Posterior Lower Leg Muscles

Dr. Julie Mercy J DavidErasmus Mundus Master in Adapted Physical Activity, MPT, BPTh/BPTPhysiotherapist

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Poor sitting posture is a common cause of sciatica. To assist the support of your lower back many simple and effective products have been developed over time. These include: lumbar d-roll bassett frame kinesiology lumbar tape please ask your physiotherapist for their advice in what will help you most. This simple stretch helps relieve sciatica pain by loosening your gluteal and piriformis muscles, which can become inflamed and press against the sciatic nerve. 1.Lie on your back with your legs extended and your feet flexed upward. 2.Bend your right leg and clasp your hands around the knee. 3.Gently pull your right leg ac 4.Ross your body toward your left shoulder. Hold it there for 30 seconds. Remember to pull your knee only as far as it will comfortably go. You should feel a relieving stretch in your muscle, not pain. 5.Push your knee so your leg returns to its starting position. 6.Repeat for a total of 3 reps, and then switch legs. 5.sitting spinal stretch sciatica pain is triggered when vertebrae in the spine compress. This stretch helps create space in the spine to relieve pressure on the sciatic nerve. 1.Sit on the ground with your legs extended straight out with your feet flexed upward. 2.Bend your right knee and place your foot flat on the floor on the outside of your opposite knee. 3.Place your left elbow on the outside of your right knee to help you gently turn your body toward the right. 4.Hold for 30 seconds and repeat three times, then switch sides. 6. Standing hamstring stretch this stretch can help ease pain and tightness in the hamstring caused by sciatica. 1.Place your right foot on an elevated surface at or below your hip level. This could be a chair, ottoman, or step on a staircase. Flex your foot so your toes and leg are straight. If your knee tends to hyperextend, keep a slight bend in it. 2.Bend your body forward slightly toward your foot. The further you go, the deeper the stretch. Do not push so far that you feel pain. 3.Release the hip of your raised leg downward as opposed to lifting it up. If you need help easing your hip down, loop a yoga strap or long exercise band over your right thigh and under your left foot. 4.Hold for at least 30 seconds, and then repeat on the other sideif you have low back pain and sciatica you can undergo intermittent pelvic traction where in your half of your body weight will be added in the electronic traction so that that would help you to reduce the pain, along with interferential therapy stimulations which would help you to get relieved from the radiating pain. Apply ice for the pain to get subsided immediately. If you cannot go immediately for the physiotherapy treatment. Ice can be kept in the low back where you have back pain. It is suggestible to wear lumbo sacral belt which would help you to build the abdominal muscle tone which itself would make you feel better. You can also wear mcr chappals which would help you to have less weight falling in the painful back. U have to take vitamin d rich foods. Likemilk,cheese, yogurt,brocoli, spinach.u need calcium consumption for increase the bone density. Lackof bone and bones crush inside the body this might be due to low calcium or vitamin d which has more impact on the bone density and also it makes one to feel that there is lack of bone strength or in a way the bones are brittle and almost breaking and they feel it is crushed in a way there are many bones breaking at the same time. You have to take vitamin d rich foods. Likemilk,cheese, yogurt, brocoli, spinach.u need calcium consumption for increase the bone density. vitamin d intake via supplements or exposure to low levels of sunlight. Vitamin d is used to absorb calcium in the bone and regulate calcium in the blood. If you have leg pain then you have to rule out the causes for having leg pain. First of all check your weight and your haemoglobin levels, as anaemia always leads to the symptoms of being tired and also having leg pain though there are no issues with the knee joint or back pain. If not if the pain radiates down the back of thigh and legs then it might be due to sciatica. Kindly consult the nearby physiotherapist. Hope you recover soon from the leg pain. Lumbar radiculopathy: pain in lower back or glutei region with sharp shooting pain radiating from hip to leg/foot region, occurs in cases of lumbar radiculopathy or sciatica. This is due to compression of lumbar nerve root or sciatic nerve by disc prolapse, facet joint, trauma, hypertrophied ligamentumflavum, piriformis syndrome, etc. L5 vertrbrae and patient has pain the legs and sensation is disturbed? That is called as lumbar vertebrae. And there are 5 lumbar vertebrae and the 5th lumbar vertebrae is always is located in the lower end where the body weight is taken and it is generally fused with sacral vertebrae. That is where the sciatic nerve passes by and the nerve gets compressed that's the reason you have pain and sensation is disturbed. Loss of concavity of l4-l5 vertebrae. It is other wise called as the lumbo sacral curve which is very important for the spine to take the entire weight evenly if not it leads to disturbance of the disc and also the vertebrae which makes the spine to loose its concavity that's why it is called as loss of posterior concavity. For which we need to improve the spine posture and we need to adapt good posture during our day to day life activities. I have pain in my left side leg. This should be due to the sciatic nerve compression in the right side probably close to your l5 vertebrae. It can also be due to the strain on the left leg, try wearing mcr chappals which would help you to get relieved from pain. We suggest you to wear a lumbo sacral corset and also modified foot wear if you want we can send you by courier. 

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Dr. Julie Mercy J DavidErasmus Mundus Master in Adapted Physical Activity, MPT, BPTh/BPTPhysiotherapist

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That is called as lumbar vertebrae. And there are 5 lumbar vertebrae and the 5th lumbar vertebrae is always is located in the lower end where the body weight is taken and it is generally fused with sacral vertebrae. That is where the sciatic nerve passes by and the nerve gets compressed that's the reason you have pain and sensation is disturbed. Loss of concavity of l4-l5 vertebrae. It is other wise called as the lumbo sacral curve which is very important for the spine to take the entire weight evenly if not it leads to disturbance of the disc and also the vertebrae which makes the spine to loose its concavity that's why it is called as loss of posterior concavity. For which we need to improve the spine posture and we need to adapt good posture during our day to day life activities. 

