How can I make my legs heal faster after surgery?

Introduction:

After a lower limb surgery it is very important to do the exercises of the part which is operated, to make the muscles stronger and once again start walking it is crucial to do Physical Therapy exercises after surgery of the leg. In this article you would come to know about the exercises of the leg after a surgery.

 These exercises are designed to increase your strength and range of motion following surgery. These exercises are meant to be done in a pain free manner as much as possible and under the supervision of a physical therapist.

There are some videos of exercises in this article which you can perform after a leg surgery. While you may experience some pain and discomfort during the exercises physical therapist try to work in a pain free range as much as possible. If you do experience excessive pain or discomfort while doing these exercises then immediately talk to your physical therapist to get some follow up advice.

Physical therapy exercises after a leg surgery:

 

Some of the exercises are described along with the video so that you can easily understand and also come to know the importance of physical therapy in our life.

1.Quadricep Muscle strengthening: for this exercise we are looking to get a good muscle contraction in the muscles on the front of your thighs. It is common after surgery to have some soreness and irritation in those muscles and so you have to do reintroduce moment to them through nice easy contractions. You can perform this exercise as shown in the video below 

2. Straight leg raising: In this exercise you have to just lie down on  bed and without bending your knee you have to just raise your knee against the gravity as shown in the video below. This exercise helps to increase your leg mobility and to keep the blood flowing while you are not walking quite as much you used to. Do this exercise about 20 times at a time throughout the day

3.Walking after surgery: when you about to walk after a surgery just make sure that the Walker is ergonomically designed according to your height and health. To find the proper height of your Walker imagine that your putting your hands in your pockets and you raise the Walker to that point. Also you have a nice band in your elbows while your using  Walker so that you have some good leverage. After your surgery you will have some pain and discomfort in your leg, in order to walk I recommend you to use the following instruction of gait pattern as shown in the video below

Move the Walker forward then step forward with your surgical like first then put your weights in your arms to support the leg before bringing your other leg to meet it. Then repeat this process with each step as shown in the video above.

4.How to use stairs: Going up the stairs you will be leading with your non surgical leg and do remember to go with one step at a time and bringing your surgical leg to meet the normal leg. So lead with the non surgical leg and bring your surgical leg to meet it, repeating this for each step that you use the stairs.

Now coming down the stairs you are going to be leading with your surgical leg first and bring your non surgical leg to meet it, this is the safest method which physical therapist uses in a lower limb injury case.

5. Static Cycling: This is a non weight bearing exercise in which your pelvis is on the seat of static cycle and legs are free to move in a particular pattern. Cycling provides movement at hips, knee and ankle joints thus enabling joint movements and recruitment of muscle fibers contraction. 

                               

Shown in the video below you can perform cycling in forward direction as well as reverse direction, which will help to gain overall strength in the thigh and leg muscles. 

6. Ankle Pumps: In this exercise you lay down on a flat surface or mat and have to move your toes up towards your shin and then down towards the floor so that you can feel maximum stretch on your ankle joint. Do this exercise about 20 times throughout a day

7. Some electrotherapy modalities were also used by physical therapist to reduce pain around the region and facilitate movement around the joint.

Conclusion: I hope this article help you regarding information of exercises after a leg surgery. If you find this article helpful then please let me know in the comment section.

How did Arnold meet Heather Milligan?

Heather Milligan  has been a physical therapist for 20 years. However in these 20 years, the 49 year-old has  constantly evolved her skills and expertise. Milligan founded Elite orthosports, and most of her clients are athletes and celebrities. Besides having a physical therapy degree Heather Milligan maintains 3 certifications to stay up to date with the latest breakthroughs in her field.

Heather Milligan has many things in common with Arnold Schwarzenegger, including a background as an athlete. The 49 year old has been a competitive gymnast for two decades before she become a full-time Physical Therapist. Bean an  athlete gives Milligan  a different perspective toward active athletes that would otherwise be impossible to attain.

Arnold Schwarzenegger and Heather Milligan have been together for a decade, the couple first met in 2012 after the 76 year old underwent shoulder surgery. Arnold had injured his shoulder while filming escape plan with Sylvester Stallone his doctor had recommended Heather Milligan as the physical therapist for the former governor.

