Dr Satyajit Mohanty blogs

(Patellar distraction technique) It is now universally accepted that patellofemoral malalignment is the main cause of anterior knee pain. The most difficult question to researchers is what is the mechanism whereby patellofemoral malalignment produces pain? Currently, there are two theories one is the neural theory and the other is the mechanical theory. Both theories are not exclusive, but complementary (1). Development of Patella Baja (Infera) after knee trauma leading to altered knee mechanics & anterior knee pain: Patella Baja (Infera): Patella Baja refers to low lying patella in frontal plane as compared to normal. This condition develops following repetitive stress or knee traumas due to patellar tendon adhesion following the said two conditions. Patellar tendon adhesion leads to a decrease in the distance between inferior patellar pole to the tibial tuberosity, effectively creating patella infera. Effect on biomechanics: Patellar changes: 1. medial and distal translation o...

Introduction: Planter heel pain & posterior heel pain: Plantar heel pain is a symptom commonly encountered by clinicians. A variety of soft tissue, osseous, and systemic disorders can cause heel pain. Tendonitis also may cause heel pain. Achilles tendonitis is associated with posterior heel pain. Bursae adjacent to the Achilles tendon insertion may become inflamed and cause pain. HPT (heel pain triad): Labib et al described the heel pain triad (HPT). HPT is a combination of plantar fasciitis, posterior tibial tendon dysfunction and tarsal tunnel syndrome. They hypothesized that failure of the static (plantar fascia) and dynamic (posterior tibial tendon) support of the longitudinal arch of the foot has resulted in traction injury to the posterior tibial nerve, i.e., tarsal tunnel syndrome. When such a situation is present then all abnormalities i.e. plantar fasciitis, posterior tibial tendon dysfunction and tarsal tunnel syndrome must be recognized and treated. Classification of ...

Pelvic floor dysfunction is a disorder predominantly affecting females. It is common and undermines the quality of lives of at least one-third of adult women and is a growing component of women's health care needs (2). The reported prevalence rates of pain within the pelvis range from 3.8% to 24% in women aged 15 to 73 years (3). Pelvic floor dysfunction affects women of all ages and is associated with functional problems of the pelvic floor. Pelvic floor dysfunction describes a wide range of clinical problems that rarely occur in isolation (2). Functional pelvic floor problems are perceived to have low priority compared with other health disorders, and treatment remains sub-optimal. Inherent in achieving and promoting better health care services for women is the need for better collaborative approaches to care(2,3). There is a need to identify and develop comprehensive interdisciplinary, multi-professional strategies that improve the assessment and treatment of pelvic floor dysfun...

The pelvic floor is a highly complex structure made up of skeletal and striated muscles, support and suspensory ligaments, fascial coverings and an intricate neural network. Its dual role is to provide support for the pelvic viscera (bladder, bowel and uterus) and maintain functional integrity of these organs (4). So the pelvic floor represents the neuromuscular unit that provides support and functional control for the pelvic viscera. Its integrity, both anatomic and functional, is the key in some of the basic functions of life (1): a. Storage of urine and feces b. Evacuation of urine and feces c. Support of pelvic organs, and d. Sexual function In pelvic floor dysfunction the aetiology is inevitably multi-factorial, and seldom as a consequence of a single aetiological factor (4). However, the problems that are encountered with pelvic floor can be broadly grouped into due to hypotonic or hypertonic status. The hypotonic condition leads to: stress incontinence, fecal inconti...

According to modern imaging techniques and surgical techniques the classical concepts concerning the subdivision of the pelvic connective tissue and muscles need to be revised (3). A compartmental clinical model basing on clinical requirements subdivides the pelvic cavity into anterior, posterior, and middle compartments which is feasible (3). Further the pelvic structures can be divided in three groups: the hollow organs, the endopelvic fascia and the muscles (1). Let us review how the pelvic floor is organised A. The pelvic floor & it’s important parts: The pelvic floor is the support of the pelvic visceras. Important pats of pelvic floor are 1. The levator ani muscle 2. Perineum & it’s myofascial structures 3. Pelvic fascia & it’s reinforcements The M. levator ani is the muscle of the pelvic diaphragm. Its parts were given different names depending on their function or localization (1). The levator ani muscle (LA) with its two bundles (pubo- and ilio-coccygeus) ...

