reddening of the skin same as moving cupping but the patient’s requirements. The after strong cupping, which rubber or a silicon type cup. It is happen. time was selected as per will be visible for upto 15 used in those patients who feel the lunar position. suction intensity is less here. It is The duration of cupping Who can practice? shoulddays after be short,the application. 3 to 5 min usedvery weakfor old or age lethargic patients with and moving cupping and is generally board for controlling the be increased to a maxi- cupping both leave a pinkish practiceThere is ofno Cupping. regulatory British mumin the of�irst 20 sessionminutes and in a can markchildren. on theMoving skin. & light moving - Cough and Acupuncture Council tries Indications single session. cold, Sore throat, Asthma, to regulate the practice in Indications - Old and frail Indications: UK. In USA also, there are registered practitioners patients.Anemia, Multiple sclerosis , Hypertension, patient, Infertility, Cancer Tonsillitis, Fatigue, Cancer Headache, Internal organ Stresspatients, release, Immune Stomach de�iciency pain. even then there is no hard 2. MEDIUM CUPPING: backheat, pain,Boils, Upper Muscular & lower syndromes, Edema, Lymphedema, andwho fast use ruleCupping for practicing therapy, limbcramps, radiating Sports pain. injury, Low 5. EMPTY/FLASH CUPPING: - used. This cannot be applied ners, Acupuncture practi- This method is frequently Cupping. Medical practitio Flash cupping is a technique used and Surgeons can practice to children below 7 years. to apply suction to the skin in Cupping.tioners, Physiotherapists There are so means that the cup is placed on cuppingThe suction cannot is �irmer be used than for short intervals or ‘�lashes’. This - moreweak thancupping. 30 minutes, Medium cians use cupping as a seconds before the pressure otherwise it will drain the the skin for approximately 5 manymode spasof relaxation. where beauti inside it is released and it is taken patient’s Qi and the patient off again.

will feel extremely lethargic.

PHYSIOTIMES Vol. 9, Issue 1, July’ 2017 29 PT Spotlight

This is repeated along the Indications: Asthma, 8. HERBAL CUPPING: Surgical blade patch of skin that has Shortness of breath, Hair Natural herbs are used here been selected for treat- loss, Skin purpura, Frozen along with cupping method. ment. It is also known as shoulder, Hemiplegia, Patient’s condition will deter- empty cupping as suction Eczema, Acne, Gout, Blood mine which herbs should be is given at intervals. So in stasis, Blood poisoning, used. It can be further classi- between two suctions, Hypertension, Sports there is an empty period. injuries, Insect bites, a. Bamboo cupping Fibromyalgia. b.�ied Herbs into: in the cup 7. MOXA CUPPING & a. Bamboo cupping – Here HOT NEEDLE CUPPING bamboo cup is boiled for 30 This is also known as minutes with herbs, prior to tonifying method. Moxa is applying. There may be chance obtained from dried leaves of burns and blisters after of mugwort plant. It can be application of hot bamboo. found in loose type, smokeless charcoal type, round, long, cigar shaped Digestion Dry Needle Indications - long type and smokeless and Gi Problems, Tired- dry cut form. Dry cut form ness & Emotional Distress, Good for Moxa rolls are divided Children, Common Cold further�its into accordingneedle handle. to their and Fever, Facial Treat- strength like medium ment & Cosmetic moxa, hot moxa and very purpose. hot moxa. Hot cupping can 6. BLEEDING/WET/ be divided into hot needle FULL CUPPING: cupping and moxa cupping, where needle is not used. This is a draining cupping Plumblossom needle and was most popular in Among all this, plumblossom the ancient time in needle is the most popular Middle East & European b. Herbs in the cup – Herbs and dry needle is the least countries. This method is are prepared separately and popular, as plumblossom the fastest to give relax- poured at the time of cupping. needle makes channel in no ation to the patient. Toxic Suction should be medium if time whereas dry needle takes substances in the form of practitioner uses herbs in the long time for making chanel. blood seem to purge out cup. Make several incision in from the patient’s body. shorter period of time & In a single cup, 20 ml to remember about the bleeding 100 ml of blood can be time (1 to 9 min) & clotting drawn out in about 5 time (8 to 15 min). So the minutes of maximum whole process should be time. It is better not to completed within 9 to 15 min. apply it more than 5 minutes. Prior to applying cup make the channel for Indications - Joint stiffness blood to come out. Indications – Asthma, Spleen or stomach cold and pain, Bed wetting of the There are 3 way to make type patterns, Wind-Cold children, Asthma, Infertility, GI incision: Bi syndrome, Cough, problems, Emphysema, Cough, 1. Surgical blade Anemia, Infertility, Impo- General relaxation purpose, 2. Dry Needle tence, Low back pain, Incontinence, Neck & shoulder 3. Plumblossom needle Dysmenorrhea pain