Today I am telling you the story of Arnold current relationship with Heather Milligan a Physical Therapist who has played a significant role in his life for the past 9 years. But before we explore for Schwarzenegger's current relationship let's take a step back in time.

 Arnold was married to Maria Shriver, a prominent figure in her own right as a member of the illustrious Kennedy family and a respected journalist and author. There paths crossed in 1977 when they were introduced at the Robert F. Kennedy tennis tournament in August.

 Their love blossomed and in 1986 they exchanged vows in a grand ceremony, eventually becoming parents to four children. However, after 25 years long marriage, the couple announced their separation in 2011 sending shock waves through the media and their fans worldwide. 

It was during this tumultuous time that Schwarzenegger made a stunning revelation. He admitted to Fathering a child with their family maid, Mildred Patricia Baena. The revelation added another layer of complexity to their already complicated situation. After a decade of separation the divorce was finalised in December 2021 Maria Shriver received a substantial settlement reportedly up to  $200 million, augmenting her already impressive net worth derived in part from her inheritance as a member of the Kennedy family.

Now about Arnold Schwarzenegger's current relationship in 2013 he revealed his romance with Heather Milligan, 47 year old physical therapist. The couple caught the public's  attention when they were spotted together in Santa Monica, confirming the relationship to the world.

 Milligan a dedicated professional in her field has her own company called Elite ortho sport, where she is  specialises in treating sports injuries of professional athletes. Her expertise led her to be involved in Schwarzenegger's renowed strength competition, the Arnold strong man classic. As one of a clients competed in the event prior to founding Elite Ortho sport, Milligan gained valuable experience in the industry. She served as the vice president for HealthSouth in 2006 and later moved to select medical, where she held a similar position in operations for 5 years. 

Her dedication and expertise have earned her and net worth estimated between 1 to 5 million dollars. Despite their long lasting relationship, Schwarzenegger and Milligan have chosen not to marry, opting  instead to savor their  time together. 

They are frequently seen on public dates, enjoying each others company and cherishing their bond. From his remarkable career to his personal life, Arnold Schwarzenegger has captivated the world as he continuous to make headlines. His relationship with Heather Milligan remains testament to the enduring power of love and companionship.

Arnolds girlfriend is a dual board certified and American physical therapy association recognised OCS. Milligan's 3rd certification designates her as a sports clinical specialist. Milligan has maintained these certifications through constant learning and testing. Heather Milligan also has an added advantage that's made her the choice for countless high profile clients.

When should I start physical therapy after a fracture?

Introduction:

Fracture is defined as a brake in the continuity of a bone. It is usually due to direct from or indirect trauma. It may occur in a disease bone following a trivial trauma  when it is termed as ''pathological fracture", the image below shows a fractured bone which is operated 

On the basis of aetiology fracture can be of two type first is traumatic fracture and second is pathological fracture. Also on the basis of relationship with an external environment fracture can be a simple or closed fracture and second is compound or open fracture.

Simple or close fracture- A fracture which does not communicate with the external environment is simple or closed fracture, i.e., the overlying skin and other soft tissues are intact.

Compound or open fracture- In this type the fracture communicates with the exterior through a wound over the fracture, there is a breakdown in the overlying skin and soft tissues.

The following terminologies are used to describe a fracture

1. Transverse fracture

2. Communited fracture

3. Spiral fracture

4. Compression fracture

5. Oblique fracture

6. Segmental fracture

Diagnosis of fractures:- the diagnosis can be arrived at from the following:

1. History- the mechanism of injury provides a useful clue to the expected site and type of the fracture.

2. Muscle spasm- muscle tenderness and loss of movement at the adjacent joint are the immediate signs. In the lower extremity fractures the patient is unable to bear body weight. These signs and symptoms are due to the natural body protector reflexes to immobilize fractured bones.

3. Oedema-the soft tissue injury  accompanying fracture often results in hematoma, and edema over the fracture site. The process of repair begins with inflammation.

4. Warmth- There may be increase in the local temperature due to the rush of blood to the area of injury.

5. Radiography- it is an important tool in the diagnosis of a fracture. 

Fracture healing

The healing of fractures is in many ways similar to the healing of soft tissue wounds, except that the end result is a bond. A fracture begins to heal as soon as the bone is broken.