Traction can be used 1. as an adjunct 2. as a independent modality to treat Traction as an adjunct treatment Gentle forcing at almost any joint is tolerated well if the move¬ment is carried out during traction. However, traction as an adjuvant therapy can affect in the following ways 1. An attempt to reduce an intra-articular dis¬placement is much more likely to succeed if the bone-ends are brought apart as far as possible. This is because the loose fragment is now given room to move. 2. If the intra-articular dis¬placement projects beyond the articular edge, the tautening of the ligaments joining the bones during the traction exerts beneficial centripetal force on he fragment. 3. Distraction produces a suction which also exerts beneficial centripetal force on the fragment. 4. If the joint is held at mid-range during traction i.e. in a position that ensures that every ligament is lax, the bones are pulled apart and pressure on the displacement ceases. Pain is thus rel...

Why a musculoskeletal physiotherapist should become familiar with assessment of the respiratory muscles? (Adpoted from the original source: Thorax 1995;50:1131-1135) 1. Firstly, because dyspnoea in patients in whom no pulmonary cause can be detected may be due to respiratory muscle weakness. Even moderately severe muscle weakness may be difficult to detect clinically and, indeed, it is possible to have total paralysis of the diaphragm without life threatening consequences. 2. Secondly, because patients with clearly documented generalised neuromuscular disease usually also have respiratory muscle weakness and, for selected cases, treatment in the form of non-invasive ventilation is indicated. 3. Finally, there has recently been increased awareness that respiratory muscle weakness can be a compounding factor in other disease processes such as malnutrition and steroid therapy. For most patients the suspicion of clinically important respiratory muscle weakness may be confirmed or ...

Several findings provide support for the proposed relationship between diaphragm EMG and postural control of trunk stability. Anatomy of Diaphragm: The diaphragmatic musculature and its fasciae imparts crucial function of respiration & postural control. The diaphragm is divided into 3 parts on the basis of these muscle fiber origins: 1. Sternal part: two muscular slips from the back of the xiphoid process. 2. Costal part: the inner surfaces of the cartilages and adjacent portions of the lower six ribs on either side, interdigitating with the Transversus abdominis. 3. Lumbar part: aponeurotic arches, named the lumbocostal arches, and from the lumbar vertebrae by two pillars or crura. There are two lumbocostal arches, a medial and a lateral, on either side. The diaphragm is innervated by the phrenic nerve. It's a branch of C3,C4,and C5. Crura and central tendon: At their origins the crura are tendinous in structure, and blend with the anterior longitudinal ligament of the vert...

In my opinion the entire medical fraternity is to be blamed for it. Speaking generally, it may be said that the "bone-setter" flourishes not because people suffer injury, but on account of the treatment they receive. A traditional bone setter’s friends & foes: 1. The doctrine of fixation, rest and splintage is his (traditional bone setter) great ally. 2. His (traditional bone setter) enemy is the treatment of recent injury by mobilisation. How far traditional bone setters will sustain? According to Dr.Mannell - until the time the old teaching of absolute and prolonged rest after injury is replaced with combination of justified rest with early mobilisation, the type of disability which fills the "bone-setter's" rooms will never decrease and hence they will flourish.