30 PHYSIOTIMES Vol. 9, Issue 1, July’ 2017 Spotlight PT

9. WATER CUPPING: Indications – Joint pain, Sports 13. Sports Cupping: It is round bruises on his injuries, Traumatic injuries, chiseled body, and by now, Water cupping treatments Muscular pain accompanied by application. It also releases the whole world is aware require a highly experienced heat pattern. thepopular myofascia for on and �ield reduce of the reason: they are the practitioner. This method the pain and spasm and after marks of cupping - an involves the very quick and 11. NEEDLE CUPPING: promote healing. It can be ancient Asian healing dexterous application of a Needle cupping is used to divided in two types by its ritual. Not just Phelps, a remove excess pathogen as well mode of application. number of celebs including with one-third full warm as reduce pain. This releases the Gwyneth Paltrow, Jennifer water,glass or without bamboo spilling cup �illed the a. Dynamic sports cup – active trigger points and also Aniston, Victoria Beckham, water. It is not so popular and Here the target muscle or the muscles. Needle size (0.5-1 Justin Bieber are also area should be selected inch is safe) depends as per the swearing by the therapy. need. Insertion of needle Cupping can reduce any muscle belly and stretching followed by the application of kind of pain, so it is said by should�irst. Two be cupdone placed along inwith the cup. Total treatment time the Cupping practitioners the cup. Then it is left for 5 may vary from 10 to 20 minutes. that Cupping can cure to 10 minutes as per the Some blood may purge out everything but cannot requirement. Stretch effect during this process. There linger death. should remain same should be needle clearance after throughout the treatment application of cup. This article is divided into 2 parts. it requires very expert hands, time. If the stretch effect is This is Part I of the article. In the and moreover the therapeutic reduced then cup can be next issue, we shall cover part II, withdrawn. which would include: Cupping effect is less for this type of equipments, Conditions where cupping. cupping is used commonly, Where not to apply, Absolute contraindi- Indications – Asthma, Dry skin, Rheumatism, Localized frequency & no of cups, Cupping swelling, Pain marks,cation, YellowMost preferred �lags, Age, time to undergo Cupping, Do’s & don’t 10. ICE CUPPING - Ice after being cupped. cupping is not TCM, it is a b. Static sports cup – Here very new method and was the stretching is done prior Prof. Satyen - to cup. After stretching Bhattacharyya apply the cup at two poles Associate Professor - pist. In TCM it is said that BIMLS, Bardhaman “cold�irst started is death”, by soa Physiothera ice cupping Indications - Arthritis of muscle (near to the Chief Physio - Fit O Fine Physio- is against the principle of (Osteoarthritis, Rheumatoid origin & insertion point). therapy Solutions, Bardhaman. TCM, but it is giving excellent Arthritis etc) Range of motion For more visit www.�ito�ine.org outcome in sports injury limitation due to muscle References patients as well as other stiffness, Muscular spasm and 1. Traditional Chinese Medicine Cupping Therapy 3rd edition by ILKAY ZIHNI CHIRALI MBAcC patients. It gives anti- pain, Sports injuries, Stiff joint. RCHM 2. Qayyim Al-Jauziyah (2003). Abdullah, Abdul Rahman (formerly Raymond J. Manderola), ed. 12. Myofascial Cupping: This Healing with the Medicine of the Prophet. ISBN 978-9960892917. in�lammatory effect and it types of cupping is basically CONCLUSION : 3. www.acupuncture.org.uk 4.http://www.ib3health.com/products/SuctionC reduces pain ef�iciently. used to release the myofascia. It upping/Literature/TypesofCupping.shtml is a two cup procedure and Cupping has become a 5. https://puretherapyclinic.wordpress.com/tag popular and effective mode 6. http://drmeelainling.com/cupping/ generally used for long & bulky 7/�lash-cupping/. A Tooth from the Tiger’s Mouth by Tom Bisio muscles. Placing two cups at the of treatment. In most of the 8. http://www.lovieacupuncture.com/cupping/ 9. same muscle belly and stretch- countries Cupping is used kolkata/City-soaring-high-on- by the Physiotherapists in cupping/articleshow/53806788.cms http://timeso�india.indiatimes.com/city/ ing them in opposite direction is 10. Essential of Medical Physiology 6th edition by K Sembulingam&PremaSembulingam the technique of application. 11.Encyclopedia of Cupping Therapy by Izharul H neuro, geriatrics etc. Other 12. The Art of Cupping by Courtney Dawson 13. Cupping Therapy by Steve Smalls 2016 Indications - Calf muscle thanvarious Michael �ield likePhelps' sports, 14. Mohammad AminSheikho. Cupping: A spasm, Low back pain (extensor spectacular performance perspective (Kindle Locations 39-41). Kindle group of muscle), Quadriceps Editionprophetical medicine appears in its new scienti�ic during the Rio Olympics, 15. Hijama by NajatHaddouch Kindle Edition weakness and spasm, Lumbar what caught the viewers' radiculopathy attention was the large,

PHYSIOTIMES Vol. 9, Issue 1, July’ 2017 31 PT Snapshot Art in Physiotherapy The need & importance

Art is an integral part of humanity. 90% of information transmitted to the brain is visual, and visuals are processed 60000x faster in the brain than text. Everyone’s brain has a visual tool kit and this depends upon what we see in normal environment on a daily basis. According to our visual kit, our brain gets the meaning of the visuals. So, visuals make it easy for our brain to understand. Bhavan Bhavsar The writer is Neuro rehab expert, creative designer, Neuro Marketer

