Saturday, 18 November 2017

Tennis Elbow And Physiotherapy Treatment :


Tennis Elbow 

Tennis elbow, or lateral epicondylitis, is a painful condition of the elbow caused by overuse.
Tennis elbow is an inflammation of the tendons that join the forearm muscles on the outside of the elbow. The forearm muscles and tendons become damaged from overuse — repeating the same motions again and again. This leads to pain and tenderness on the outside of the elbow.
There are many treatment options for tennis elbow. In most cases, treatment involves a team approach. Primary doctors, physical therapists, and, in some cases, surgeons work together to provide the most effective care.


Anatomy Of Muscle And Joint

Elbow joint is a joint made up of three bones: upper arm bone (humerus) and the two bones in forearm (radius and ulna). There are bony bumps at the bottom of the humerus called epicondyles. The bony bump on the outside (lateral side) of the elbow is called the lateral epicondyle.
Muscles, ligaments, and tendons hold the elbow joint together.
Lateral epicondylitis, or tennis elbow, involves the muscles and tendons of forearm. Forearm muscles extend wrist and fingers. Forearm tendons — often called extensors — attach the muscles to bone. They attach on the lateral epicondyle. The tendon usually involved in tennis elbow is called the Extensor Carpi Radialis Brevis (ECRB).


  • Overuse.
  • Activities.
  • Age.
  • Unknown.


  • Phase 0: No pain or soreness. 
  • Phase 1: Soreness after activity, usually gone in twenty-four hours.
  • Phase 2: Mild stiffness and soreness before activity which disappears with warm-up. No pain during activity, but mild soreness after activity that disappears within 24 hours. 
  • Phase 3: Mild/moderate stiffness and soreness plus mild pain during activity which does not alter activity.
  • Phase 4: Pain during activity which alters activity.
  • Phase 5: Constant pain even at rest.


  • Diffuse achiness.
  • Morning stiffness.
  • Occasional night pain.
  • Dropping of objects/ weak grip strength.
  • Pain with palpation of lateral epicondyle.
  • Pain with active or resisted extension.
  • Pain with grasping objects with the effected hand.
  • Pain or tenderness on the outer side of the elbow.
  • Pain when you straighten or raise your wrist and hand.
  • Pain made worse by lifting a heavy object.
  • Pain when you make a fist, grip an object, shake hands, or turn door handles.
  • Pain that shoots from the elbow down into the forearm or up into the upper arm.


  • Weak muscles.
  • Overuse- playing or working with excessive and repetitive forceful gripping.
  • Gripping while extending or twisting of the wrist.
  • Racquets/ tools that are too heavy or unbalanced.
  • Improper equipment- incorrect grip size, strings too tight.
  • poor playing technique- too much wrist action, jerky strokes, poor ball contact.




Examination Of Patient

Cozen's test:

Resistive Tennis Elbow Test:The patient sits with the examiner stabilizing the involved elbow while palpating the lateral epicondyle With a closed fist, the patient pronates and radially deviates the forearm and extends the wrist against the examiner’s resistance”. A positive result would be if there is pain along the lateral epicondyle or objective muscle weakness.


Tapping Technique In Tennis Elbow

Medication: Anti-inflammatory medication helps to reduce pain.
Steroid Inection:  Steroids, such as cortisone, are very effective anti-inflammatory medicines.
Rest: You may have temporarily stop the aggravating activity. A period of rest is most important to allow the injury a chance to heal. You will make the condition worse by continuing the activity that cause the injury, especially if you experience pain. Avoid heavy liftting or carrying opening doors or repeatedly shaking hands.
Ice: Apply cold to your elbow three times a day for 20 to 30 minutes at a time in the early painful stage and for 20 minutes after active use of arm. Protect skin by putting a towel between elbow and the ice bag.
Brace: A counter force brace which is and elastic strap that is worn 1-2 inches below the elbow. This type of brace gives compression to the forearm muscle and helps lessen the force that the muscle transmits to the tendon.
Interferential current.
Cold pack.
Laser therapy.

Physiotherapy Exercises:
Exercise Of Grip Muscle 

  • Resisted wrist extension.
  • Resisted wrist flexion.
  • Resisted forearm supination and pronation.
  • Wrist flexor stretch.
  • Wrist extensor stretch.
  • Finger extension.
  • Hand squuze.
Strenthening Exercise Using Weight 