There are stages in fracture healing of cortical bone so the first stage is 

1.Stage of hematoma- blood leaks out through the torn vessels in the bone and forms a hematoma between and around the fracture, this stage last less than 7 days.

2.Stage of granulation tissue- in this stage the precursor cells produces cells which differentiate and organised to provide blood vessels, fibroblasts, osteoblasts etc. The fracture is still mobile and still last up to 2 to 3 weeks.

3.Stage of callus- In this stage granulation tissue differentiates further and creates osteoblast which results in formulation of the callus also called woven bone, the callus is the first sign of union visible on X-rays. The fracture is clinically United and this stage last up to 2 to 3 months.

4.Stage of remodelling- The process of remodelling ends by reconstruction of the new bone similar to the one before injury. The soft callus gets hardened and the lamellar bone formation occur by callus, this stage last up to 1-2 years. 

Physical therapy management of fractures or post fracture physical therapy:-

Physical therapy plays a  significant role in the return of function following fractures. Physical therapy has a important role in the management of fracture and bringing the patient in to it's original position after injury. Physical therapist faces a challenge in regaining the functional independence in a patient with complicated multiple fractures, mismanaged fractures, non-unions and fractures where surgery is contraindicated.

 A physical therapist has not only to use professional skill but also has to modify the procedures of physical therapy to suit each stage of healing of the fracture. After the fracture is held or the cast has been removed physical therapy is continued for 3 to 12 months or until you have regain your full level of function, the principal functions of a physical therapist are:-

1. Physical assessment which includes joint, muscle, tendon of the fractured area.

2. Identification of the nature of injury

3. Planning of the procedures of physical therapy on an individual basis.

Due to the fracture the fracture site has pain with movement, mobility of the joint near the fracture is also decreased which results in the decrease of joint play and also there is scar tissue adhesions over the fracture site which decreases the strength and endurance of muscles around the fracture site.

 So the plan of care of physical therapist is to initiate active exercises along with increase joint and soft tissue mobility and also increase strength and muscle endurance along with educating the patient.

Physical therapist begin with gentle stretches and joint mobilization techniques which are very effective for regaining lost join play without traumatizing the articular cartilage or stressing the fracture site. After that therapist progresses the intensity as joint reaction becomes predictable.

➤Neuromuscular inhibition techniques were also performed by physical therapist once the bone is healed. 

➤Near fractures site there is also scar formation so techniques for scar mobilization is also performed by physical therapist.

➤Isometric and isotonic exercises where also performed under  the supervision of a physical therapist.

➤Physical therapist helps to improve strength, endurance, and flexibility of the muscles around the fracture area. The techniques performed in such a manner that it should be simple, objective, and within the limits of discomfort.

➤Along with manual techniques performed by physical therapist there are also some electro therapy modalities which were used by therapist in order to reduce the pain of the fracture site, some machines which are used are LASER, ultrasound, paraffin wax bath, TENS, hot or cold pack.

➤If there is a fracture of leg then weight bearing exercises were also performed by the physical therapist.

 

conclusion:

As we come to know that fracture at any part of our body affects the lifestyle of our daily routine so Physical therapy facilitates fracture healing and helps in speedy recovery. If you like the above article please let me know in the comment section.

physical therapy for hip joint pain

 Introduction:

One of the most common musculoskeletal problem is the hip joint pain, worldwide the incidence of hip pain is increasing in part because of the ageing of population. In the united states only 84% of women suffer from hip joint pain significantly more than men. Multiple factors contribute to the increasing incidence of hip pain such as Osteoporosis or either a sudden twisting motion of the lower extremity or the impact from a fall can all leads to hip area pain. To overcome all this incidence Physical Therapy should be the first line of treatment of hip joint pain supported by medication and lifestyle changes.

In this article you would come to know about Physical therapy treatment of hip joint pain,its management and prevention.

