Dr Satyajit Mohanty blogs

Because of the direct attachment to the vertebrae, both passive and active strain from the musculature influence the spinal kinematics in normal or destabilized motion segments. Kinetic behavior of the spine refers to studies of the spine motions. Kinetic behavior & stability not only of the spinal motions is studied extensively but also the neutral region is studied. A transition zone for example between spine movements such as flexion & extension occurs is called the neutral region. Segmental instability in the lumbar spine is associated with abnormal intervertebral motion. Most of biomechanical studies have studied the common stabilizing structures i.e., intervertebral disc, facet joints, and ligaments and have not simultaneously considered the effects of active musculature on spinal kinematics. Recent researches reveal that: 1. Axial translation increases in response to injuries to the disc. 2. Sagittal rotation and shear translation changes in response graded injurie...

The following Part of another my review………… Lumbar disc herniations can be a direct mechanical consequence of prolonged sitting in static or vibration environments that challenges the stability of this region. Static loading: A 1 hour exposure to static lumbar loading such as sitting cause significant changes in the mechanical properties of the lumbar intervertebral disc exhibited by a sudden, large flexion and/or lateral bend rotation response to an axially applied load. This further implies that a motion segment in the lumbar spine suddenly buckles and applies a tensile impact loading to the posterolateral region of the disc. Vibratory loading (Driving a car, truck, tractor etc): A combined lateral bend, flexion, and axial rotation vibration loading could cause tracking tears proceeding from the nucleus through the posterolateral region of the annulus. Mechanical impacts of static & vibratory loading on disc reveal that mechanism for disc herniation is mechanical change leading...

There is no gold standard for measurement of magnitude of force applied or joint displacement. Many scientific tools & methodologies have been used to measure quantity of force applied by manual therapy procedures and joint displacement thus caused. Among these equipments some serve to mobilize the spine others serve as measurement tools for mobilization. Different grades of mobilization have helped manual therapists to compartmentalize the quality & quantity of the energy package they provide to the receptive tissue. Having said so the general feeling is that, grades of mobilization helps in this regard only partially, because standardization of delivery can not be warranted for it is individualistic and dependant on the therapist. Therapist centered module delivery is dependant on many factors so inter-therapist variance is quite inevitable. The PA mobilization: PA technique of spinal mobilization is both a diagnostic & therapeutic tool. Both subject & instrument orie...

Spinal manipulation (SM) is a popular form of manual therapy used by variety of manual medicine practitioners to treat patients with low back and neck pain. The HVLA or the high velocity low amplitude thrust technique is one the most common form of SM application. HVLA characterized by following: 1. High-velocity (duration less than 150 ms), 2. low-amplitude (segmental translation less than 2 mm, rotation less than 4 degrees , and applied force 220-889 N) 3. Impulse thrust. The skill set for success in applying an HVLA-SM lies in the practitioner's ability to 1. Control the duration and magnitude of the load (ie, the rate of loading). 2. The direction in which the load is applied. 3. The contact point at which the load is applied. Clinical effects are highly dependant on the control over its mechanical delivery. This procedures set up biomechanical changes & that is responsible for physiological consequences especially by changes in sensory signaling from para...

I. Calin Criteria (inflammatory back pain) Four out of 5 must be present: Age Back pain >3 months Insidious onset Improvement with exercise Early morning stiffness. II. Rudwaleit criteria (axial spondyloarthropathy) A positive likelihood ratio of 3.7 is achieved if 2 of 4 criteria are present and increases to 12.4 if 3 of 4 criteria are present: Morning stiffness >30 minutes Improvement in back pain with exercise but not with rest Awakening in the second half of the night because of back pain Alternating buttock pain. III. Modified New York criteria for classification Definite AS if criterion 4 and any one of the other criteria are fulfilled. Low back pain of at least 3 months' duration that is improved by exercise and not relieved by rest. Limited lumbar spinal motion in sagittal and frontal planes. Chest expansion decreased relative to normal values for sex and age. Bilateral sacroiliitis grade 2 to 4, or unilateral sacroiliitis grade 3 or 4. IV. European Spondyloarthropath...

Background (Need of TBC): Similar pathologies presenting with similar clinical features do not respond to similar physiotherapy treatment methods, rather to different physiotherapeutic treatment strategies. Fritz reported 3 patients; each patient had signs and symptoms of compressive nerve root pathology with a similar anatomical distribution of pain. However, basing on TBC (Treatment based classification), each patient was treated with a different approach based on the assigned classification. One patient was classified as needing treatment for a lateral shift, one patient was classified as needing flexion-oriented treatment, and the other patient was classified as needing extension-oriented treatment. The approach used for each patient was successful in reducing patient-reported pain severity and level of functional disability (4). Introduction: Classification of patients with low back pain into homogeneous subgroups has been identified (3). Further the development of valid classific...

