Dr Satyajit Mohanty blogs

Introduction: Occupations & occupational demands have changed in the recent era. Modernization & Industrialization has changed the face of occupational activities & need of work related physical performances. We have slowly crawled in to mostly a sedentary era. On the other side passive leisure time pursuits are taking over active leisure time pursuits. The situation is such that the average office going adult hardly moves his or her axial & apendicular joints in it’s full range of motion. Mean temporal classification of ADL (activity of daily living) closely equates 7-8 hours of sleeping; 8-10 hours of working and rest of hours are spent in house hold activities like washing, watching TV, purchasing grocery, rarely gardening or a sports etc. Office hour activities span more than one third of the day. Except in blue collar jobs (manual labor class) office hours consists of at least 2-4 hours sitting to full office hour invested in sitting like in banking, IT sector job...

Introduction: Sociocultural, economic, and manufacturing factors are 3 different major factors that influence sitting. "Correct" seated posture is associated with spine health was known to people possibly from Hippocratic era. But the debate has not dampened yet whether the sitting is directly a cause of LBA or it predisposes or precipitates LBA. From 1980s much of research has been put into ergonomically correct sitting & providing a work environment for correct sitting posture. However there is a question; is there any medically correct sitting posture? The correct sitting posture refers to maintenance of a correct lumbar spine lordosis actively (muscle contraction) or passively (chair or sitting back support) (described below elaborately in neutral spine position). Passive maintenance is sought because it is noticed that within minutes of sitting lordosis is reversed or lost. According to Ernst even the correct sitting is not out of danger because of the repetitive nat...

Annu Rev Med. 2009;60:55-68. Stroke rehabilitation: strategies to enhance motor recovery. O'Dell MW, Lin CC, Harrison V. Department of Rehabilitation Medicine, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York 10021, USA. mio2005@med.cornell.edu Abstract Recent evidence indicates that the brain can remodel after stroke, primarily through synaptogenesis. Task-specific and repetitive exercise appear to be key factors in promoting synaptogenesis and are central elements in rehabilitation of motor weakness following stroke. Expert medical management ensures a patient is well enough to participate in rehabilitation with minimal distractions due to pain or depression. Contraint-induced motor therapy and body-weight-supported ambulation are forms of exercise that "force use" of an impaired upper extremity. Technologies now in common use include robotics, functional electrical stimulation, and, to a lesser degree, transcranial magnetic stimulation a...

Parts of SC joints: The sternoclavicular articulation is a double arthrodial joint. The joint is made out of following boby articulating parts sternal end of the clavicle, the upper and lateral part of the manubrium sterni, and the cartilage of the first rib. The articular surface of the clavicle is much larger than that of the sternum, and is invested with a layer of cartilage, which is considerably thicker than that on the latter bone. Important parts (ligaments & disc) of this joint are: 1. The Articular Capsule 2. The Anterior Sternoclavicular ligament 3. The Posterior Sternoclavicular ligament 4. The Interclavicular ligament 5. The Costoclavicular ligament And the 6. The Articular Disk According to a retrospective analysis articular disk injuries were seen in 80% of patients. Injuries of the anterior, posterior, interclavicular and costoclavicular ligaments were seen in 73%, 39%, 29% and 14% of patients, respectively (10). Movements possible in this joint- T...

Link: http://www.thefreelibrary.com/Autonomy+and+the+future+of+physiotherapy.-a0181366670 Either follow the link. If the link is not working properly then copy the above link in a web browser. Then type search. I assure you this is a topic to ponder.

Preamble: RMSG can be called an exclusive Japanese contribution to our knowledge pool. First invented & later on further researched by Japanese researchers only. We found 6 papers by search of PUBMED with the search word “Respiratory muscle stretch gymnastics”. Abstract plus search categories found 3 full articles out of 6 mentioned journals listed in PUBMED. This article is a small review of those 6 articles. What is RMSG? RMSG is a group of stretching exercises sequentially performed to stretch specific muscles involved in respiration. There are 5 different muscle groups targeted in RMSG. Respiratory Muscle Stretch Gymnastics RMSG was designed to be easy to learn and to perform at home on a daily basis, and to stretch either the inspiratory intercostal muscles during inspiration or the expiratory intercostal muscles during expiration, in attempt to reduce chest wall stiffness. Who devised it first? Yamanda M et al of Japan devised it first time in 1996 and they applied it on 13...

