Dr Satyajit Mohanty blogs

According to Rubik & colleagues (1994) massage therapy, the manual manipulation of soft body tissues to enhance health and well-being, is one of the oldest forms of medicine known to mankind and has been practiced worldwide since ancient times. Today, more than 80 different forms of massage have been identified, many developed in the last 30 years. Lack of consistent terminology for describing the treatments given by therapists are felt world wide. Sherman & colleagues developed taxonomy to describe therapist guided module delivery for patients with musculoskeletal pain. Due to this work a new classification system evolved. Using this, practitioners using different styles of extramural medicine (manual medicine technique) can describe the techniques they employ using consistent terminology. About the study: A review of the literature for treatment musculoskeletal pain was done for creating the taxonomy & neck pain was the matter subjected to further studies. The results war...

Mulligan's mobilization with movement treatment technique for the elbow (MWM), a peripheral joint mobilization technique, produces a substantial and immediate pain relief in chronic lateral epicondylalgia. Abbott JH & colleagues reported MWM is a promising intervention modality for the treatment of patients with Lateral Epicondylalgia. They found immediate impact on grip strength in making it pain-free (48% increase in pain-free grip strength). Both pain-free grip strength and maximum grip strength of the affected limb increased significantly following the intervention. Pain-free grip strength increased by a greater magnitude than maximum grip strength. Non-opioid pain modulation of spinal manual therapy: Naloxone antagonism and tolerance studies, which employ widely accepted tests for the identification of endogenous opioid-mediated pain control mechanisms, have shown that spinal manual therapy-induced hypoalgesia does not involve an opioid mechanism. However immediate hypoal...

Introduction: Fibromyalgia syndrome includes symptoms of widespread, chronic musculoskeletal aching and stiffness and soft tissue tender points. It is frequently accompanied by fatigue and sleep disturbance (1). The impact of the disease is considerable both for those directly affected (restriction in activities of daily living and in ability to take part in family, professional, and social life) and for society as a whole (direct and indirect costs) (4). Fibromyalgia requires a comprehensive treatment care (2). Definition: Fibromyalgia is a fairly common syndrome characterized by chronic, widespread musculoskeletal pain, multiple "tender points", fatigue, sleep disturbance, stiffness and other symptoms such as headache, dizziness, trouble with concentration, irritable bowel syndrome, urinary urgency, depression (2). The disease usually has a chronic course (3). Epidemiology: Fibromyalgia is a common chronic pain syndrome affecting particularly middle aged women as it occurs ...

(Part of one of my paper in a upcoming journal……….) Lateral epicondylitis is degenerative than an inflammatory process. Old treatment methods based on anti-inflammatory module delivery are facing theoretical nihilism. Currently few researchers are trying to inject autologous blood in to the painful area of the lateral elbow. The thought behind injection of autologous blood in such case is; it might provide the necessary cellular and humoral mediators to induce a healing cascade. Example of a study: Edwards SG et al injected 2ml autologous blood under the extensor carpi radialis brevis to treat refractory lateral epicondylitis. All patients had failed previous nonsurgical treatments including all or combinations of physical therapy, splinting, nonsteroidal anti-inflammatory medication, and prior steroid injections. The average follow-up period Edwards SG et al’s study was 9.5 months (range, 6-24 months). They found: After autologous blood injection therapy 22 patients (79%) in whom nons...

(This is a form of MFR to upper anterior thoracic ) Many hemiplegics presents with shoulder hand syndrome. Shoulder hand syndrome is also known as CRPS (complex regional pain syndrome) or RSD (reflex sympathetic dystrophy). In past and also recently I have used SPAM to mid thoracic vertebrae & MFR to upper posterior thoracic level (precisely in physiotherapeutic terms bilateral rhomboidus stretch) with moderate results on pain & disability plus overall reduction menifestation of RSD in my patients. Peers usually associate these effects of mobilization & MFR with autonomic balancing act in the zone. Various grades of touch has been shown to affect central neuronal out puts to endocrine perturbations. Myofacial release is unique in this aspect however not many research papers are there. Relief of vasospasm by MFR is claimed by researcher Walton in 2008. Following is a micro review of that paper that found MFR is a effective modality in treatment of primary Raynaud's pheno...