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Dr. Julie Mercy J DavidErasmus Mundus Master in Adapted Physical Activity, MPT, BPTh/BPTPhysiotherapist

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Herniated disc 1. Spinal decompression how it helps – spinal decompression should be the very first thing you do to treat a herniated or bulging disc because it essentially creates space between your vertebrae, and thus takes pressure off the discs. How to do it – use a bar or the top of a door (or anything you can hang from) and allow your body to “just hang”. – hang for 30 seconds and do 3 sets. – release very slowly from this so as not to cause any spasms. ** this should not cause any pain. If you feel pain during it is not a good one for you. In that case, stop and try some of the other exercises below instead. 2. Standing extension how it helps – this standing extension helps reverse what you do on a daily basis (hunching)… since most bulging discs and herniated discs are caused by poor posture and repeated flexion of the spine (esp bending fwd in bad posture), this stretch helps push the disc back to neutral position. How to do it – begin this exercise by standing up with good posture. Now take both hands and place them on both sides of your lower back. Now with the help of your hands push your pelvis forward and extend your spine back. Follow the extension with your neck so that you end up facing the ceiling. – start with 10 repetitions and do 2-3 sets. – this one is particularly great to do when you need a break from sitting at your desk. ** this should not cause any pain. If you feel pain during it is not a good one for you. In that case, stop and try some of the other exercises below instead. 3. Half cobra pose (prone lumbar extension) how it helps – the half cobra stretch helps to push the disc material back towards the center of the inter-vertebral disc to allow for improved healing. The goal of repeated lower back extension is the “centralization of symptoms”, which basically means pain that travels down the affected leg to the foot should come back up closer to the low back – which will in turn alleviate the pain. How to do it – begin this exercise by lying on your stomach (prone position) and slowly prop yourself up on your elbows while keeping your hips in contact with the floor. – hold the prop-up position for 10-15 seconds before returning to the prone position (lying face down). – gradually increase to holding the end position for 30 seconds. Aim for 10 repetitions of this stretch. ** initially, you may not be able to tolerate this position very well, so make sure you start slowly and carefully. If there’s any pain, try a different exercise instead. 4. Full cobra pose (advanced extension) how it helps – this stretch is based on the same principle as the half cobra pose above. This advanced extension helps to push disc material back towards the center of the intervertebral disc, with the goal of alleviating pain symptoms. How to do it – once you’ve mastered the half cobra pose, you can increase the difficulty by moving to the advanced version of this stretch. Begin this exercise by lying on your stomach in the prone position (lying facing down) and slowly press up on your hands while keeping your pelvis in contact with the floor and lower back relaxed. – hold the prop-up position for 10 seconds. Aim for 10 repetitions of this stretch. – eventually try to hold this pose for longer if it feels good (20-30 seconds). ** if you feel pain during this exercise, it is not a good one for you. In that case, stop and try some of the other exercises instead. 5. Cat-cow how it helps – this is one of the most popular herniated disc exercises. By combining two yoga poses, the cat-cow stretch can help to relieve pressure on the herniated disc by opening the intervertebral disc space. It also improves mobility of the spine, which may help to relieve disc herniation pain and speed recovery. How to do it – begin this stretch on your hands and knees. Inhale and let your stomach “drop” towards the floor as you look up towards the ceiling. – follow this by exhaling and slowly rounding your spine while pressing into the floor with your hands and slightly curving your neck to look at your feet. – aim for 10 repetitions of this stretch and do 2-3 sets. How it helps – this exercise will help strengthen and stabilize your lower back and deep spine muscles. This will help you to maintain a good posture and avoid future episodes of herniated discs. How to do it: – begin on your hands and knees with your hands positioned under your shoulders and knees positioned under your hips. – raise your left arm and reach it forwards until it is aligned with your torso; at the same time, kick your right leg backwards until is it aligned with your torso. – hold this position for 2-3 seconds before slowly returning to the starting position. – repeat with your right arm and left leg. – alternate sides for 10 repetitions and do 2-3 sets. ** ensure that your head, neck, and back maintain a neutral alignment to minimize stress on your neck. 6.plank: how it helps – just like the bird dog, this “core” exercise will help bring your pelvis into right position by strengthening the deep spinal muscles and glutes (butt muscles). How to do it – begin lying on your stomach with your forearms against the mat. – engage your core and lift your body so that you are resting on your forearms and toes. – start with 10 second holds and work up to 30 second holds, do 2-3 sets. ** ensure to keep your back straight throughout the entire exercise – spine in neutral position. Thoracic expansion if you’re using a chair, sit facing forward and allow your upper body to fall over the back of the chair. Extend your arms above your head for a deeper stretch. Hold either position for 10 seconds and release. Repeat 3 times. 7.sitting spinal stretch sciatica pain is triggered when vertebrae in the spine compress. This stretch helps create space in the spine to relieve pressure on the sciatic nerve. 1.sit on the ground with your legs extended straight out with your feet flexed upward. 2.bend your right knee and place your foot flat on the floor on the outside of your opposite knee. 3.place your left elbow on the outside of your right knee to help you gently turn your body toward the right. 4.hold for 30 seconds and repeat three times, then switch sides. 8. Standing hamstring stretch this stretch can help ease pain and tightness in the hamstring caused by sciatica. 1.place your right foot on an elevated surface at or below your hip level. This could be a chair, ottoman, or step on a staircase. Flex your foot so your toes and leg are straight. If your knee tends to hyperextend, keep a slight bend in it. 2.bend your body forward slightly toward your foot. The further you go, the deeper the stretch. Do not push so far that you feel pain. 3.release the hip of your raised leg downward as opposed to lifting it up. If you need help easing your hip down, loop a yoga strap or long exercise band over your right thigh and under your left foot. 4.hold for at least 30 seconds, and then repeat on the other sideif you have low back pain and sciatica you can undergo intermittent pelvic traction where in your half of your body weight will be added in the electronic traction so that that would help you to reduce the pain, along with interferential therapy stimulations which would help you to get relieved from the radiating pain. 9.anterior pelvic tilt 1.lie on the back with the knees bent and feet flat on the floor, hip-width apart. 2.squeeze the buttocks and tilt the pelvis upward. 3.the back should feel as though it is flattening to the ground. 4.return to normal pelvis position. 5.repeat 10–12 times. Apply ice for the pain to get subsided immediately. If you cannot go immediately for the physiotherapy treatment. Ice can be kept in the low back where you have back pain. It is suggestible to wear lumbo sacral belt which would help you to build the abdominal muscle tone which itself would make you feel better. You can also wear mcr chappals which would help you to have less weight falling in the painful back. U have to take vitamin d rich foods. Likemilk, cheese, yogurt, brocoli, spinach. U need calcium consumption for increase the bone density. Lackof bone and bones crush inside the body vitamin d intake via supplements or exposure to low levels of sunlight. Vitamin d is used to absorb calcium in the bone and regulate calcium in the blood.this might be due to low calcium or vitamin d which has more impact on the bone density and also it makes one to feel that there is lack of bone strength or in a way the bones are brittle and almost breaking and they feel it is crushed in a way there are many bones breaking at the same time. You have to take vitamin d rich foods. Likemilk, cheese, yogurt, brocoli, spinach. U need calcium consumption for increase the bone density. 