 

Structure of Hip Joint:

The hip joint is a ball and socket joint which offers stability during weight bearing and free mobility during activities. Forces from the lower limb extremities are transmitted upward through the hips to the pelvis and trunk during walking or other lower extremity activities. The hips also support the weight of the head, trunk and upper extremities. Stability of the hip joint is provide by the following structures-:

➤ Articular capsule

➤ Bony configuration 

➤ Muscles

➤ Ligaments

The two hip joints are linked to each other through the bony pelvis and to the vertebral column through the sacroiliac and lumbosacral joints. Hip joint has its strength from the thick articular capsule and strong ligaments like Iliofemoral, Pubofemoral, Ischeofemoral and glenoid labrum.

During normal walking hip goes through a range of motion of 40 degrees of flexion and extension. When there is musculoskeletal disorder of hip region, bone and joint deformities change alignment of lower limb extremity and mechanics of gait. Painful conditions cause antalgic gait patterns, which are characterised by minimum stance on the painful side to avoid the stress of weight bearing.

The muscles of hip joint are iliopsoas, rectus femoris, obturator externus, gluteal muscles, sartourius, all these muscles play an important role in the movement if hip joint along with stability.

The hip joint capsule is richly supplied with mechanoreceptors that respond to variations in position, stress, and movement for control of posture, balance, and movement. 

The major nerve of the hip joint region is sciatic nerve which forms in the posterior region of the pelvis from the sacral plexus and leaves the pelvis across the lower edge of the greater sciatic notch. Sciatic nerve entrapment results in the sensory changes along the lateral and posterior portion of the legs and dorsal and plantar surface of the foot. Progressive weakness also develop in the hamstring muscles, a portion of the adductor magnus muscle, and all the muscles of the leg and foot as shown in the image below

Hip joint impairments interface with many weight bearing and ADL activities, therefore a careful analysis of the factors involved in the mechanics of hip joints play a prominent role in the planning and implementation of the objective Physical therapy program.

In the early stage of hip joint disability one can feel the progressive pain with continued weight bearing and gait or at the end of the day after repetitive lower extremity activities. The pain may interfere with work (job specific) or routine household activities that involve weight bearing, such as meal preparation, cleaning, and shopping.

With the progressive degeneration of hip region there is increased difficulty in rising up from a chair, climbing stairs, squatting, and other weight bearing activities. Restricted routine ADL, such as bathing, toileting, and dressing (putting on pants, hose, socks) .

Physical Therapy for hip joint pain Management: 

 The important and basic objective of physical therapy treatment is to regain maximum possible range of motion at the affected hip along with strength to achieve physical independence. With the combination of electrotherapy and exercise therapy a wide range of hip joint pain conditions were treated by physical therapy. The therapeutic approaches includes-

➤ At hip joint to gain pain free motion mobilization with movement (MWM) technique is applied along with myofascial release technique by the Physical Therapist. 

➤ For muscle spasm and tightness passive stretching is performed by qualified licensed physical therapist.

➤ Electrotherapy modalities were also applied for pain reduction such as LASER, Tens machine, ultrasound machine, hot or cold pack according to acute or chronic stage of hip joint pain.

➤ For maintaining the muscle tone isometric exercises were performed under the supervision of physical therapist.

➤ As healing progresses and symptoms subside strength training around the hip musculature especially gluteus maximus, gluteal medius, and rotators and that improve stability and balance when performing weight bearing activities. Therapist begin with submaximal isometric resistance and then progresses to dynamic resistance.

➤ Now therapist progress to functional exercises as tolerated using Theraband and weight bearing activity as shown in the video below.

Here are some exercises shown in the video's for hip joint pain region under the supervision of physical therapist

➤ Physical therapist also educate the patient to establish a balance between activity and rest and learn the importance of minimizing stressful deformity forces by maintaining muscle strength and flexibility in the hip region.

Precautions and Ergonomic changes: 

During the hip joint pain and impairment there are some ergonomic changes and precautions which has to be taken by patient in performing daily activities, such as 

👉 When ascending stairs lead with the sound leg and when descending lead with the affected leg which has pain around hip joint.

👉 Avoid activities in standing that involve rotating the body toward the painful hip joint leg.

👉 Sleep in supine with an abduction pillow and avoid sleeping or resting in side lying position.

👉 Transfer to the sound side from bed to chair or chair to bed.