Pandiculation (whole body stretch) We like to stretch our whole body after getting off the bed which usually comes with a yawning. This stretch is different form the regular stretching exercise we do. Noteworthy is the difference between the pandiculation-type stretch, which arises spontaneously, is pleasurable and increases joint stability, with the regular stretching, which is produced by a volitional action, may produce displeasure and joint instability (because of this, stretching has been contraindicated before physical activity). Pandicular stretching activity is remarkably reduced after spine & proximal appendicular pathologies (Luiz Fernando Bertolucci). Following is more on the description of Pandiculation form following site: http://www.baillement.com/stretching-fraser.html. The symmetrical, coordinated stretching and stiffening actions of the body as one unit is true pandiculation. This action typically occurs in man and animals alike, as an exertion which sweeps wavelik...

Your coaches lie to you. you do not require any supplement just because all supplement you take comes in your food. if the caloric requirement is more, the increase of it (calories & proteins. fruits & vegetables) in a balanced way assures a adequate intake of all the nutrients. renowned researchers in exercise physiology & nutrition sciences (Katch & Mcardle) refute the idea of taking supplements in training. More to it you can not assess the deficiency of particular nutrient (that you take as supplement) in common laboratory conditions. Toxic levels too occur with high intakes. However generally the nutrient requirement is in a vary wide range. That means one can tolerate increased nutrients as supplements in a wide range which does not mean that we require it more than a adequate level. More than adequate range do not also mean a high training output or competitive result or augmented health. Following are self-explanatory terms associated with nutrient requirements....

Many authors & researchers claim & have demonstrated that therapeutic effects of manual therapy are due to pain modeling via sensory inputs through their well designed researches. But many clinicians believe that manual therapy lead to subtle bony adjustments which leads to it’s therapeutic effects. However, it is not well demonstrated that adjustments occurs in such cases. This following paper by Keller & colleagues is one among the many papers that indicates but do not clearly demonstrate the potential mechanical adjustments by manual therapy. The experiment was carried out on a replica (model) of the spine & model validity was determined which showed good agreement with in vivo human studies. This study reveals following: 1. Quasi-static and low-frequency ( 2. Impulsive forces (Such as used in HVLA manipulative techniques) produced much lower segmental displacements in comparison to static and oscillatory forces. 3. Differences in inter-segmental displacemen...

There is increase in PA spine stiffness during voluntary contraction of the lumbar extensor muscles. PA dynamic spinal stiffness at rest and during lumbar isotonic extension tasks ware studied by Colloca & colleagues (2004) in patients with low back by a dynamic mechanical impedance study. About the study: 13 patients with LBP underwent a dynamic spinal stiffness assessment in the prone-resting position and again during lumbar extensor efforts. Same measurements are taken after PA manipulative thrusts (approximately 150 N, Dynamic spinal stiffness characteristics revealed that 1. A significant increase in the PA dynamic spinal stiffness was noted for thrusts over spinous process during isotonic trunk extension tasks compared with prone resting. 2. But no significant changes were noted for the same measures over the transverse processes. This study suggest in trunk extension tasks normally the spine stabilization occurs by the paraspinal muscles any PA force to the central spi...

SPAM includes commonly applied forces of low-frequency sinusoidal oscillations ( Spinal mobilization is usually applied to 1. modulates pain 2. improve mobility of a stiff segment 3. finally, to assess the condition However these benefits are marked in the subject suffering from mechanical spine disorders. Fundamental to this concept is the belief that spinal mobilization will influence the mechanical properties of the symptomatic motion segment. Nothing is known about what are the effects of SPAM in asymptomatic subjects. Using proper control methods trained physiotherapist applied the standardized PA mobilization technique to L1, L3 & L5 spinous process for two minutes. The mean force of 146 N (standard deviation = 8 N) at a frequency of 1.5 Hz was applied. It was found that SPAM has no segmental effect on spinal PA stiffness (1). Discussion: This paper of Allison & colleagues questions “Which mechanisms contribute to the changes that occur after PA spinal mobilizat...

A part of my review for a journal.................. Functional radiography or Cineradiography refers to radiography in the time course of the movement. Spine Cineradiography reveals many interesting aspects of stable (normal) & unstable (lysthetic) spine. I. Normal spine flexion-extension kinesis During flexion, initial lumbar motion starts stepwise from the upper level to the lower levels with phase lags. Angular velocity at the onset of motion increases as the level descended. On the contrary, during extension, initial motion started from the lower level (L5/S1) to the upper levels. There is no relation between velocity and spinal levels during backward flexion. Through out the F-E excursion there is a harmonious relation between the angular motion and translatory motion of the motion segment (10). The motion profiles at L5/S1 were different between flexions & extension (11). In extension, motions in upper lumbar segments were small, and the L5-S1 segmental motion only contri...

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....