Ankle joint = tibio-talar joint, permits DF & PF Dorsiflexion (DF) is performed by the tibialis anterior , EHL,EDL,and peroneus tertius. DF limited by the tension of the tendocalcaneus , the posterior fibers of the medial ligament and the calcaneofibular ligament. During dorsiflexion the wider anterior part of the articular surface of the talus is forced between the medial & lateral malleolus, causing them to separate slightly & tighten the ligaments of the distal tibiofibular joint. This arrangement increases the stability of the ankle joint when the foot is in the initial position for major thrusting movements in running , jumping and walk . Plantar flexion is performed by the gastrocnemius, soleus,plantaris, peroneus longus & brevis , tibialis posterior, flexor digitorum longus and flexor hallucis longus It is limited by the tension of the opposing muscles , the anterior fibers of the medial ligament and the anterior talofibular ligament . When the ankle is full...

Bony Anatomy • Curved trochlear surface of talus produces a cone-shaped articulation whose apex is directed medially; thus the fan-shaped deltoid is all that is needed for support medially • A larger area of movement and the subtalar joint articulation laterally dictates more soft tissue involvement to produce stability, thus, more commonly injured Anatomy of Ligaments • The lateral ligaments should include not only the ATFL, CFL, and PTFL of the tibiotalar joint, but should also include the subtalar joint which is supported by the CFL, inferior extensor retinaculum, the lateral talocalcaneal ligament, the cervical ligament, and the interosseous talocalcaneal ligament • Note: the CFL is included in both these joints and is crucial to the proper biomechanics of both joints • ATFL - originates at the distal anterior fibula and inserts on the body of the talus just anterior to the articular facet (not unto the talar neck). ATFL - Makes an angle of approximately 75° with the...

1. In the absence of relaxation the movement of the joint is forced, and therefore strain is placed upon it. The result is that any synovitis or other pathological condition is perpetuated or increased. 2. There is great danger of inflicting further injury on the already damaged structures, so that adhesions of greater density and strength will ultimately form. 3. Repair is retarded owing to undue strain on the structures that are undergoing repair. 4. The muscles are strained, and possibly even torn, in their vain attempt to resist the movement. 5. The circulation of the venous blood and of the lymph may be assisted, but extravasation will be increased; and 6. The disorganisation of the vaso-motor system is increased as the result of repetition of trauma, and so oedema increases in proportion as repair decreases. 7. The joint-sense is outraged by repeated trauma, and all power of co-ordination is thereby destroyed.

A. In Massage of the Limbs. Massage is a form of surface stimulation that can produce a muscular contraction by reflex; antagonistically it can also secure muscle relaxation. We invoke instinctively the aid of massage for its mechanical effect in day to day activity, for example rub our eyes hard to reduce intra-ocular tension, or press upon temple or forehead after a day of great fatigue. B. In Massage for Diseases of the Nervous System -In the treatment of an irritable neurasthenic, the victim of insomnia. C. In Abdominal Massage- According to Kleen mechanical stimulation of abdomen does not produce chemical stimulation in producing, secretion of active digestive juices. It is possible that by mechanical means we can help empty a dilated stomach, and we can certainly assist in the softening and molding of scybala, in those very exceptional cases where they are palpable, and therefore amenable to manipulation. In this event we can also assist their passage along the bowel. However dur...

An introduction to Mannel Dr.James Mannell’s name is associated among the pioneers of physical therapeutics applied in modern medicine. James Mannell was a qualified medicine specialist & physician. First book of Mannell’s concept emerged in 1920 as a result of twelve years' experience of massage and its allied arts, and effects of treatment of six thousand medical cases of fracture. The book was named massage-its principles and practice which was forwarded by Dr. Robert Jones, then the major general of army medical services of United Kingdom. The early experiences of James mannell was modified by following findings: 1. Positive out comes of effects of "early movement" on post-immobilization stiffness. 2. Effect of simple manual handling providing distraction at a particular joint (that was stiff post-fracture-immobilization) which seemed like a massage can attend joint mobility painlessly and without any attempt at force that are attained by the exercise of considera...