Objective of this review: To provide the reader basic idea of the anticipatory postural adjustments with spinal disorders. Understanding this topic will lead to appreciate the kinetic chain concepts through understanding of basic postural system operation. Posture & Poise: Posture is a term to describe shape whether good or bad. Poise is either present or absent at any moment so to describe poise as good or bad is to misunderstand its meaning. The term posture is generally accepted to relate to the dynamic relationship of the body segments in activity. Poise is a state; an ability to maintain appropriate muscle tension at all times in both movement and static positions. A well-balanced structure is supported and mobilised by gravitational forces with minimal effort. Correct posture is considered vital for health and functioning of the internal organs and all bodily functions. A poorly balanced structure requires inappropriate muscular activity to maintain position and initiate mo...

Various scapular connections: Following group of muscles are essential for proper shoulder functioning: 1. Scapulo-humeral group (Supra & infraspinatus, Subscapularis) 2. Cervico-scapular group (Levator scapulae, Upper trapezius) 3. Thoraco-scapular group (Ex: Rhonboids, middle trapezius) 4. Other muscle like latissimus dorsi etc Shoulder is one of the most active joints of human body & upper limb function is heavily dependant on optimal shoulder joint function. However, the shoulder function is in turn heavily dependant on the scapular stability & mobility. Among various attachments of the scapula, scapular position is also dependant on the Cervico-scapular & other muscles described above. Various scapular conjugate movements with shoulder joint function demands heavy stress on all of it’s attachments. Specific shoulder tasks demands specific static & dynamic scapular positions. Scapular positional faults & shoulder pain: Rhomboids dominance: This ...

Shoulder elevation mechanics in impingement syndrome: Both glenohumeral and scapulothoracic kinematics are altered during impingement syndrome. Normal & altered mechanics during shoulder elevation is discussed below. Normal mechanics: Functions of Trapezius muscle: Upper trapezius produces clavicular elevation and retraction. The middle trapezius is primarily a medial stabilizer of the scapula. The lower trapezius assists in medial stabilization and upward rotation of the scapula. Functions of serratus anterior muscles: The middle and lower serratus anterior muscles produce scapular upward rotation, posterior tilting, and external rotation. Pectoralis minor: The pectoralis minor is aligned to resist normal rotations of the scapula during arm elevation. Rotator cuff: The rotator cuff is critical to stabilization and prevention of excess superior translation of the humeral head, as well as production of glenohumeral external rotation during arm elevation. Alterations of shoulder musc...

Tate AR et al recently tried to define the dosage and specific techniques of manual therapy and exercise for rehabilitation for patients with subacromial impingement syndrome in a case series. 10 patients (age range, 19-70 years ware treated with a standardized protocol for 10 visits over 6 to 8 weeks. More about this program: 1. Strengthening rotator cuff and scapular muscles (3-phase progressive strengthening program) 2. Manual stretching 3. Manual therapy aimed at thoracic spine (Both thrust and nonthrust manipulation) 4. Manual therapy aimed at and the posterior and inferior soft-tissue structures of the glenohumeral joint (Both soft & bony. Bony manipulation: Both thrust and nonthrust manipulation) 5. Other components of this program: Activity modification and a daily home exercise program of stretching and strengthening. Result of this program: This case series describes a comprehensive impairment-based treatment which resulted in symptomatic and functional im...