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Dr. Julie Mercy J DavidErasmus Mundus Master in Adapted Physical Activity, MPT, BPTh/BPTPhysiotherapist

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1.lie on your back with your legs extended and your feet flexed upward. 2.bend your right leg and clasp your hands around the knee. 3.gently pull your right leg ac 4.ross your body toward your left shoulder. Hold it there for 30 seconds. Remember to pull your knee only as far as it will comfortably go. You should feel a relieving stretch in your muscle, not pain. 5.push your knee so your leg returns to its starting position. 6.repeat for a total of 3 reps, and then switch legs. 1. Reclining pigeon pose pigeon pose is a common yoga pose. It works to open the hips. There are multiple versions of this stretch. The first is a starting version known as the reclining pigeon pose. If you are just starting your treatment, you should try the reclining pose first. 1.while on your back, bring your right leg up to a right angle. Clasp both hands behind the thigh, locking your fingers. 2.lift your left leg and place your right on top of the left knee. 3.hold the position for a moment. This helps stretch the tiny piriformis muscle, which sometimes becomes inflamed and presses against the sciatic nerve, causing pain. 4.do the same exercise with the other leg. Once you can do the reclining version without pain, work with your physical therapist on the sitting and forward versions of pigeon pose. 2. Sitting pigeon pose 1.sit on the floor with your legs stretched out straight in front of you. 2.bend your right leg, putting your right ankle on top of the left knee. 3.lean forward and allow your upper body to reach toward your thigh. 4.hold for 15 to 30 seconds. This stretches the glutes and lower back. 5.repeat on the other side. 3. Forward pigeon pose 1.kneel on the floor on all fours. 2.pick up your right leg and move it forward on the ground in front of your body. Your lower leg should be on the ground, horizontal to the body. Your right foot should be in front of your right knee while your right knee stays to the right. 3.stretch the left leg out all the way behind you on the floor, with the top of the foot on the ground and toes pointing back. 4.shift your body weight gradually from your arms to your legs so that your legs are supporting your weight. Sit up straight with your hands on either side of your legs. 5.take a deep breath. While exhaling, lean your upper body forward over your front leg. Support your weight with your arms as much as possible. 6.repeat on the other side. 7. Knee to opposite shoulder. Back pain due to muscular pain it looks like a muscle pain kindly do some exercises that may help you to get rid of your pain and regular stretch may help you to relax the muscles of your back and lower limbs the exercises I personally recommend are listed below in the order I use with my patients. Exercise #1 in the early stages of a disc bulge, your body’s natural response is to tighten up and protect the spine and buttocks area. Because of this, one of the the simplest things you can do yourself to relieve radiating back pain caused my a disc bulge is stretching piriformis muscle. How to perform it: ● begin lying on your back with your knees bent and feet positioned flat on the floor ● place your right ankle over your left knee ● use your hands or a band to pull the left thigh towards your chest, and hold for 20 to 30 seconds ● repeat on the other leg ● aim for 3 repetitions on each side exercise #2: prone alternating leg raisesthe prone leg lift creates spinal extension helping push the jelly-like material back towards the center and reduce bulging disc. How to do it: ● lay face down with your palms on the floor under your forehead. ● straighten one leg then lift it a few inches off the ground with your toe pointed. ● lower your leg to the floor with your knee remaining straight. ● switch legs ● repeat 3 x 15 reps each side ● 3 x a day exercise #3: half cobra pose the half cobra pose creates spinal extension helping push the nucleus (jelly) back towards the center and reduce bulging disc. How to do it: ● begin this exercise by lying on your stomach (prone position) and slowly prop yourself up on your elbows while keeping your hips in contact with the floor. ● hold the prop-up position for 10-15 seconds before returning to the prone position (lying face down). ● gradually increase to holding the end position for 30 seconds. Aim for 10 repetitions of this stretch. ** initially, you may not be able to tolerate this position very well, so make sure you start slowly and carefully. Recommended: half cobra pose exercise video demo exercise #4: full cobra pose the full cobra pose creates even more spinal extension than half cobra helping push the nucleus (jelly) back towards the center and reduce bulging disc. How to do it: ● begin lying on the ground with your hands flat on the floor at the level of your shoulders ● slowly push your hands to raise your shoulder off of the ground until you feel a slight stretch ● increase your range of motion by exhaling as you push further into lumbar extension ● aim for 5 repetitions exercise #5: abdominal drawing maneuver a solid core foundation helps provide stability which in turn prevents re-injury and further injury from occurring. This will help reset the spine into neutral position. How to do it: ● lie on your back ● bend your knees ● contract your stomach muscle (abdominals) ● hold for 5 seconds ● release ● perform 3 x 20 sets daily. 