At one workshop, a reaches to inferior temporal an exercise regime to which can be remembered participant asked me, how lobe where it understands the remember, and what do we visuals can give meaning? object in space & depth. At last give to them? and explained home exercise I told “when you think it is the parietal lobe which programfor long. Ais clearly important de�ined to about innovation, which gives the meaning. Our brains recovery. The correctly object do you remember?” have to do a lot of work with prescribed and performed I am sure most of us all that raw data that comes in exercises can greatly reduce remember the light bulb - stitching it all together, pain and help restore which relates to innova- choosing what to concentrate function. Likewise, an tions or innovative on and what to ignore. It’s the incorrectly prescribed or thinking. brain that constructs our performed exercise has the A handout for Basic visual world. Chair squat or potential to aggravate a sit-to-stand movement condition. This is exactly how our brain process Now the question is how we where a more effective information.Let us �irst understand When we see make such art, object or We know Google guru visual communication would any object or art or activity which can be easily always stands up for be an advantage, both for the remembered and all this anything and we give therapist and the patient as comes from the primary depends upon how we copy/paste print outs to it would aid treatment visualactivity cortex the �irst which response gives regulate the above-mentioned them which are not at all adherence and patient outline of the object or process more attractively. appealing and many of our compliance. activity. In progression to clients even don’t bother to How many of us have experi- that it goes to secondary see them. The role of A research done by the enced that our clients (saying creativity and art comes in University of Waterloo, patients is not ethical now in color and gives insight to where we want to pass our Canada states that visuals, some countries) ask for thevisual object. cortex Then which after �ills it information more purpose- pictures or signs are more handouts for home exercise or fully and with an impact

32 PHYSIOTIMES Vol. 9, Issue 1, July’ 2017 Snapshot PT effectively remembered for For Example: To make it simple let us ONLY 10% a long time in comparison see a few examples: 1. Why do we make pediatric to written information. OF THE SPOKEN wards in a way which appeal Charts: Information can 40% of people will respond to the kids? be easily produced with WORDS ARE better to visual information pie chart for better REMEMBERED than plain text. 65% of all 2 . Why in many of the understanding than the population are visual AFTER 2 HOURS. written contents. learners in the world. Only lemon scent? Lemon scent is Where art can be useful in 10% of spoken words are provedconsumer to impactstores wepositively �ind in Better diagram Visuals: physiotherapy? remembered after 72 decision making of buyers. of exercise can be easily hours. All word or letters remembered and 1. Education - academic level 3. Why we choose different are transmitted as pictures executed than written / self-learning colors for different gender? to our brain. messages. 2. Feed-forward for clients 4. Why Kinesio tapes, rock 3. Branding & marketing Art or creative visuals can Infographic: Informa- tapes or other tapes come with 4. Improve self-assurance be used in physiotherapy to tion narrated in graphi- 5. Establishment of treatment propagate the information cal way can sharply get are now coming up with self protocols for purpose of education to into the brain tattoo�lashy colors?design toDynamic attract moretapes 6. Innovation in therapies students/clients clients and give less negative How physiotherapists /self-learning. It can be impact on our clients about can learn or execute 8. Shape up positive environ- used in our educational tapping because it matches the such art form? ment7. Design of equipment system to make vital skin color and looks like tattoo understanding easy, for Art is not something that Marketers & designers are on skin. clients to remember is always taught in there to build up art for prescribed exercises & 5 schools and colleges. therapists but we need to be co-relate therapist’s One needs to be passion- more creative to pass on our sayings, while self-learning . Why do we �ind orthosis in ate and if one draws message clear and loud. There are many such examples can be executed by �lashy colors ? attention and sees the to make us understand why we To sum up, physiotherapists e-learning or other environment with a need to balance likes/dislikes who would embrace visual medium. different eye than of clients. content are likely to see huge he/she can be creative. There is one more emerg- returns in terms of, well, As mentioned in the process of One needs to think out of - visual transmission, we box to be more creative marketing” which can also clients. Oh, also revenue. So understated that outline & and artful. Most helping �ield our calledunderstanding as “neuro takemore a inquiries, re-look at leads, your marketand - color has got its importance profound thing that further. Neuromarketing is ing program and patient and we need to apply that researchers found to be a �ield that applies the communication and see how while making the visuals. creative is not to have principles of neuroscience visually competent it is. expectations. If you don’t to marketing research, visuals transmitted through expect the things the studying consumers' ourCircle brain is the easily. �irst Red,shape blue of and way it is than you have sensorimotor, cognitive, yellow are the shades which that urge to be more and affective response to give positive impact and creative and which can marketing stimuli. person remembers more produce many innova- In neuro marketing one can objects with these colors. tions. understand the consumer What are different art forms? Many online resources behavior by many methods are available for making (Eye tracking, Heat maps, Art form can be anything. It your creatives. One can EEG, EMT..etc ) and make can be pictures, charts, also create the visual the end product more infographics, visuals, videos, TAKE ACTION program with few profound in a sense which paintings, drama etc. Choosing softwares which can be TODAY. GET can make more appeal to the most appropriate art form done with the help of a the viewers. By knowing is again a skill and can be VISUAL. GET designer or neuro likes/dislikes of our clients developed by learning few marketing professional. NOTICED. we can modify our design, principles of neuro marketing. working pattern, working GOOD LUCK. environment etc.