According to Knudson HA (a doctor of physical therapy) real time ultrasound imaging can provide answer all of the following questions or identify the following problems associated with LBA. 1. Test voluntary activation through conscious effort. Identify change in motor control in individuals with low back pain. If muscle wasting is identified, what is the % difference between sides of the specific segment? Identify unilateral muscle wasting within a specific segment of lumbar multifidus. Is the patient able to consciously contract lumbar multifidus while in an unloaded position without trunk movement or limb loading? Can the patient emphasize activation of deep fibers of multifidus while limiting activation of superficial fibers? (Poor quality of lumbar multifidus contraction?) Does the muscle composition of multifidus look healthy, without fatty infiltrate, fluid from injury, fibrosis, soft tissue adhesions, or calcium deposits? 2. Does the patient display one of 5 clinical patterns o...

Following is a part of a review that is for a journal. Background: The use of ultrasound imaging by physical therapists is growing in popularity (21). A special issue of the JOSPT (journal of sports physical therapy) in 2007 has been released on collection of commentaries, case reports, and research reports that document current applications and evidence for rehabilitative ultrasound imaging (RUSI) in patients with neuromusculoskeletal disorders. Professor Maria Stokes of Southampton university of UK is a renowned researcher in the field of neuro-rehabilitation has put much of her efforts in researching on RUSI. According to Professor Maria Stokes there is a need of development of investigative & rehabilitation techniques for the following purposes: 1. Provide accurate, objective tools to aid clinical assessment and motor recovery. 2. Provide valid and reliable investigative tools for research to examine mechanisms of neuromuscular function & to examine the effectivenes...

Anatomy: The midtarsal or transverse tarsai joint is comprised of two separate joints: the Talocalcaneonavicular and the Calcaneocuboid. The Calcaneocuboid Joint is formed by the articulation between the calcaneus and the cuboid. 3 primary ligaments support the Calcaneocuboid joint. They are: Dorsal Calcaneocuboid Ligament, Lateral or calcaneocuboid portion of the Bifurcated Ligament & Plantar Calcaneocuboid Ligament, a dense, thick, white structure consisting of two distinct layers. 2 layers of Plantar Calcaneocuboid Ligament are: Deep layer , runs from anterior tubercle of calcaneus to plantar surface of cuboid posterior to groove for peroneus iongus. Also known as the short plantar ligament Superficial layer , arises from calcaneus and inserts into cuboid bone continuing in anterior direction, forming tunnel for peroneus longus (PL) and finally inserting into the 5th, 4th, 3rd, and on occasion 2nd metatarsal heads. Injury: Involvement of calcaneo-cuboid joint is a rare entity....

Key words: sacral nerve stimulation, sacral neuromodulation, pelvic floor dysfunction, voiding dysfunction Sacral neuromodulation provides a new option for the management of voiding dysfunction. Tanagho and Schmidt first introduced sacral nerve neuromodulation in 1981 (2,3). Tanagho and Schmidt implanted the stimulator to treat voiding disorders like urinary urge incontinence, urgency-frequency, and nonobstructive urinary retention (3). For patients with voiding disorders, this procedure has resulted in significant improvement in urinary frequency, voided volume and pelvic pain (1). However since then, it has become increasingly popular and the indications for this procedure are growing well beyond just voiding disorders. These additional benefits have included re-establishment of pelvic floor muscle awareness, resolution of pelvic floor muscle tension and pain, decrease in vestibulitis and vulvadynia, decrease in bladder pain (interstitial cystitis), and normalization of bowel functi...

Massage can be of various depths. It can be superficial or penetrating to quite a tissue depth. How ever studies on what effect different depth of massages produce on ANS activity are not studied largely. Recently Diego & colleagues of Touch Research Institute of Florida, USA explored the same. They took HRV (heart rate variability) as the indicator for ANS activity. This study found: 1. Effect of moderate pressure massage: Moderate pressure massage elicits a parasympathetic nervous system response suggesting increased vagal efferent activity. Further, there is shift from sympathetic to parasympathetic activity that peaked during the first half of the massage period. 2. Effect of light pressure massage: On the other hand, those who received the light pressure massage exhibited a sympathetic nervous system response. Blooger’s Comments: the following must be noted. Caution: Massages are generally perceived to be safe. However the carry over ANS effects of moderate depth is not ...

Introduction to the debate – short bout or long drawn exercise: Current physical activity guidelines endorse the notion that the recommended amount of daily physical activity can be accumulated in short bouts performed over the course of a day. Metabolic impacts of exercises are specific; so training impacts are also specific which vary with duration & intensity & fuel ingestion. Aerobic exercise is low to medium output held for an extended period. Anaerobic or supra-aerobic exercise is high output, but short in duration. Dr Alsears (USA) recommends supra-aerobic exercise than to aerobic exercise for following training benefits: 1. Lose pounds of belly fat 2. Build functional new muscle 3. Reverse heart disease 4. Build energy reserves available on demand 5. Strengthen immune system 6. Reverse many of the changes of aging. Dr Alsears of USA calls his program PACE® program. The following prototype is similar to PACE program: 1. Instead of a slow, steady pace...