👉 Do not sit in cross leg position for a long time if you had hip joint pain.

👉 When sitting keep the knees slightly lower than the hips and also avoid sitting in low, soft chairs.

👉 Use a raised toilet seat to avoid hip joint region pain.

 👉 For bathing, take showers or use a shower chair in the bathtub.

Also read- can exercise cycle reduce belly fat

Conclusion:

Hip joint is an important part of our body and should not be ignore in any kind of disease or deformity, when required always consult a Physical therapist.

If you like the article please let me know in the comment section. 

What is myofascial pain release?

Introduction:

Myofascial pain is the type of pain which is there in the muscles and connective tissue in body, caused by tightness and sensitivity of myofascial tissues. Myofascia is a type of sheath covering muscles throughout our body which helps to protect and support the muscle in some form or the other. Any injury or trauma to the muscle disrupt the myofascia sheath depending upon the extent of injury. Physical Therapy plays a important role in any type of myofascial pain to overcome it.

What is Myofascial ? 

Myofascial is a sheath covering muscles and supporting them throughout our body,''Myo'' means muscle and ''fascial'' refers to the connective tissue which is a thin layer above the muscles to support and cover muscular portion of our body. Fascia is stretchable, strong and flexible, also able to move without any restrictions. When our body experience any kind of injury or trauma the fascia loses its flexibility and becomes tightened and more rigid. This tightness leads to pain and loss of motion of affected body part which in turn affects the quality of life of person.

Symptom and Cause of Myofascial Pain:

 The symptoms of myofascial pain syndrome include persistent pain, tender muscle knot, pain in the muscle, back, mouth, difficulty falling asleep, sleep disturbances, tenderness, fatigue, and muscle spasm. The exact cause of myofascial pain syndrome is not known, but it is believed to occur when a trigger point in a muscle causes strain and pain throughout the muscle. Poor posture and emotional disturbances are some of the risk factors that can lead to myofascial pain syndrome. If left untreated for a prolonged period, myofascial pain syndrome may lead to sleep problems, fibromyalgia, and widespread pain.

Myofascial Pain Conditions:

It is seen commonly in patient's which have the following-:

➤ Fibromyalgia

➤ Deep vein Thrombosis

➤ Migraine

➤ Post operative muscle spasm

➤ Delayed onset of muscle soreness(DOMS)

➤ Muscle knot or tight muscles

➤ Inflammation like bursitis, plantar fasciitis, osteoarthritis etc.

➤ Varicose veins

Can Stress Cause Myofascial Pain ?

Yes, stress can be a contributing factor to myofascial pain syndrome. It is believed that people who experience stress and anxiety may be more likely to develop trigger points in their muscles, which can lead to myofascial pain. If you are experiencing persistent pain, tender muscle knots, difficulty sleeping, or fatigue, it is recommended that you consult a physical therapist.

How Myofascial Pain is Release ?

To release the myofascial pain special technique is performed by Physical Therapist to overcome this pain, a licensed qualified Physical therapist has the knowledge of myofascial release(MFR).It takes around 30 to 50 minutes on an average patient to perform this technique, the pain usually originates from specific points within myofascial tissue in muscle called "trigger points" or "muscle knots". So for a therapist it is important to cover the whole muscle group from its origin to insertion point.

After a proper assessment and evaluation of affected muscle a firm pressure is applied by therapist to remove the trigger point and pain around the tight or stiff muscle group. This process is repeated multiple times until the therapist feel the release of complete tension in particular muscle.

Benefits of Myofascial Release:

There is a amount of extra tension in muscles which leads to pain and after releasing that pressure the muscle comes to its original form by MFR, this helps to overcome in conditions like:-

➤  Delayed onset of muscle soreness(DOMS)

➤ reduces fibromyalgia

➤ helps in migraine and headache

➤ decreases the web of varicose veins

➤ low back pain muscle strain and tightness is reduced

➤ Temporo mandibular joint disorder is corrected by MFR

➤ spasm of muscle decreases

➤ recovery of deep vein thrombosis

Role of Physical Therapist in Myofascial pain 

Myofascial release is a hands-on technique performed by professionally qualified licensed Physical therapist to overcome myofascial pain. It is a very delicate process which requires years of experience and knowledge for precise treatment of myofascial pain. Physical therapy should be the first line of treatment rather than chiropractor or occupational therapist for any kind of myofascial pain. In combination with electro-therapy modalities and hands-on technique any type of myofascial pain whether it is acute or chronic can be treated by Physical therapy.