PHYSIOTIMES Vol. 9, Issue 1, July’ 2017 33 PT Techvantage

The healthoid way

Whether we agree or not, we are already in De�initely there is no reason Physiotherapy is a vast Scales commonly used for grading the clutches of as to speak; to avoid smart subject and there are a medical conditions technology and the phones and the apps. But as lot of areas which a youth these days is Anatomical landmarks, surface health care providers - as physiotherapist needs to suﬀering from the anatomy for easy reference physiotherapists, how refer during the course of APP FEVER. The cell professionally are we being assessment and treat- Flowcharts and �igures for treat- phones with faster bene�itted? Is there a need to ment. It might not be ment purposes. internet, 4G and develop physiotherapy and possible to carry huge mobile application A clinical know how for differential health related apps? YES of books to clinical areas market in diﬀerent diagnosis course! where students are stores (GOOGLE PLAY posted. In instances Clinical bedside pearls which make STORE, APP Store) is There is no one who can deny where they have a doubt the diagnosis and treatment much gripping us; whether of not having any ache in the and they need to quickly more precise you are a student, a spine, knee, foot; commonly! refer something, a professional, a Just one random search on Database of physiotherapist, clinics, physiotherapy mobile technical person, a Google Play store would and hospitals - so that it becomes applicationThe health care would mobile help. teacher, a doctor; reveal that there are already a applications would easier for patients to search physio- name a profession plenty of apps available for usually contain informa- therapists. and you have an app the use of physiotherapists. tion like: Through these apps students can for your taste and However, this article would refresh their knowledge anytime, for skill. discuss, why should there be optimal use of their time. Patients more new apps developed for Normal and pathological get a brie�ing about the disease physiotherapy and what are reference ranges condition they suffer, so as to be the areas that can be covered (biochemical laboratory well informed before consultation. If in those apps. test references) exercise videos are made available in the app, these would help 34 PHYSIOTIMES Vol. 9, Issue 1, July’ 2017 Techvantage PT patients do the exercise Suggested pages section correctly even at home containing physiotherapy without supervision and related information enhance motivation and 2) CREATING NEW PHYSIO- compliance. THERAPY RELATED APPS: Mobile applications can This is for the new develop- actually help both the end ment of the application, users & the service provid- which can be customised and ers by providing a common framed as per the need of the platform & knowledge. therapist. It is further divided Here we mention different into the following categories. strategies as to how APP MARKET can be a boon for a) FOR PROFESSIONALS physiotherapists. These & STUDENTS: guidelines would help the The designing of the mobile technical people to design applications should include the app & the physiothera- the following points: WORKSHOPS pist to guide accordingly in Manual Therapy: the process of instructing - the app makers. tions, concepts Module 1 (Spine) & Module 2 (Periphery) • Newer inventions, interven Therapeutic Taping Dry Needling 1) EXISTING NON PRO- up gradation of knowledge FESSIONAL APPS: • evidence based studies for Cupping Muscle Eneregy Technique (MET) There are a lot of mobile for professionals to use for Ergonomic training for corporates applications which are their• newer patients, treatment so that protocols the already installed in our cell therapists are up to date phones, those common professionally ones; the new applications can use the existing in the last minute. These platforms for introducing application• Basics for informationstudents to revise themselves to the potential would include basic sciences, customers in the following conversion tables, laws, manner: theorems By creating an advertisement of the clinical setup, and clinical notes (like instrument, any course for bedside• Normative pearls) reference values physiotherapists; in any health related app or in information by the profes- other top grossing apps. •sional, provision as a partfor storing of medical patient records keeping - messages that are eye catchingFlashing -and like �lickering conditions any,• common they can suggested also provide investi we treat, consultation fees, nearbygations diagnosticand their �indings laboratory for details below the common applications.package bene�its scrolling common conditions Easy to click link available • differential diagnosis of in the same commonly physiotherapists to explain Resource Person- used apps - which would their• blogs experiences exclusively which for they Prof. Satyen Bhattacharyya redirect the patients to a face in day to day life in the Associate Professor, physiotherapist’s contact clinical set up, do’s & don’ts BIMLS, Bardhaman information. Contact - 8348050005 Website - www.fitofine.org