Chiropractic was invented by a non-medico named DD palmer of USA. The literal meaning of chiropractic is "by hand". Hence treatment by hand is called chiropractic. treatment We in India never got to know what is chiropractic treatment? Yesterday i was preparing to teach my students "history of manual therapy", i happen to come across the following in classic encyclopedia(1911) & Wikipedia. Read it & wonder (also feel for simon singh, UK who was sued for defaming chiropractic) Rule of Nerves by DD Palmer Palmer hypothesized that vertebral joint misalignments, which he termed vertebral subluxations ( his type of subluxations can not be seen on X-rays or such investigations) interfered with the body's function and its inborn (innate) ability to heal itself. D.D. Palmer repudiated his earlier theory that vertebral subluxations caused pinched nerves in the intervertebral spaces in favor of subluxations causing altered nerve vibration, either too tense or...

The Rule of Artery by AT still Early osteopathy teaches that 1. Structural derangement (SD) of the body is the predisposing cause of disease 2. SD causes functional distortion (FD) of the vascular and nervous systems 3. Which further leads to a. Weakening the nutritional processes and lowering the powers of resistance of the body b. Production of congestion, either general or local, active or passive further depriving tissues of an adequate blood and lymph supply c. impairs the rebuilding of cells and retards the elimination of waste products through body drainage 4. As drainage & elimination are affected, body is unable to withstand climatic changes or unhygienic and unsanitary surroundings, and offering a open medium for the invasion and propagation of pathogenic germs. Dr. Still, the founder of osteopathy, said, "A disturbed artery marks the beginning to the hour and minute when disease begins to sow its seeds of destruction in the human body. The rule ...

The scalene muscles are a group of three pairs of muscles in the lateral neck, namely the scalenus anterior, scalenus medius, and scalenus posterior. They are innervated by the spinal nerves C3-C8. Origin and insertion Scalenus anterior & medius: Scalenus anterior muscle arises from anterior tubercles of transverse processes of C3-6 vertebrae. It gets inserted into scalene tubercle on the first rib. Scalenus medius arises from posterior tubercles of transverse processes of C2-7 vertebrae. It gets inserted on the superior surface of the first rib behind the groove for subclavian artery. (J.Anat.Soc. India 55 (2) 52-55 2006 52) Function On neck: All 3 scalene muscles produce rotation of the cervical spine to the same side. Maximum stretching of the scalenes should include rotation to the opposite side. (J Orthop Sports Phys Ther. 2002 Oct;32(10):488-96.) On ribcage & respiration: The action of the anterior and middle scalene muscles is to elevate the first rib and rotate the nec...

Radiographic study: coupling of cervical motions in lateral head translations. The clinically common posture of lateral head translation results in an S-shaped cervical spine and may occur in side impact trauma. This posture has not been studied for cervical coupling patterns or range of motion (ROM) (2). In a radiographic experimental study (2) on 20 subjects lateral (a mean of 51 mm) translation was produced by translating the head over a fixed thorax. The major coupled motion was lateral bending (z-axis rotation). The following was found: 1. S-shape in cervical spine was created & there is change in direction at C4–C5 disc space. 2. Upper cervical (C3–C4) lateral bending was contralateral to the main motion of head translation direction. Lower cervical and upper thoracic lateral bending was ipsilateral. 3. During the translation other segmental motions averaged less than 1 mm and 1°. This study shows in cervical spine side bending usually there in nil-minimal involvemen...

Dominant eye assessment has been an integral part of spine conditions especially to reason out the spinal asymmetry. Activity of splenius capitis (SC) is modified with gaze shift. Further, control of the neck muscles is coordinated with the sensory organs of vision, hearing and balance. Impact of eye movement on cervical muscles & movements are not much studied in the context of management of cervical dysfunctions. we can pick up some clues from the study below: The following is a study of division of physiotherapy (University of Queensland, Australia) which investigates interaction between eye movement and neck muscle activity in influencing the control of neck movement. The effect of eye position on neck muscle activity during cervical rotation was studied on 11 subjects. Muscles to rt. Side cervical rotation (in sitting) was under real-time EMG surveillance i.e. right obliquus capitis inferior (OI), multifides (MF), and splenius capitis (SC), and left sternocleidomastoid (SCM). ...