Physical therapy program aids in the relief of myofascial pain is described in the below video and image

Medical Management of Myofascial Pain:

 Medications such as amitriptyline, ibuprofen, naproxen sodium, carisoprodol, citalopram, and clonazepam can help relieve pain and discomfort.

The following medications are used to treat Myofascial pain syndrome:

1. Amitriptyline: A nerve pain medication that blocks pain caused by damaged nerves.
2. Ibuprofen and Naproxen sodium: Analgesics that relieve pain.
3. Carisoprodol: A muscle relaxant that reduces muscle tension and helps relieve muscle pain discomfort.
4. Citalopram: An antidepressant that helps reduce pain and improve sleep.
5. Clonazepam: A sedative that relaxes muscles.

What to Eat in Myofascial Pain:

Foods rich in proteins such as fish, cheese, pork, beef, lamb, and green vegetables such as spinach, broccoli, lettuce, and brussel sprouts can help alleviate myofascial pain syndrome. 

 Foods to avoid include sugary foods such as chocolates, sodas, and energy drinks that contain carbohydrates. 

Conclusion: 

For any type of myofascial pain whether it is acute or chronic Physical therapy should be the first line of treatment for its recovery. I hope you like this article about knowledge and information regarding myofascial pain, if you have any type of query or question regarding this topic you can reach me.

What kind of physical therapy is good for Parkinson's disease?

 Introduction:

Parkinsonism is a clinical syndrome characterised by a disorder of movement consisting of tremor, rigidity, elements of brady-kinesia (slowness of movement), hypo-kinesia (reduced excursion of movement) and akinesia (slowness in initiating movement with loss of spontaneous movement) and postural abnormalities.

Parkinson's disease(PD) is a disease which affect the basal ganglia which in turn produce characteristic types of motor dysfunction such as involuntary movements ,tremor, changes in muscle tone, slowness of movement and posture. It was first described by James Parkinson as 'shaking palsy' which now bears his name.

PD is the third most common neurologic disease that affects some 1 in 1000 of population, both men and women. The average age of this disease is around 58 years.

Cause of Parkinsonism:

Brain nerve cells produce a chemical like substance called Dopamine which was drastically reduced in patients with PD was shown to have a casual role in the disease. 

Sign & symptoms of parkinsonism:

1. Tremor at rest is a cardinal sign of PD and is often the first sign of disease, tremor is defined most simply as the rhythmic, mechanical oscillation of a body part. Tremor is usually maximal at the periphery and affects the arm more frequently than leg, tremor activity is usually suppressed by voluntary movement, willed activity, sleep and complete relaxation.

2. Akinesia is the most disabling manifestation of PD, individual with PD demonstrates a loss of spontaneous movements easily recognized by reduced facial expression and reduced arm swing during gait.

3. Rigidity is characterized by increased stiffness throughout range of passive movement at a joint, this stiffness has the same intensity in both extensor and flexor muscles. Mechanical changes in the muscle have also been shown to contribute to resistance to passive movement. There are two types of Parkinson rigidity- one is 'lead pipe' where the resistance is smooth or plastic, and second one is 'cogwheel' where the resistance is intermittent.

4.The freezing phenomenon, difficulty in starting or continuing rhythmic repetitive movements such as speech, handwriting and gait is a well known and incapacitating problem in PD. It particular affects gait and person experience freezing when walking through an enclosed space or when turning. The feet appear to get stuck to the floor while momentum carries the center of body mass forward, with an increasing likelihood of falls as postural adjustments are impaired.

5.The typical posture of a man with Parkinson's disease is 'simian posture' due to slight flexion at all joints.

Diagnosis of Parkinsonism:

Diagnosis is primary clinical and is based on medical history and physical examination by Physical Therapist, from head to toe assessment and evaluation done by physical therapist  such as reaction time(RT) and movement time(MT) and the ability to perform simultaneous or sequential movements confirms the diagnosis of PD.