PHYSIOTIMES Vol. 9, Issue 1, July’ 2017 35 PT QuintessentialTechvantage

Coming days would see a lot of innovative apps • online chat zone - to The good news is that a lot of being made to enhance discuss patient issues so the above is already being that peer advice and done by many proactive effectiveness for physio- reference is available professionals. The only thing therapy in the clinic, in handy to take care is not to mix education or just for • legal health care other things with proces- professional development advisory information as sional exchange. For example, medical professional do a whatsapp group sharing lack legal knowledge e-books must only focus on • app to buy and sell various books. Members 8. Videos or links for videos physiotherapy related must refrain themselves from where appropriate stuff and equipment, so posting any unwanted 9. Direct to website links 4) VIDEOS AND PICTURE that it is easy to set up a information. for wholesome information GALLERY: clinic for a new comer 10. Provide help • hospitals, clinics, desk/support/contact us vacancies and home care section for feedback & database - to join, apply These exclusively designed resolution of issues if any for job, to deliver treat- applications contain pictures 11. Chat zone with prompt ment is all made easy and & videos of professional reply and response from b) FOR PATIENTS: at �inger tips content. Such apps can be the technical support team 3) COMMUNICATION APPS: developed where information 12. Rating and reviews regarding disease is available section When we think of making pictorially. For example, an application exclusively • X-rays of common condi- PHYSIOTIMES app has There are lot of social connect done justice to the physio- for the patient or a applications which are tions. Typical radiographic section to be designed for features being highlighted. therapy fraternity by rampantly used for informa- providing a platform to the use of the patient it tion transfer among peer • videos demonstrating should be kept in mind to exercises for common learn, express from the groups. Such platforms should knowledge pool of physio- keep things as easy as be used for professional conditions possible. • videos pertaining to good therapy. It ensures to cover interaction and information health care holistically. • Apps showcasing scope transfer as much as possible. ergonomics, good posture of physiotherapy and its bene�its We are sure the coming • content should be easy • Communication apps like • life style modi�ication days would see a lot of and simple to follow even whatsapp, viber, hike to name • disease prevention strate- innovative apps being CRITERIA TO DEVELOP by a layman a few; can be used exhaus- gies made to enhance effective- PHYSIOTHRAPY APP: • health and disease tively for knowledge transfer ness for physiotherapy in awareness and sharing. the clinic, in education or • role of physiotherapy in • these apps enable the user just for professional disease prevention to form a group of profession- 1. A catchy name development thereby • lifestyle changes so that als / students of same college 2. An attractive logo helping the physiotherapy life is healthy or different college to share 3. Consume less phone fraternity and patient • contact numbers, information internal memory population derive its timings, route to reach a • physiotherapists of a 4. Listed in the free applica- bene�its. Dr. Smruti physiotherapist clinic/ particular locality or state can tion category to reach masses Swagatika Dash (PT) hospital - the ease of form a group and help each (paid applications may be treatment process other during patient referral available for physiothera- Assistant Professor • easy to �ix appointment and case discussion pists) Narayana Hrudayalaya through app • same way groups/network 5. Easy to use Institute of Physio- therapy,MR. ANSUMAN Bangalore RATH • online help desk by can be formed by different 6. Contain use of simple physios to answer physiotherapy clinics, hospi- terminologies questions asked by tals, colleges, instrument 7. Diagrammatic representa- BTECH (EEE), MBA suppliers Strategic Marketic patients tion for advises and exercises, Manager, Ramsoft • online payment mode • these can be means of with easy to follow �low Technologies Pvt Ltd, for services advised sharing e books between peer charts Bangalore groups

36 PHYSIOTIMES Vol. 9, Issue 1, July’ 2017 AN ISO 9001 :2008 COMPANY ISO 13485:2012 www.chiragphysio.com

Digital Mini Stimulator

India’s first computerised mini stimulation with Buzzer and Timer. 14 Inbuilt programs with Galvanic, Faradic, Surge faradic and Tens. Unbreakable electrode wires with Rubber electrode. Fully feather touch control. 4 Electrodes, Double channel high output. Latest cover case, Pen Electrode Included. Attractive PRICE Mini Stimulator 2 Electrodes/4 Electrodes OFFER Available

A handy unit designed for field work and ward Output 0 to 90 volt. 3 Types of current (SF, IG, Tens) In SF, Contraction Period can be varied from 1 sec to 9 sec approx. Rest period is 1 sec. fixed. Operates on 230 volt AC. SF, IG and Tens Led indication.

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Poonam Botadara Assistant Consultant, Ramakrishna Mission Hospital, Khar West , Mumbai Home Healthcare: Best Practices

Home health care is a system After listening to the home functional level. However in already tried some home of care provided by skilled health care experiences of my India, most of us are not remedies but to no avail. She practitioners to patients in colleagues at work and other currently facing such issues resided with two maids in their homes. The goals of physiotherapists, I thought of due to the standard of the house and her daughters home health care services are writing about this important practice being different would visit/stay whenever to help individuals to improve topic from my point of view. I from other countries but possible. We started function and live with greater have been actively involved in very soon I am sure that we rehabilitation keeping all the independence; to promote the home health care for about will also have these proce- factors such as age, medical client’s optimal level of three years now along with my dures soon enough with so history (HTN, IHD and well-being; and to assist the job at the hospital and thus much advancement in our severe OA of both knees patient to remain at home, thought of taking up this topic requiring TKR which she avoiding hospitalization or on a larger scale for all of us in didn’t wish to undergo), x- Let me narrate a small admission to long-term care �ield in the last few years! ray and orthopedic clearance incidence that prompted institutions. When it comes to in mind and progressed very While I was in the United me to take this up more physiotherapy, home health this �ield. slowly with her. care is an integral part of the States, I was constantly sincerely. I will highlight the practice. More so in the reminded about the impor- important things. I was I explained all precautions modern era, where people tance of documentation, treating an elderly lady and necessary steps that have started expecting insurance policies and also aged around 80 years for needed to be taken to the everything over a single click heard numerous cases of her right knee pain, which daughter and the maids, of a button, home health care clients suing the therapist or developed after having gave regular updates to the is fast becoming a more the Insurance Company’s twisted her knee while daughter post every session convenient and usually less queries for Physiotherapists to trying to get off the car. She and handed an exercise expensive alternative, justify the number of sessions was unable to travel due to sheet with instructions in especially for the elderly needed by the patient to the pain thus wanted to be the language understood by population. restore them to their prior seen at home. They had her daughter and maid