Wrist range of motion: Bend your wrist forward and backward as far as you can. Repeat 10 times. Do 3 sets.
Forearm range of motion: With your elbow at your side and bent 90 degrees, bring your palm facing up and hold for 5 seconds then slowly turn your palm facing down and hold for 5 seconds. Repeat 10 times. Do 3 sets. Make sure you keep your elbow bent at 90 degrees throughout this exercise.
Elbow range of motion: Gently bring your palm up toward your shoulder and bend your elbow as far as you can. Then straighten your elbow out as far as you can. Repeat 10 times. Do 3 sets
Forearm pronation and supination: Hold a soup can or hammer handle in your hand, with your elbow bent 90 degrees. Slowly rotate your hand with palm upward and then palm down. Repeat 10 times. Do 3 sets.
Wrist extension: Stand up and hold a broom handle in both hands. With your arms at shoulder level, elbows straight and palms down, roll the broom handle backward in your hand as if you are reeling something in using the broom handle. Repeat for 1 minute and then rest. Do 3 sets.
Wrist strenghening.
(1) Wrist flexion: Holding a soup can or hammer handle with your palm up, slowly bend your wrist up. Slowly lower the weight and return to the starting position. Repeat 10 times. Do 3 sets. Gradually increase the weight of the can you are holding.
(2) Wrist extension: Holding a soup can or hammer handle with your palm down, gently bend your wrist up. Slowly lower the weight and return to the starting position. Repeat 10 times. Do 3 sets. Gradually increase the weight of the can you are holding.
(3) Wrist radial deviation: Hold your wrist in the sideways position with your thumb up. Holding a can of soup or . hammer handle, gently bend your wrist up with your thumb reaching towards the ceiling. Slowly lower to the starting position. Do not move your forearm throughout this exercise. Repeat 10 times. Do 3 sets.
Elbow rehabilitation program:
A gradual progression of the exercises is extremely important. Although they may seem easy at first you must follow the enclosed steps closely to prevent an increase or re-aggravation of your symptoms. Before beginning the strengthening exercises you should warm-up your body to a light sweat. Try 3 to 5 minutes of brisk walking, cycling, jogging etc. Do exercises only once a day: more is not better and can re-aggravate your symptoms. Wear the Count’R-Force brace if advised by your therapist or if you experience pain while performing the exercises. Do each exercise at its own rate. You will achieve higher weights faster on some exercises than others. Do each exercise properly and slowly do not work through peavierain.

Stage 1 Exercises:

Keep your elbow bent to 90 degrees. If this is  painful lean forward and bend your elbow even more. Your forearm should be well supported on your thigh or a table.
Begin with no weight, doing 10 to 15 repetitions for each exercise.
Slowly progress the repetitions in sets of 10, every few days as your elbow allows until you are comfortably doing 3 sets of 10 repetitions for 2 consecutive days without increasing your symptoms.
Increase to a one-pound weight (a small can of soup works well). Go back to 10 to 15 repetitions for each exercise.
Slowly work up to 3 sets of 10 repetitions again.
Increase to a two-pound weight and again cut back to 10 to 15 repetitions.
Slowly progress to  3 sets of 10 repetitions.
Continue this gradual progression until you are using a three-pound weight for 3 sets of 10 repetitions without increasing your symptoms.
Progress to next stage as able.

Stage 2 Exercises:

Rubber band and squeeze exercises:
Begin with your elbow bent at your side and progress by performing the exercises with your arm straight out in front of you as able. You should do these two exercises several times a day, every day. It is a good idea to have a ball and rubber band in convenient places like in your car, at your desk, or by the television. Be careful not to overdo these exercises as they can increase your pain.
Ice after exercises.

Wednesday, 21 June 2017

Rectus Abdominis Muscle Detail : 8 Pack Muscle

Rectus Abdominis muscle :

Rectus Abdominis Muscle
 The rectus abdominis muscle, also known as the  "abs", this is a paired muscle running vertically on each side of the anterior wall of the human abdomen. There are two parallel muscles, separated by a midline band of connective tissue called the linea alba. It extends from the pubic symphysis, pubic crest and pubic tubercle inferiorly, to the xiphoid process and costal cartilages of ribs V to VII superiorly. The proximal attachments are the pubic crest and the pubic symphysis. It attaches distally at the costal cartilages of ribs 5-7 and the xiphoid process of the sternum.

The rectus abdominis muscle is contained in the rectus sheath, which consists of the aponeuroses of the lateral abdominal muscles. Bands of connective tissue called the tendinous intersections traverse the rectus abdominus, which separates this parallel muscle into distinct muscle bellies. The outer, most lateral line, defining the "abs" is the linea semilunaris. In the abdomens of people with low body fat, these bellies can be viewed externally and are commonly referred to as "four", "six", "eight", or even "ten packs", depending on how many are visible; although six is the most common.

Origin/Insertion :

The rectus abdominis is a long flat muscle, which extends along the whole length of the front of the abdomen, and is separated from its fellow of the opposite side by the linea alba.

The upper portion, attached principally to the cartilage of the fifth rib, usually has some fibers of insertion into the anterior extremity of the rib itself.

It's typically around 10 mm thick or 20 mm thick in young athletes such as handball players

Nerve Supply :

The muscles are innervated by thoraco-abdominal nerves, these are continuations of the T7-T11 intercostal nerves and pierce the anterior layer of the rectus sheath. Sensory supply is from the 7-12 thoracic nerves.