A therapist evaluates the balance reaction of patient and is asked to

→ sit unsupported for 1 minute

→ stand without an aid for 5 seconds

→ stand on one leg and then the other without an aid for 5 seconds.

Another method is positron emission tomography(PET) is being used to determine striatal dopamine concentrations which may indicate an increased likely hood of pre-symptomatic PD. At the end of assessment the therapist should be in a position to categorise the patient's disease severity and list the aims of treatment.

Treatment of Parkinsonism:

Physical therapy should be the first line of treatment of Parkinson's disease followed by medication and lifestyle changes. The aim of Physical therapy should be to help the patient maintain his independence for as long as possible. Physical therapy techniques were focused on musculoskeletal Sequel and were aimed at 

➤increasing range of motion

➤decreasing rigidity

➤improving coordination

➤maintaining functional abilities

➤stretching soft tissue technique

➤proprioceptive neuromuscular facilitation(PNF)

Rigidity is generally considered by physical therapist to b the major deficit underlying the disability and physical therapy aimed at decreasing rigidity is thus expected to lead automatically to an improvement in functional ability.

To overcome rigidity some manual techniques were performed by qualified licensed Physical therapist such as PNF and stretching which has a very good result on patient with PD. Physical therapy is always given in conjunction with drug treatment and occupational and speech therapy. 

Postural awareness training by Physical therapist in lying, sitting, standing and walking is also included in the treatment program particularly in the early stages of disease. The position of one part of the body in relation to the adjoining part and to the body as a whole is a useful method used by Physical therapist.

With more severely disabled patients group work at clinic is impracticable and patients should be treated on individual basis. Domiciliary treatment should be considered for these patients, some patients find regular hospital and clinic visits exhausting both physically and emotionally.

As Parkinson's disease is progressive so Physical therapy must be concerned with helping the patient to maximize his/her physical potential so that the quality of life can be improved at that time. The difficulties and goals will constantly change as the disease progresses but prolongation of functional independence is important with Physical therapy.

General care and advised to relatives is also important because relatives and family member tend to be over anxious to help and must be advised to allow and encourage the patient to remain independent however long it takes for him/her.

Ergonomic changes is also advised by Physical therapist such as advice to have a higher chair (raised lavatory seat), zips and velcro fastening to clothes, electric razor and toothbrush are such examples of ergonomic changes in day to day life.

• Related article -: Gait

Conclusion: 

For a person suffering from Parkinson's disease regular physical therapy should be encouraged and person should remain at work if possible and continue to maintain and interest in hobbies, sports and social activities.

If you like the above article informative then please let me know in the comment section.

What does having a gait mean?

Introduction:

Walking is one of the most consistent  yet flexible actions we perform, individuals displaying the same qualitative pattern of movement. In simple words gait is define as the pattern of walking of an individual and it varies from person to person. Just as standing up is essential to independence so also is walking. The ability to walk independently is a life enriching activity and the most efficient way of getting from one place to another in the course of our daily lives.

The human gait is an extremely complex mechanism, it involves perfect synchronisation of various body systems in general with nuero-muscular and musculoskeletal systems in particular. The physical therapist has the total responsibility of gait training which becomes absolutely essential to critically observe and analyse the pattern of gait.

The major requirements for successful walking are 

➤ Production of a basic locomotive rhythm

➤ Support & propulsion of the body in the intended direction

➤ Dynamic balance control of the moving body

➤ Ability to adapt the movement with the demand & goal

During each gait cycle the center of gravity(CG) is constantly displaced, disturbing the balance of body. Coordinated action of the muscles and the adaptations of the skeletal components restore the CG by controlling its displacement without much exertion. Locomotion in the real sense involves first disturbing the balance and then regaining it. To understand this complicated mechanism, it is necessary to know the following 

1. Phases of gait cycle

 2. Kinematics of gait

3. Kinetics of gait

Phases of gait cycle-  Every gait cycle is divided into a stance phase and a swing phase, which commences at heel contact and toe off. Each leg in turn has a stance phase when the upper body moves forward from behind the foot on the ground to in front of the foot, and a swing phase when the leg swings forward from behind the pelvis. There is also a brief double support phase when both feet are in contact with the support surface.