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Dr. Julie Mercy J DavidErasmus Mundus Master in Adapted Physical Activity, MPT, BPTh/BPTPhysiotherapist

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Kindly do these exercises. Plank the world record for the longest plank is 8 hours. Luckily, you don’t need to hold it that long for the exercise to have an effect! in fact. You can hold it for 10-15 seconds. • the plank is similar to a push-up position, but instead of resting on your hands, you rest on your elbows and bring them directly underneath your chest. • after kneeling, lean forward and place your elbows on the ground directly below your shoulders. • lift your knees off of the floor and push your feet back. Ensure your back is straight and keep your neck aligned with the rest of your spine. • hold the position and tighten your core muscles for the desired time. 2. Side plank just like the original plank, but only balancing on one side. • lie on the floor on your side, facing sideways with your feet together. • lift up your body until you are supporting yourself with your elbow, directly below your shoulder. • raise your hips until your body is in a straight line and tighten your core muscles; your body should create a slant from your shoulders to your feet. • hold this position without dropping your hips. • repeat on the opposite side. 3. Pelvic tilt with exercise ball sit on a ball that allows your legs to be at a 90-degree angle with your feet flat on the floor. • keep your shoulders back and spine straight. • tilt your hips forward and flex your abdominals tight. • tilt your hips backward as you stick your tailbone out. • move back and forth slowly, keeping your shoulders back. • repeat 10 times for 3 sets. 4. Superman lie on your stomach, face down, with your arms out in front of you. • lift arms, legs, and chest off the floor simultaneously while keeping your hips grounded. • hold for a minimum of two seconds. • lower back down slowly. • repeat 10 times for 3 sets. 6. Crunches lie flat on your back, placing your feet flat on the floor with your legs bent. • fold your arms across your chest and lift your torso up until your head, neck, and torso are off the ground. • hold for a moment before lowering back down. • repeat. 6. Quadruped arm opposite leg raises • kneel on the floor, lean forward, and place your hands palm-down on the floor. • make sure your back is straight, your knees are below your hips, and that your palms are directly below your shoulders. • raise one arm as you raise the opposite leg until both are aligned straight out from your body, parallel to your spine. • slowly lower both your arm and leg until you are back in the starting position. • switch arm and leg, and repeat. 7. Dead bug lie flat on the floor on your back. • lift your arms straight up from your body, reaching through the air. • raise one leg until it is at a 90-degree angle from your body. • slowly lower until it is in the starting position. • switch legs and repeat. 8. Hip bridge lie on your back with your knees bent and raised, your feet flat on the floor, and your arms at your sides. • keep your feet hip-distance apart and try to keep your leg in vertical alignment with your knee. • flex your glutes and push through your heels to raise your hips upward. Try to make a diagonal line from your shoulders to your knees. • hold for a short moment before lowering back down. • repeat 10 times for 3 sets. 

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Dr. Julie Mercy J DavidErasmus Mundus Master in Adapted Physical Activity, MPT, BPTh/BPTPhysiotherapist