What is Condensing osteitis of clavicle? Osteitis condensans of the sternoclavicular joint was first described by Brower et al in 1974 (5). Till 1989 only 16 cases ware reported in world medical literature (6). Definition: Condensing osteitis of the clavicle is a benign idiopathic entity that is probably degenerative or mechanical in etiology manifesting by variably painful and tender swelling over the medial end of the clavicle. There is no clinical or laboratory evidence of infection in all cases of Condensing osteitis. Where else Condensing osteitis is also marked? Condensing osteitis is also marked at ilium, and pubis (4). The etiopathogenesis of this rare benign clinico-radiologic entity remains unknown (7). However Berthelot et al have proposed a pathogenic hypothesis for condensing osteitis of the clavicle, ilium, and pubis. According to their observation joint aspects spared by the sclerosis are covered with hyaline cartilage but occurs in bone overlaid by fibrocartilage. Clin...

What is a dynia? The "dynias" are a group of chronic, focal pain syndromes with a predilection for the orocervical and urogenital regions. They include glossodynia, carotidynia, vulvodynia, orchidynia, prostatodynia, coccygodynia, and proctodynia. In some cases, the dynias occur secondarily, but more often, despite an exhaustive evaluation, no etiology is found and in these remaining cases, the cause of the pain remains enigmatic. The controversy that surrounds this group of disorders, which ranges from questioning their existence to suggesting that they are purely psychosomatic, is counterbalanced by an extensive literature attesting to their organicity (1). What is coccygodynia? & Causes of coccygodynia: The three most common functional disorders causing anorectal and perineal pain are levator ani syndrome, coccygodynia and proctalgia fugax. However, Alcock's canal syndrome is also responsible for pain in these areas (3). A review of Mayo clinic records Physical Med...

1. Excessive lateral pelvic tilt (Trendelenburg): Areas that may be affected due to compensation: Lumbar spine, sacroiliac joint (SIJ), greater trochanter bursa, insertion of muscle on greater trochanter, overactivity of piriformis and tensor fascia lata (TFL) . 2. Medial knee drift: Areas that may be affected due to compensation: Lateral tibiofemoral compartment (via compression), patellofemoral joint, patella tendon and fat pad, pes anserinus, iliotibial band (ITB) 3. Lateral knee drift: Areas that may be affected due to compensation: Medial tibiofemoral compartment (via compression), ITB, posterolateral compartment, popliteus 4. Same-sided shift of trunk (lateral flexion of trunk): Areas that may be affected due to compensation: Lumbar spine (increased disc and facet joint compression), SIJ (increased shear)

Lumbar facet pain (1): Lumbar facet joints are a well recognized source of low back pain and referred pain in the lower extremity in patients with chronic low back pain. Conventional clinical features and other non-invasive diagnostic modalities are unreliable in diagnosing lumbar zygapophysial joint pain. However with invasive diagnostic technique the chance of false positive result may be up to 47% but these controlled diagnostic studies have shown the prevalence of lumbar facet joint pain in 27% to 40% of the patients with chronic low back pain without disc displacement or radiculitis. Facet joint surface area in LBA (2): Facet joint surface area is an important parameter for understanding facet joint function and pathology. Otsuka et al investigated lumbar facet joint surface area in relation to age and the presence of chronic low back pain. In this invivo study the following things are found: 1. The lumbar facet area was significantly greater at the inferior lumbar levels and a...

How facet joint pain manifests? Facet or zygapophysial joints are considered to be common sources of chronic spinal pain. In addition to causing localized spinal pain, facet joints may refer pain to adjacent structures. Cervical facet joint pain may radiate to the head, neck, and shoulders. Thoracic facets may produce paraspinous mid-back pain with neuralgic characteristics; and lumbar facet joints may refer pain to the back, buttocks, and proximal lower extremities. Referred pain may assume a pseudoradicular pattern, making the underlying diagnosis difficult to confirm, without the use of diagnostic blocks. Joint innervation: Facet joints are well innervated by the medial branches of the dorsal rami. Neuroanatomic, neurophysiologic, and biomechanical studies have demonstrated free and encapsulated nerve endings in facet joints, as well as nerves containing substance P calcitonin gene-related peptide; facet joint capsules contain low-threshold mechanoreceptors, mechanically sensitive n...