The Stance phase is longer and occupies 60% of gait cycle whereas swing phase lasts for the remaining 40% of gait cycle. The length of time of double support period is directly related to the cadence. It decreases with the increase of cadence and is absent during running. The stance phase is further divided into 3 stages 

(a) Heel strike (occupy up to 15% of gait cycle)

(b) Mid stance (from flat foot to maximum dorsiflexion)

(c) Push off ( body is propelled forward)

In the stance phase of walking the lower limb's principal functions are 

1. Support

2. Balance

3. Propulsion

4. Absorption

In the swing phase lower limb's main function is to clear the foot from the ground and to prepare the foot for its landing on the support surface

 Kinematics of Gait:

Kinematics is the term used to describe movement itself independent of internal and external forces. A wide variety of measurement techniques have been used to quantify kinematic variables and include video based motion analysis system, electro goniometry, electro myographic data. So is the study of pattern of angular movements and their excursion by smooth coordinated muscle control.

Kinetics of Gait:

Kinetics is concerned with individual muscle forces, the forces producing displacements of the segments of lower limb are muscular, gravitational and interactive with ground reaction forces.

Gait assessment:

There are various methods for the assessment and evaluation of gait, some of them are as follows:-

1.Electrogoniometric method

2.Observational method

3.EMG method

4.Spatial and temporal measurement method

5.Multichannel functional stimulation method

6.The force studies method

7.Photographic method

8.Combination of various methods

 Gait Abnormalities:

 Analysis of an individual's walking pattern is very complex, yet physical therapist must do this in the clinic in order to be able to plan an appropriate training program for individuals with movement dysfunction. Some of the abnormal gait are as follows

➤ Trendelburg gait or Gluteus medius dip gait →  weakness of hip abductors muscle with dropping of the pelvis on the opposite side with lateral flexion of the trunk and head on the affected side. 

 

➤ Antalgic gait → This type of gait is commonly seen in person with lower limb injury and the pain arising from hip, knee, ankle or foot causes stance period reduction of the painful leg. At the onset of stance phase the person jerks his head, arms and trunk downwards. Common gait deviations in certain diseases like Parkinson's disease, Stroke hemiplegic and Duchenne muscular Dystrophy(DMD) are easily identified because of their gait pattern.

➤ High Stepping gait →  This gait occurs due to weakness of dorsiflexors muscle of leg which produces foot slapping at the early stance and foot drop at the swing phase.

➤Weakness of quadricep muscle → There is forcible extension of knee at heel strike which is done by using hand on thigh position. At mid stance, knee can be drawn backward by hip extensor as well as by gastro-soleus muscle on weight bearing by producing equinus foot.

➤Weakness of hamstring muscle→ gait is disturbed and it may give rise to genu recurvatum due to repeated posterior thrust of weight bearing.

Gait Training:

Your Physical Therapist will give you gait training according to the type of deformity you have, so it is important to note that gait training should be started after the first evaluation of a patient and not only when the patient is allowed to stand and walk. So gait training consist of 5 phases and they are 

1.Pre gait training assessment and evaluation

2.Detection of the restricting factors

3.Therapeutic measures

4.commencement of gait training 

5.independence in other activities of ambulation

Physical Therapy for Gait:

Physical therapist plays a major role in gait training by emphasis on muscles of lower limb by weight bearing and strengthening. Since these muscles provide the basic support, balance and propulsion functions. Physical therapy may have to be practised to elicit contraction of a muscle or to strengthen a weak muscle group. The position in which muscles are activated may not be of any consequence in the early stage of training, since such exercises are designed to get weak or inactive muscles to twitch and generate force. However, for muscles to be able to both generate and time the necessary muscle force in the synergy required for walking or stair walking, it is clear that closed chain(foot on support surface) actions must be practised repetitively, frequently and under different environmental and speed conditions.

   Conclusion:

Physical Therapist are to be part of rehabilitation in the twenty first century for gait training, it is time for a paradigm shift to a more scientifically based walking rehabilitation. So there has to be a training guidelines designed to increase lower limb muscle strength and optimize walking performance.