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Kindly do exercises that are listed below 2. Standing extension how it helps – this standing extension helps reverse what you do on a daily basis (hunching)… since most bulging discs and herniated discs are caused by poor posture and repeated flexion of the spine (esp bending fwd in bad posture), this stretch helps push the disc back to neutral position. How to do it – begin this exercise by standing up with good posture. Now take both hands and place them on both sides of your lower back. Now with the help of your hands push your pelvis forward and extend your spine back. Follow the extension with your neck so that you end up facing the ceiling. – start with 10 repetitions and do 2-3 sets. – this one is particularly great to do when you need a break from sitting at your desk. ** this should not cause any pain. If you feel pain during it is not a good one for you. In that case, stop and try some of the other exercises below instead. 3. Half cobra pose (prone lumbar extension) how it helps – the half cobra stretch helps to push the disc material back towards the center of the inter-vertebral disc to allow for improved healing. The goal of repeated lower back extension is the “centralization of symptoms”, which basically means pain that travels down the affected leg to the foot should come back up closer to the low back – which will in turn alleviate the pain. How to do it – begin this exercise by lying on your stomach (prone position) and slowly prop yourself up on your elbows while keeping your hips in contact with the floor. – hold the prop-up position for 10-15 seconds before returning to the prone position (lying face down). – gradually increase to holding the end position for 30 seconds. Aim for 10 repetitions of this stretch. ** initially, you may not be able to tolerate this position very well, so make sure you start slowly and carefully. If there’s any pain, try a different exercise instead. 4. Full cobra pose (advanced extension) how it helps – this stretch is based on the same principle as the half cobra pose above. This advanced extension helps to push disc material back towards the center of the intervertebral disc, with the goal of alleviating pain symptoms. How to do it – once you’ve mastered the half cobra pose, you can increase the difficulty by moving to the advanced version of this stretch. Begin this exercise by lying on your stomach in the prone position (lying facing down) and slowly press up on your hands while keeping your pelvis in contact with the floor and lower back relaxed. – hold the prop-up position for 10 seconds. Aim for 10 repetitions of this stretch. – eventually try to hold this pose for longer if it feels good (20-30 seconds). ** if you feel pain during this exercise, it is not a good one for you. In that case, stop and try some of the other exercises instead. 5. Cat-cow how it helps – this is one of the most popular herniated disc exercises. By combining two yoga poses, the cat-cow stretch can help to relieve pressure on the herniated disc by opening the intervertebral disc space. It also improves mobility of the spine, which may help to relieve disc herniation pain and speed recovery. How to do it – begin this stretch on your hands and knees. Inhale and let your stomach “drop” towards the floor as you look up towards the ceiling. – follow this by exhaling and slowly rounding your spine while pressing into the floor with your hands and slightly curving your neck to look at your feet. – aim for 10 repetitions of this stretch and do 2-3 sets. How it helps – this exercise will help strengthen and stabilize your lower back and deep spine muscles. This will help you to maintain a good posture and avoid future episodes of herniated discs. How to do it: – begin on your hands and knees with your hands positioned under your shoulders and knees positioned under your hips. – raise your left arm and reach it forwards until it is aligned with your torso; at the same time, kick your right leg backwards until is it aligned with your torso. – hold this position for 2-3 seconds before slowly returning to the starting position. – repeat with your right arm and left leg. – alternate sides for 10 repetitions and do 2-3 sets. ** ensure that your head, neck, and back maintain a neutral alignment to minimize stress on your neck. Plank: how it helps – just like the bird dog, this “core” exercise will help bring your pelvis into right position by strengthening the deep spinal muscles and glutes (butt muscles). How to do it – begin lying on your stomach with your forearms against the mat. – engage your core and lift your body so that you are resting on your forearms and toes. – start with 10 second holds and work up to 30 second holds, do 2-3 sets. ** ensure to keep your back straight throughout the entire exercise – spine in neutral position. Thoracic expansion if you’re using a chair, sit facing forward and allow your upper body to fall over the back of the chair. Extend your arms above your head for a deeper stretch. Hold either position for 10 seconds and release. Repeat 3 times. Can tight neck muscles cause vertigo. Your inner ear might not be the culprit. Vertigo is the technical name for dizziness, especially the type where it feels like the room, or the patient, is spinning. Theneck structures most likely to cause vertigo are a muscle called the sternocleidomastoid (scm for short) and the uppermost joints of the spine shin pain 1.Keep your legs elevated. 2.Use ice packs to reduce swelling. Shop for cold compresses. 3.Take an over-the-counter anti-inflammatory, such as ibuprofen (advil) or naproxen sodium (aleve). Shop for ibuprofen and naproxen sodium. 4.Wear elastic compression bandages. 5.Use a foam roller to massage your shins. Finger stretch 1.Place your hand palm-down on a table or other flat surface. 2.Gently straighten your fingers as flat as you can against the surface without forcing your joints. 3.Hold for 30 to 60 seconds and then release. 4.Repeat at least four times with each hand. Scapular dyskinesis technique #1: overhead wall rollout this is a great exercise for retraining scapulohumeral rhythm and activating the serratus anterior as well as integrating shoulder flexion with core stability. 1.Stand leaning against a wall with an ab-wheel in your hands 2.Protract your scapulae 3.Slowly roll the ab-wheel up the wall and ensure you’re shrugging your shoulders to elevate your scapulae as your arms rise up while keeping tension in your core to avoid lumbar extension 4.Roll back down slowly and with control and return to the initial position. 5.Breathe naturally throughout the movement scapular dyskinesis technique #2: supine serratus activator this activation technique will help reset your scapulae in the correct position, while reactivating the inhibited posterior muscles of your shoulder. 1.Lay on your back with legs bent, feet flat and arms by your side 2.Bend your elbows so your fingers are pointing up towards the sky with palms facing together 3.Drive your elbows into the ground to activate the lats and posterior deltoids without trying to pinch your scapulae together 4.Picture your chest opening and the medial border of the scapulae moving up into your body and hold for 5 seconds 5.Relax briefly and repeat. 

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Dr. Julie Mercy J DavidErasmus Mundus Master in Adapted Physical Activity, MPT, BPTh/BPTPhysiotherapist

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In the early stages of a disc bulge, your body’s natural response is to tighten up and protect the spine and buttocks area. Because of this, one of the the simplest things you can do yourself to relieve radiating back pain caused my a disc bulge is stretching piriformis muscle. Not sure about the surgery part. If you have l4-l5 disc bulge which is quite common, since you are young you can definitely go for conservative management - physiotherapy and rehabilitation exercises for the abdomen and spine which will help you to improve much better.in the early stages of a disc bulge, your body’s natural response is to tighten up and protect the spine and buttocks area. Because of this, one of the the simplest things you can do yourself to relieve radiating back pain caused my a disc bulge is stretching piriformis muscle. How to perform it: ● begin lying on your back with your knees bent and feet positioned flat on the floor ● place your right ankle over your left knee ● use your hands or a band to pull the left thigh towards your chest, and hold for 20 to 30 seconds ● repeat on the other leg ● aim for 3 repetitions on each side exercise #2: prone alternating leg raises the prone leg lift creates spinal extension helping push the jelly-like material back towards the center and reduce bulging disc. How to do it: ● lay face down with your palms on the floor under your forehead. ● straighten one leg then lift it a few inches off the ground with your toe pointed. ● lower your leg to the floor with your knee remaining straight. ● switch legs ● repeat 3 x 15 reps each side ● 3 x a day exercise #3: half cobra pose the half cobra pose creates spinal extension helping push the nucleus (jelly) back towards the center and reduce bulging disc. How to do it: ● begin this exercise by lying on your stomach (prone position) and slowly prop yourself up on your elbows while keeping your hips in contact with the floor. ● hold the prop-up position for 10-15 seconds before returning to the prone position (lying face down). ● gradually increase to holding the end position for 30 seconds. Aim for 10 repetitions of this stretch. ** initially, you may not be able to tolerate this position very well, so make sure you start slowly and carefully. Recommended: half cobra pose exercise video demo exercise #4: full cobra pose the full cobra pose creates even more spinal extension than half cobra helping push the nucleus (jelly) back towards the center and reduce bulging disc. How to do it: ● begin lying on the ground with your hands flat on the floor at the level of your shoulders ● slowly push your hands to raise your shoulder off of the ground until you feel a slight stretch ● increase your range of motion by exhaling as you push further into lumbar extension ● aim for 5 repetitions exercise #5: abdominal drawing maneuver a solid core foundation helps provide stability which in turn prevents re-injury and further injury from occurring. This will help reset the spine into neutral position. How to do it: ● lie on your back ● bend your knees ● contract your stomach muscle (abdominals) ● hold for 5 seconds ● release ● perform 3 x 20 sets daily. 