38 PHYSIOTIMES Vol. 9, Issue 1, July’ 2017 separately. Having learnt regarding the Physiotherapist Be an achiever the importance of docu- not having enough knowledge mentation, I used to keep a and thus she had landed with Be a Certified MDT record of general patient a tibial stress fracture (She Start your Certification in Mckenzie details, anything clinically used colloquial words on relevant or the changes behalf of the Orthopedic Be an expert in Mechanical made in exercise protocol which I do not deem appropri- Diagnosis and therapy in a notebook as and when ate to quote here as I am Course Highlights: possible, more for my aware of only one side of the - Patients evaluated and followed up - conversation). The daughter - 6 months passwords for videos of practicals tion to modify didn’t accuse me directly of - A copy of “Treat your own back” book treatment/evaluation.reference and self re�lec anything but I was deeply hurt - Online support on your difficult clinical cases by her statements and sudden Faculty: The sessions were irregu- - Universally credited certificates change of words. Dr. Asha lar after sometime as she - Same study material round the world Menon was having other health Despite repeated requests and - Continue the certification in any part of the world Mckenzie concerns and I insisted on concerns to take her mother Institute - Helps you excel clinically after the course International medical clearance from her to an Orthopedic they refused Cardiologist before to do it when it was needed Upcoming Courses: continuing her physio- and found it so easy to put us Level A (Lumbar Spine) therapy treatment. Her at fault for what could have Mumbai Gurgaon daughter contacted me gone wrong at their end. after sometime stating that Luckily having my notes, 26 TO 29 17 TO 20 her mother was better and images of the patients knee Oct Oct Nov Nov the doctor said we could range (after taking her continue rehabilitation. I web: www.mckenzieinstitute.org/india resumed the session and that I had taken all precau- email : [email protected] noted that she was tionspermission) and still I wasfaced con�ident with this complaining of increased unpleasant situation. I start pain in her right knee on wondering what if I wasn’t CONFERENCE OF MECHANICAL weight bearing which keeping a note of things, what DIAGNOSIS & THERAPY 2017 wasn’t present earlier and I if I had not stopped further “SIMPLIFYING THE COMPLEX” requested her daughter to treatment at the right time? see an Orthopedic at the This led me to thinking that so earliest, however they said 9-10 December 2017 much could have gone wrong they had shown him and he @Hotel Avion Vile Parle, Mumbai, India in terms of not knowing the had advised TKR only so truth from the daughter or the www.mckenzieinstitute.org we should continue. house help regarding patients Registration Details However I refused to go activities at home which could Category Till 30th Sept After 30th Sept ahead with the treatment have led to the increase in DIP.MDT/CERT.MDT 7500/-INR 9000/- INR as I noted increased pain, any carelessness on the MDT(A-D) 5000/-INR 6000/- INR swelling, bruising and pain part of the house help as they REGISTERED PHYSIO 3500/-INR 4000/- INR in her knee. I also noted have their own advice to give UG & PG 3000/-INR 3500/- INR that the maids and daugh- to patients, what message was SPOT REGISTRATION 10,000/-INR ter had different versions conveyed to the Orthopedic, Payable By NEFT to our Axis Bank A/C (Mira Road Branch) of details which were told were the exercises being done Ac Name: Mckenzie Institute India (Type: Saving Account) to me when I inquired or not, were they not followed Account No.913010037508085, IFSC Code: UTIB0001842 about my patient’s activi- correctly and so many small Key Features: ties in details. After a few things which could have gone days the daughter said that wrong. Luckily she didn’t land Radiculopathy I Mechanical Deformities of Spine I she took her mother to a up with anything severe or it The Extremities: Focused on Shoulder & Ankle I different Orthopedic who could have led to a negative Geriatrics: How to Handle I Thoracic Spine: The Unexplored advised her bed rest and mark on ones career without Territory I Rheumatology: Brain Teaser I Quiz & Poster also made a comment being at fault. Presentation I Credit Points For Dip/cert MDT Applications for abstract & poster presentations to be emailed at: [email protected]

PHYSIOTIMES Vol. 9, Issue 1, July’ 2017 39 PT Special Article ADVERTISEMENT I discussed this with all Avoid using signatures and try MRP my colleagues and HOD at using a stamp (there could be Rs.395/- work and also started a misuse of your signature in thinking that even when your absence) or Letterhead. we try to go with the right clinical decision every 3. DOCUMENTATION time we may not have Document details especially evidence to prove it. medical history and any other I would like to take this relevantclinical �indings, information reports, needed opportunity to provide on day 1 of the visit. with some guidelines and safety measures for all Keep a copy of the reports. those practicing home Make a note of exercises health care. added/changed and a note of A few important things important progress notes with which I think we need to dates. take care are: It is also important to notify 1. SAFETY the orthopedic/doctor concerned with the updates in Have brief knowledge of patients rehabilitation. It the family members of the could be in the form of a patient you will be message/call or a simple note visiting. when the patient has an Safety is important and an appointment scheduled with issue that is not given lot the doctor concerned. That is of thought. an appropriate way of gaining - For female therapists dence as well. make sure there is some the patients faith and con�i Order ONLINE: http://www.physiotimes.com female present in the FOR THE THERAPIST Pay Rs. 445 by PAYTM on 8141585752 house while treating male Take care of your own body Rs.50 extra towards Shipping and Handling Charges. patients and visa versa. posture while treating payment in front of the Keep someone informed patients. other staff at home and about the area / homes Ask for help where possible as respect the privacy of your (tape, goniometer, pulse one plans to visit. a home set up is different payment. oximeter, stethoscope, from a hospital set up and theraband, pocket 2. CHARGES Keep a tab on medical thus make use of equipment diary/notepadTNS/US/IFT, measuring and pen). Be clear about the charges condition of the patient & to enable easy functional tape, sanitizer, tissues, before you visit (these are remember to STOP therapy If you are unsure about transfers. variable everywhere but if there is slightest suspi- till then its ethical to keep Sanitize. cion of any abnormality. please discuss and ask for charges uniform for all guidanceanything regardingthan proceed the withcase, Wear comfortable and Give clear instructions to from a particular work- something that may prove appropriate clothing including the family members with place). detrimental to the patient. I footwear. regards to exercise and how would be more than happy Discuss how the payment they need to be done. even if one small thing is of will be given (Cheque/ FEW POINTERS IN GENERAL: Train the staff with regards use to any one of us! I am Cash/other means). Make sure you keep a record sure there may be things I of the days that you make a Inquire if they require a for the patient. may have missed out but I visit and notify patients to do receipt for the sessions in to hygiene, transfers , care would be happy if this topic the same. Carry a small physiotherapy the beginning itself. leads to a discussion kit. The following things Request the patient / family amongst us! which comes to my mind members not to make