Alterations in shoulder kinematics in shoulder impingement: Ludewig et al investigated (humeral elevation in the scapular plane); glenohumeral and scapulothoracic kinematics and associated scapulothoracic muscle activity in a group of subjects with symptoms of shoulder impingement relative to a group of subjects without symptoms of shoulder impingement matched for occupational exposure to overhead work. Their work revealed: 1. In subjects of impingement there is: i. decreased scapular upward rotation at the end of the 1st of the 3 phases, ii. increased anterior tipping at the end of the third phase, and iii. increased scapular medial rotation under the load conditions. 2. EMG pattern in impingement cases showed hyperactivity upper and lower trapezius in the final 2 phases, although the upper trapezius muscle changes were apparent only during the loaded condition. The serratus anterior muscle demonstrated decreased activity in the group with impingement across all loads a...

Two level & multiple level thoracic disc herniation. A. Boriani & colleagues reported a two-level thoracic disc herniation. According to the authors only 26 cases of dual disc herniations are reported before 1994. However, this case was a double, contiguous disc herniation in the thoracic spine (T7-T8, T8-T9) in a 44-year-old man. The findings are as follows: 1. Intermittent episodes of weakness and numbness in the lower extremities. 2. Paraesthesias radiating to the anterior and medial surfaces of the thigh and the leg (in this case parasthesia was mostly on the left side). 3. Mild sexual and urinary dysfunction. B. Chen & colleagues reported a single case of acute noncontiguous multiple-level thoracic disc herniations with myelopathy. According to these authors multiple-level symptomatic disc herniations of the thoracic spine are rare, and the reported cases are mostly of contiguous, two-level lesions with chronic clinical presentation. Prior to 2004 no case of ...

Introduction: Frozen shoulder or adhesive capsulitis describes the common shoulder condition characterized by painful and limited active and passive range of motion (1). Adhesive capsulitisis is controversial by definition and diagnostic criteria that are not sufficiently understood. Substantial disability and significant morbidity can result from shoulder disorders (2). Idiopathic adhesive capsulitis is a commonly recognized but poorly understood cause of a painful and stiff shoulder (3). According to prevalence reports (2), shoulder disorders have been reported to range from seven to 36% of the population (Lundberg 1969). The clinical course of this condition is considered self-limiting and is divided into three clinical phases (6). Symptoms in adhesive capsulitis can last up to 2 years (5) and longer even up to 30 months (7). The diagnosis is primarily clinical and no significant changes are normally present at MRI or CT scan (7). Most treatments are conservative; however, indicatio...

Overload is a fundamental criterion for strength training. In order to stimulate further adaptation toward specific training goals, progressive resistance training (RT) protocols are necessary. Fundamental principles: The optimal characteristics of strength-specific programs include 1) Use of all verities of muscle contraction: Use of concentric (CON), eccentric (ECC), and isometric muscle actions. 2) Performance of bilateral and unilateral single- and multiple-joint exercises. 3) Sequential protocol: Strength programs sequence exercises to optimize the preservation of exercise intensity i.e. a. Large before small muscle group exercises. b. Multiple-joint exercises before single-joint exercises c. Higher-intensity before lower-intensity exercises). How the novices should go about their strength training: Novice refers to untrained individuals with no RT experience or who have not trained for several years. For novice, training, it is recommended as follows: 1. Loa...

Oxidative stress because of smoking: Both cigarette smoking and high fat meals induce oxidative stress, which is associated with the pathogenesis of numerous diseases (1, 2 , 3, 4 & 5). Postprandial oxidative stress: Postprandial lipemia and oxidative stress provide more important information concerning susceptibility to disease, in particular cardiovascular disease (5). Studies on oxidative stress by smoking A. Bloomer & colleagues compared blood antioxidant status, oxidative stress biomarkers (xanthine oxidase, hydrogen peroxide, malondialdehyde) and TAG in 20 smokers and 20 non-smokers, matched for age and physical activity, in response to a high fat test meal standardized to body mass. Findings of this study indicate that young cigarette smokers experience an exaggerated oxidative stress response to feeding, as well as hypertriacylglycerolaemia, as compared with non-smokers. Hence it provides insight into another possible mechanism associating cigarette smoking with ill h...

Introduction: Recently the focus has shifted to motor control than strength because “a strong muscle may lack a proper motor control over the joint it controls” (one may call it inability in strength). This might cause a array of dysfunction or painful disorders in a joint of it’s concern or may also be a cause for a disorder away from that place where the muscle does not exerts it’s works (Because of long kinetic chains i.e. effects of weakness in any part of the chain has a repercussion on other parts of the kinetic chain). Many research articles off late on back pain focusing on muscle dysfunction in patients with low back pain have led to discoveries of impairments in deep muscles of the trunk and back. The muscle impairments are not those of strength but rather problems in motor control (1). When it was found that it is not strength that has to be augmented rather a motor control has to be reinstituted; the approach of physiotherapy has also changed to “a motor learning exercise p...