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Dr. Julie Mercy J DavidErasmus Mundus Master in Adapted Physical Activity, MPT, BPTh/BPTPhysiotherapist

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This exercise will strengthen the extension muscles in the upper back. How to do it: lie face down with your head lifted off the floor. Your lower back needs to be slightly hyper-extended. Stretch your arms straight out in a y position with your thumbs pointing up. Pull your arms back in an arc until your hands are in a ‘handcuff’ position. Slowly reverse your arms until you’re at the start. Repeat 2 or 3 times. •wall sliding (wall angels) this exercise will strengthen the scapular retractors and will provide good shoulder mobility. How to do it: stand with your back against a wall but take one small step forward. Hold your arms out in the shape of a w with your hands facing up. Push your hands up toward the wall until they reach a y position. Return your arms to the w position. Repeat 5 times. •t-spine rotation thoracic spine rotations are essential for increasing mobility in the thoracic spine region (where the kyphosis affects). How to do it: get on all fours making sure your arms are at full length and your hands are positioned just in front of your shoulders. Take your right arm and stretch out your arm. Slowly move your arm underneath your body (and slow twist at the waist) until your arm is as far through as possible and you are looking at the palm of your right hand. Slowly reverse. Do 3 of these then repeat with the other arm. •crucifix spending too much time in a seated position causes lower and upper back muscles to shorten which leads to poor posture. This stretch helps to undo these shortened muscles. How to do it: stand tall with your arms extended straight out to your sides at shoulder height. Turn your wrists so your thumbs face backwards and pull your (straight) arms up over your head. Bend your elbows until your elbow is at a 90 degree angle. Lower your left hand until it touches your shoulder. Take your right hand and place it on the left elbow. Lower your left hand as far as you can go and hold for as long as you can. Slowly release. Repeat 2 times then switch to your other arm. Do this exercise several times a day. Bad posture can contribute to the severity and appearance of pectusexcavatum. Strengthening your postural muscles can help. Because we often work on our front body — especially when strengthening our chest to help with pectusexcavatum — this exercise will help balance your body by strengthening your posterior chain — those muscles on the back of the body. 1.Lie on your stomach on a mat with your arms extended in front of you and your forehead resting on the ground. 2.As you inhale, lift your head, legs, and arms. 3.Hold for a count of 5 and gently release back to the ground. 4.Complete 2 sets of 10. 

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Dr. Julie Mercy J DavidErasmus Mundus Master in Adapted Physical Activity, MPT, BPTh/BPTPhysiotherapist