40 PHYSIOTIMES Vol. 9, Issue 1, July’ 2017

PT Current Affairs

The latest physiotherapy and rehabilitation research from prestigious universities and journals across the globe.

Neonatal physios NICE has recommended nerve through the skin, it is Can Accelerometers, should monitor that physios should be hoped the bladder should also Fitness Trackers Be preterm babies until involved in preterm be stimulated too. The treat- Used For Research? age of two, NICE says. infants' care plans until ment is akin to using a TENS they reach the age of two, machine for pain such as that carrying out assessments, associated with labour. advising on treatment and Published: July 19, 2017 Source: attending face-to-face https://goo.gl/7hbTN4 follow-up appointments to monitor progress. Scientists testing new (Published: Aug 21, 2017 Source: walking technique for https://goo.gl/WfWYi7) rheumatoid arthritis patients Specially trained physio- Fitness trackers are nowadays Funding has been approved therapists should be commonly used to track daily Could physiotherapy for a new study that aims involved in the care plans of physical activity levels. But they exercises help reduce to see whether gait premature babies from as may not be a good choice to use incontinence? rehabilitation could work soon after they are born as them as a source of objective as a therapy for patients possible. This is according to A study is to take place to data for research. with rheumatoid arthritis new clinical guidelines from test whether a type of (RA). In a "state of the science" physiotherapy could reduce the National Institute for review, Roy J. Shephard, identi- Health and Care Excellence the incidence of urinary The walking technique has incontinence in Britain's care (NICE), which recommend be worked out in using data homes. that the expertise of neona- for people with mobility from�ies some activity key monitors issues that to need to already proven bene�icial tal physiotherapists is used Researchers from Glasgow issues resulting from - more commonly when it Caledonian University want neurological conditions dations for physical activity to comes to treating preterm such as stroke, multiple promotecon�irm and good clarify health. recommen ‘Acceler- babies. delivering a mild electrical sclerosis and Parkinson's ometers perform fairly well at to investigate the ef�icacy of disease. NICE has recommended that stimulation to the leg that moderate walking speeds, but should also affect the Now, the National Institute are less accurate under other physios should be involved in bladder. for Health Research (NIHR) conditions - for example, slow preterm infants' care plans Transcutaneous tibial nerve has provided Glasgow walking, vigorous running, and atypical gait patterns.’ until they reach the age of two. stimulation (TPTNS) Caledonian University with involves placing two surface £1.8 million to run Continued technical advances electrodes on the patient's Neonatal physiotherapists might help to overcome some of ankle and using a small the limitations of current could also help with cognitive �ive-year trials that will test electrical stimulator to send have painful joints and activity monitors. In the near and sensory developmental a pulse to the nerve near the its ef�icacy on people who challenges, advising parents future, more complex devices ankle. This is because nerves result of RA. may be capable of linking on exercises and activities dif�iculty walking as a that control the bladder are simple body acceleration data to they can do with their child to also connected to the tibial Published: July 5, 2017 Source: give them the best possible https://goo.gl/R3NRdY other factors such as posture nerve at the back of the and GPS location. chance in their early years. lower leg. By stimulating this

42 PHYSIOTIMES Vol. 9, Issue 1, July’ 2017 medilab India www.medilabindia.com 9341071364 Importers and Distributors for Physio and Occupational therapy product range

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Self-guided physio- The intervention might be Physios should over the same time period. therapy could benefit useful as an initial treatment recommend yoga for chronic fatigue back pain It was found that for patients to help manage regularly taking part in patients the symptoms of CFS. yoga was as effective at reducing pain levels, The self-help intervention improving movement (guided graded exercise and helping patients to self-help, or GES) involves come off or lower their slowly and safely building dosage of pain medica- up physical activity levels tion as standard physio- (eg. a few minutes walk- therapy. ing) after establishing a daily routine, with the Yoga is just as effective as other mind, physiotherapists support of a specialist forms of physiotherapy in couldWith these begin �indings suggesting in physiotherapist over the easing lower back pain, A self-help approach to a yoga to their patients as phone or Skype™. meaning physiotherapists may graded exercise program, an alternative to continu- want to recommend it to their supervised by a specialist The self-help approach ing with the exercises patients. physiotherapist, is safe and may means that patients do not they have learnt during reduce fatigue for some people need to travel to a clinic, New research carried out by their regular physio- with chronic fatigue syndrome and the authors say the scientists based at Boston therapy sessions. The (CFS), according to a new trial intervention might be Medical Center in the US saw two forms of therapy of 200 people published in The useful as an initial treat- 320 patients suffering from could even be combined, Lancet. The intervention, ment for patients to help pain in their lower back as both achieve the same undertaken over 12 weeks, had manage the symptoms of assigned to either a 12-week pain-reducing outcomes. a smaller effect on reducing CFS. course of yoga classes or 15 (Published: June 21, 2017 Source: physical disability. (Published: June 24, 2017 Source: sessions with a physiotherapist https://goo.gl/MHck72) http://www.thelancet.com/)