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You need to consume good protein and iron diet in your body which will help you to break the fatigue and general body pain. However non veg foods definitely makes you to get increased with the toxin levels in the body and it makes your knee to have less fluid content in the system. In general we suggest patients who has knee pain to eat more water content vegetables which will definitely help you to feel better. Ice therapy would definitely help to reduce the inflammation. We also advise you to use knee cap which would help to prevent the knee from damaging further and also to maintain the quadriceps muscle tone. Stiffness have developed due to weakness of the ligaments &inflammed cartilage. Specific knee exercises will also help ie. Keeping ball underneath the knee and keep pressing it. That's the simple exercise which will help you to strengthen the knee. • ultrasound- which heals the damaged tissues and heals • electric stimulation / ift- which reduces the pain • kinesiology taping • application of heat or ice • soft tissue massages or knee joint mobilization 5 do’s & don’ts to reduce your knee pain. 1. Don’t take too much rest- not only your body muscles may become weaker even your joint’s pain may become worse. Take consultation from your physiotherapist to guide you with knee pain exercises which are safe for your knees & keep doing it. 2. Do exercise– exercises help in strengthening the muscles, increase flexibility & also support your knee. You can also do swimming, walking, elliptical machines & bicycles, etc. 3. Don’t avoid your weight– excess weight may increase the stress on your knee and if you have inflammatory arthritis then it may become worse. You don’t need to have ideal weight, you just need to start working to reduce the weight. 4. Rice -this process is good for joint pain caused due to minor injury or an arthritis. • • r (rest) – give some rest to your knees. • I (ice) – massage your knees with ice to reduce swelling. • c (compression)- start wearing compression bandage. • e (elevation)- keep your knee elevated. 5. Don’t wear bad shoes- we actively wear shoes in our daily life for hours without noticing how it can affect your knees badly. So, if you are facing knee pain, then check your shoes first. Is it giving you good comfort? If not then change it urgently. The importance of buying braces and splints from us – orthopaedic support braces we suggest you to wear knee brace which is available at our clinic. If you want you can buy from us, if you are far away from chennai we can send you by courier. The reason why we are conveying you to buy from us is we can demonstrate over the videocall and also we can monitor you throughout when to wear it and how long to wear it. And also if you find any difficulty wearing the brace you can also revert back to us for few more suggestions and we can propose you good solution how to go about it. Resisted terminal knee extension: make a loop with a piece of elastic tubing by tying a knot in both ends. Close the knot in a door at knee height. Step into the loop with your injured leg so the tubing is around the back of your knee. Lift the other foot off the ground and hold onto a chair for balance, if needed. Bend the knee with tubing about 45 degrees. Slowly straighten your leg, keeping your thigh muscle tight as you do this. Repeat 15 times. Do 2 sets of 15. If you need an easier way to do this, stand on both legs for better support while you do the exercise. Standing calf stretch: stand facing a wall with your hands on the wall at about eye level. Keep as arthritis is very common that you get generally bilaterally. Ice therapy would definitely help to reduce the inflammation. We also advise you to use knee cap which would help to prevent the knee from damaging further and also to maintain the quadriceps muscle tone 1. Heel and calf stretch to do this stretch: 1. Stand facing a wall. 2. Place your hands on the wall and move one foot back as far as you can comfortably. Toes on both feet should be facing forward, heels flat, with a slight bend in your knees. 3. Lean into the stretch and hold for 30 seconds. You should feel the stretch in your back leg. 4. Change legs and repeat. 5. Do this stretch twice for both legs. Short arc quad / isometeric quad exercise the short arc quad exercise is a great way to really focus in on properly contracting your quadriceps muscles. Here is how you do it: lie on your back and use a yoga block or basketball to prop your knee up. Slowly straighten your bent knee until it is all the way straight. Tighten your quad muscle with your toes pointed toward the ceiling and hold it tight for five seconds. Slowly lower your leg down. Repeat for 15 repetitions. Quadriceps, isometric (strength) this exercise is for an injured right knee. Switch sides if the injury is to your left knee. 1. Sit on the floor with your right leg straight in front of you. Bend your left knee up and put your left foot flat on the floor. 2. Flex your right foot and tighten the thigh muscles of your right leg. Press the back of your right knee toward the floor. Don’t arch your back or hunch your shoulders. 3. Hold for 5 to 10 seconds. Then relax. 4. Repeat 10 times, or as instructed. 5. Do this exercise 3 times a day, or as instructed. 2. Quadriceps stretch to do this stretch: 1. Stand next to a wall or use a chair for support. Your feet should be shoulder-width apart. 2. Bend one knee so your foot goes up toward your glutes. 3. Grab your ankle and gently pull it toward your glutes as far as you can comfortably. 4. Hold for 30 seconds. 5. Return to the starting position and change legs. 6. Repeat 2 times on each side. Hamstring stretch • take a break from strenuous activities to allow the injury to heal. • use a cane or crutches to avoiding putting your full weight on your injured leg. • apply ice packs several times a day to relieve pain and reduce swelling. • wrap the injured area with a compression bandage or wear compression shorts to minimize swelling. • rest with your leg elevated above the level of your heart, if possible, to improve drainage and minimize swelling. To do this stretch: to do this stretch: 1. For this stretch, you can use a mat to add cushioning under your back. 2. Lie down on the floor or mat and straighten both legs. Or, if it’s more comfortable, you can bend both knees with your feet flat on the floor. 3. Lift one leg off the floor. 4. Place your hands behind your thigh, but below the knee, and gently pull your knee toward your chest until you feel a slight stretch. This shouldn’t be painful. 5. Hold for 30 seconds. 6. Lower and change legs. 7. Repeat 2 times on each side. Strengthening exercises 5. Half squat to do this exercise: 1. Get into a standing squat position with your feet shoulder-width apart. Place your hands on your hips or out in front of you for balance. 2. Looking straight ahead, slowly squat down about 10 inches. This is the halfway point to a full squat. 3. Pause for a few seconds, then stand up by pushing through your heels. 4. Do 2 to 3 sets of 10 repetitions. 5. Calf raises to do this exercise: 1. Stand with your feet shoulder-width apart. Position yourself next to a wall or hold on to the back of a chair for support. 2. Lift both your heels off the ground so that you’re standing on the balls of your feet. 3. Slowly lower your heels to the starting position. Control is important with this exercise for strengthening your calf muscles. 4. Do 2 to 3 sets of 10 repetitions. 6. Hamstring curl 7. Leg extensions to do this exercise: 1. Sit up tall in a chair. 2. Put your feet flat on the floor, hip-width apart. 3. Look straight ahead, contract your thigh muscles, and extend one leg as high as possible without raising your buttocks off the chair. 4. Pause, then lower to the starting position. 5. Do 2 to 3 sets of 10 repetitions for each leg. 8. Straight leg raises to do this exercise: 1. For this exercise, you can use a mat to add cushioning under your back. 2. Lie down on the floor with one leg bent and one leg straight out in front of you. 3. Contract the quadricep of your straight leg and slowly raise it up off the floor until it’s the same height as your bent knee. 4. Pause at the top for 5 seconds, then lower to the starting position 5. Do 2 to 3 sets of 10 repetitions for each leg. 9. Side leg raises to do this exercise: 1. Lie on your side with your legs stacked on top of each other. Cradle your head in your hand, and place your other hand on the floor in front of you. 2. Raise your top leg as high as you comfortably can. You should feel this on the side of your hips. 3. Pause briefly at the top, then lower your leg. 4. Do 2 to 3 sets of 10 repetitions for each leg. 10. Prone leg raises to do this exercise: 1. For this exercise, you can use a mat to add cushioning beneath you. 2. Lie on your stomach with your legs straight out behind you. You can let your head rest on your arms. 3. Engage your glute and hamstring muscles in your left leg and lift your leg as high as you exercise. 4. Hold your leg in the lifted position for 5 seconds. 5. Lower your leg, rest for 2 seconds, then repeat. 6. Do 2 to 3 sets of 10 repetitions for each leg. Lifestyle and home remedies rest. Take a break from your normal activities to reduce repetitive strain on your knee, give the injury time to heal and help prevent further damage. A day or two of rest may be all you need for a minor injury. More severe damage is likely to need a longer recovery time. Ice. Ice reduces both pain and inflammation. A bag of frozen peas works well because it covers your whole knee. You also can use an ice pack wrapped in a thin towel to protect your skin. Although ice therapy is generally safe and effective, don't use ice for longer than 20 minutes at a time because of the risk of damage to your nerves and skin. Heat. You may experience temporary pain relief by applying a heat pack or hot-water bottle to the painful area on your knee. Compression. This helps prevent fluid buildup in damaged tissues and maintains knee alignment and stability. Look for a compression bandage that's lightweight, breathable and self-adhesive. It should be tight enough to support your knee without interfering with circulation. Elevation. To help reduce swelling, try propping your injured leg on pillows or sitting in a recliner. Home remedies and prevention: •drinking plenty of water. Over-the-counter nsaids (nonsteroidal anti-inflammatory drugs), such as ibuprofen (advil, motrin). •home remedies may be very beneficial for the management of chronic gout, as well. The dietary modifications detailed above can be very effective in certain patients. Drinking plenty of water to remain well-hydrated can be beneficial in preventing gout attacks. •limit or avoid alcohol. Talk with your doctor about whether any amount or type of alcohol is safe for you. Recent evidence suggests that beer may be particularly likely to increase the risk of gout symptoms, especially in men. •get your protein from low-fat dairy products. Low-fat dairy products may actually have a protective effect against gout, so these are your best-bet protein sources. •limit your intake of meat, fish and poultry. A small amount may be tolerable, but pay close attention to what types — and how much — seem to cause problems for you. •maintain a desirable body weight. Choose portions that allow you to maintain a healthy weight. Losing weight may decrease uric acid levels in your body. But avoid fasting or rapid weight loss, since doing so may temporarily raise uric acid levels. Food to eat: •fresh fruits and vegetables such as berries, oranges, bell pepper and pineapple. •low-fat dairy products, such as yogurt and skimmed milk. •nuts including nut butter ••s such as almond butter and peanut butter. •whole grains. •potatoes, rice, whole-grain bread and pasta. •eggs (in moderation). •oils such as olive oil.•flax and other seeds. •plenty of water and other non-sugary and non-alcoholic drinks. •vitamin c. Supplements containing vitamin c may reduce the levels of uric acid in your blood. •cherries have been lower levels of uric acid, as well as reduce the number of gout attacks. •decaffeinated coffee and caffein will lower uric acid levels. Foods to be avoided: •alcohol is a major trigger for gout attacks. Beer is especially bad for gout since it is rich in purines. •certain fish, seafood and shellfish, including anchovies, trout, sardines, herring, codfish, mussels, codfish, scallops and haddock. •organ meats such as liver, kidney, sweetbreads and brain. People with gout, however, can have a moderate intake of lean meats such as chicken and turkey. •red meat including bacon, turkey, veal and venison.•dried beans and peas. •food products containing a high amount of fructose such as soda and some juices, cereal, ice cream, candy and junk food. 

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Dr. Karuna ChawlaBHMSHomeopathy Doctor

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Below are exercises that strengthen the lower back and help manage lower back pain: 1. Bridges—lie on the ground and bend the knees, placing the feet flat on the floor hip-width apart. Press the feet into the floor, keeping the arms by the sides. Raise the buttocks off the ground until the body forms a straight line from the shoulders to the knees. Squeeze the buttocks with the shoulders remaining on the floor. Lower the buttocks to the ground and rest for a few seconds. Repeat 15 times and then rest for 1 minute. Do 3 sets of 15 repetitions. 2. Knee-to-chest stretches— lie on the back on the floor. Bend the knees, keeping both feet flat on the floor. Use both hands to pull one knee in toward the chest. Hold the knee against the chest for 5 seconds, keeping the abdominals tight and pressing the spine into the floor. Return to the starting position. Repeat with the opposite leg. Repeat with each leg 2–3 times twice a day. 3. Lower back rotational stretches—lie back on the floor with bent knees and feet flat on the ground. Keeping the shoulders firmly on the floor, gently roll both bent knees over to one side. Hold the position for 5–10 seconds. Return to the starting position. Gently roll the bent knees over to the opposite side, hold, and then return to the starting position. Repeat 2–3 times on each side twice a day. 4. Draw-in maneuvers— lie back on the floor with knees bent and feet flat, keeping the arms by the sides. Breathe in deeply. While breathing out, pull the bellybutton toward the spine, tightening the abdominal muscles and keeping the hips still. Hold the position for 5 seconds. Repeat 5 times. 5. Pelvic tilts— lie back on the floor with knees bent and feet flat, keeping the arms by the sides. Gently arch the lower back and push the stomach out. Hold for 5 seconds, then relax. Flatten the back and pull the bellybutton in toward the floor. Hold for 5 seconds, then relax. Increase the number of repetitions daily, building up to 30. 6. Lying lateral leg lifts— lie on one side with the legs together. Keep the lower leg slightly bent. Draw the bellybutton into the spine to engage the core muscles. Raise the top leg about 18 inches, keeping it straight and extended. Hold the position for 2 seconds. Repeat 10 times. Turn onto the other side of the body and repeat, lifting the other leg. Perform 3 sets on each side. 7. Cat stretches— get onto the hands and knees with the knees hip-width apart. Arch the back, pulling the bellybutton up toward the spine. Slowly relax the muscles and allow the abdomen to sag toward the floor. Return to the starting position. Repeat 3–5 times twice a day. 8. Supermans— lie face down on the ground and stretch both arms out in front of the body, keeping the legs stretched out and flat on the ground. Raise both the hands and feet, aiming to create a gap of about 6 inches between them and the floor. Try to pull in the bellybutton, lifting it off the floor to engage the core muscles. Keep the head straight and look at the floor to avoid neck injury. Stretch the hands and feet outward as far as possible. Hold the position for 2 seconds. Return to the starting position. Repeat 10 times. 

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