PHYSIOTIMES Vol. 9, Issue 1, July’ 2017 43

PT EVENT CALENDAR th 8 September 2017 11th Gujstate Conphycs 2017 WORLD 13-14 October, 2017 Organised by J G College of Physiotherapy, Ahmedabad PHYSIOTHERAPY DAY http://www.conphycs2017jg.com Stride 2017, International Physiotherapy Conference 26-27 October 2017, Organised by Saveetha College of Physiotherapy, Chennai www.scpt.saveetha.com/stride17 MTFI MANCON 2017: Manual Therapy Conference 29 October 2017, Jodhpur http://mtfi.net/ PGCON 2017, JSS College of Physiotherapy, Mysore SHARE YOUR STORIES of the 3-4 December 2017, www.jssphysiotherapy.edu.in SAICON 2017 - International conference on Sports World PT DAY Celebrations Medicine & Sports Sciences Your stories will be published in PHYSIOTIMES Sept-Oct 2017 7-9 December, 2017, New Delhi email: [email protected] http://www.sportsauthorityoﬁndia.nic.in You can email us in brief (not more than 200 words) about the activity you undertook on the World PT Day in your area / town / city / college / clinic / 6th International Conference of Physical therapy hospital along with the key impact that this activity had on the people. You can 9-10 December’ 2017, AIIMS, New Delhiwww.incptaiims.org/ also send us a few high resolution photographs of your event along with the write up. Your mail must reach us on or before 14th Oct’2017 National Conference on Physical Therapy (NCPT) Note: Submission of the story doesn’t guarantee publication. PHYSIOTIMES reserves the right to reject 16-17 December 2017, Mumbai http://ncpt2017.com/ a story without citing any reasons thereof. Best of web Book Review

In this section we bring to you interesting ORTHOSES, PROSTHESES websites of clinical & academic relevance to & ASSISTIVE DEVICES physiotherapists. In this issue, we introduce... FOR PHYSIOTHERAPISTS by Sinha Akhoury Gourang, Sharma Raju, http://www.themanualtherapist.com Tripathy Subrat Kumar This site features daily blog updates, This book presents a comprehen- weekly podcasts, research reviews, sive, yet concise description of orthoses, prostheses and various videos, and more!" Winner of Therapydia’s assistive devices such as wheel- coveted Best Overall Blog for 2014,* *which should be enough to make you check out the link. chairs, walking aids and therapeutic positioning devices (chairs, https://www.webpt.com/blog standing frames and parawalkers). The subject matter is Stay on top of the latest rehab therapy presented in three sections dealing with orthoses, prosthe- tips, trends, and best practices. WebPT ses and assistive devices. In this book detailed description provides great content. If you are struggling to figure out of hand splints and foot orthoses (Jaipur foot), concise what PQRS is, or what Medicare is going to do next, this is descriptions of spinal orthoses with specific clinic uses and a great place to start. biomechanics, and the types and components of upper and lower limb prostheses. In order to facilitate the under- https://cinemasays.wordpress.com/ standing, the book contains a good number of figures and A selection of a Physio’s curiosities, photographs of most of the devices described. The book interests, and explorations. Content will range intends to fulfill these requirements and attempts to from Physical Therapy to other interests and more. provide all the relevant information in one place.

46 PHYSIOTIMES Vol. 9, Issue 1, July’ 2017 Word Maze PT Word Maze On “Myofacial Trigger Points” 32 Search as many words as you can related to Myofacial Trigger U S E R U M T R P S O Points from the given word maze. They can be in any order or L F L T I N N I T U S any direction. (Horizontal, vertical, from left to right, right to left, top to bottom, bottom to top & overlap). N A U F R I C T I O N A I D N A B T U A T L You can e-mail the answers (only key) of this word maze along with R X O H S A L P I H W [email protected] before 14th Oct’2017 & the participant(s) N O N I N V A S I V E yourwith maximumname, city, correctdesignation responses & a pro�ile will be picture declared on ouras the email winner(s). id: The winner’s details will be published in our forthcoming issue with O P A R A S P I N A L photograph & he/she will be entitled to win the Special Prize. I Y T I L I B O M C A T H O R A C I C K E R Special Prize for the Winner A N T A G O N I S T E N R E G G I R T A Y H Biophysics and Therapeutic Electricity I Y R O S N E S I L P - Physical Agents in Physiotherapy L R E T E S S A M C I (Principles and Practice: Volume 1) E H A I G L Y M E H R by Subin Solomen and Y E H C A D A E H O E Pravin Aaron M S I C I V R E C L P ISBN: 9788184452105 Published by: PEEPEE Publishers E R E M O C R A S I J & Distributors (P) Ltd. D R Y N E E D L I N G No.of Pages: 250 T Y C I D O S I P E Y MRP: Rs. 295/- Shipping and Handling Charges Rs:50/-

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