8 Pack Of Rectus Abdominis Muscle

Action :

The rectus abdominis is an important postural muscle. It is responsible for flexing the lumbar spine, as when doing a so-called  sit up Exercise. The rib cage is brought up to where the pelvis is when the pelvis is fixed, or the pelvis can be brought towards the rib cage (posterior pelvic tilt) when the rib cage is fixed, such as in a leg-hip raise. The two can also be brought together simultaneously when neither is fixed in space.

Sit Up Exercise is Most Common Form Of Exercise Where Rectus Abdominal Musct is Chief Muscle Used In This Action.

Six Pack Abs Workout Video :

Eight Pack Or Six Pack Exercise is most Common And Famous Among People.

Exercise Of Rectus Abdominals :

Sit Up Exercise :

Sit Up Exercise

In Supine Position Flexes Both Legas , Hands Behind Head And Flexes The Spine And Heads Towards Knee And Repetation Of Same .

Sit Up Exercise 

Bilateral Leg Elevation In Supine Postion Uses Lower Abdominals Muscle.

Rectus Abdominis is strong Back Flexor Muscle.

Knee To Chest Exercise

To Reduce Lordosis Strenthening Of Rectus Abdominis Muscle is Required.
strengthening of Rectus Abdominis And Other Back Flexor Muscle is Back Pain is Most Common And Is Called Williams Abdominal Exercise.

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Thursday, 11 May 2017

Know Your Muscle : Hamstring Muscle Detail

 Hamstring (Lower Limb Muscle ) :
Hamstring Muscle Detail

In human anatomy, a hamstring is a Group Of three muscle in posterior side of thigh  (from medial to lateral: semimembranosus, semitendinosus and biceps femoris).
Main Action Of Hamstring is Flexion Of Knee Joint. Working With Quadriceps And Mainly Doing Co-Contraction During Running And Our Day-to-day Activities And Tightness is the most common in this Muscle require Stretching Exercise At Regular Interval.

Common Features Of Hamstring Muscle : 

They All Originates Arounds Tibial Tuberocity.
Insertion Below Knee Joint Over Tibia or Fibula.
Innervated By Tibial Nerve Branch Of Sciatic Nerve.
Must Flex The Knee And Extends The Hip Joint

All This Functionality is Compulsory to include in Hamstring Group.

Origin And Insertion  :

Semimembranosus : Origin From Ischial Tuberocity And Insertion over Medial Tibial Condyle.

Semitendinosus : Origin Also From Ischial Tuberocity And Insertion Over Medial Surface Of Tibia.

Biceps Femoris (Long Head ) : Origin Also From Ischial Tuberocity And Insertion Over Lateral Side Of The Head Of The Fibula.

Biceps Femoris (Short Head) : Origin From linea aspera & lateral supracondylar line of femur And Insertion Over Lateral Side Of The Head Of The Fibula With Long Head Common Tendon.

Nerve Supply : 

Semimembranosus,Semitendinosus And Biceps Femoris Long Head Nerve Supply is Tibial Nerve Part Of Sciatic Nerve.

Biceps Femoris Short Head Nerve Supply is Common Peroneal Nerve Part Of Sciatic Nerve.

Action Of Hamstring Muscle : 

Strenthening Exercise Of Hamstring Muscle

Hamstring Muscle Crosses Two Joint So Working Chiefly Over The Knee Joint And Do Strong Action is Knee Flexion And Part time Also Helping in Hip Extension With Gluteus Maximus.

Semimembranosus,Semitendinosus Extends Hip Joint And Flex The Knee Joint And Also Rotate Knee Joint When Knee is Flexed.

Long Head Of Biceps Femoris is Extends The Hip Joint And Both Long And Short Head Flex The Knee Joint And Laterally Rotate The Hip When Knee Flexion Position.

Hamstring is One Of The Strongest Antagonist Muscle As Compared To Other Antagonist Muscle Require All Day To Day Activity Like Running, Jumping, Walking , Squating And Working With Quadriceps and Doing Co-contraction.
Co-Contraction Of Hamstring And Quadriceps Muscle 

Clinical Significance :

Hamstring Muscle Is One Of The Commonest Muscle That Tightness Is Present Too Often And Require Regular Stretching Exercise To Avoid to Tear Or Damage to Related Muscle And Ligament.Sciatica is Also Associated With Tightness Of Hamstring is seen Too Often.
Semitendinosus is Also Used In Surgery Of ACL Ligament Reconstruction Surgery.

Exercise Of Hamstring Muscle :

Strenthening Of Hamstring  In Standing Position

Strengthening Exercise : Strentherning Exercise In Prone Position With Sandbag in Early Stage And Later Stages Standing Position Body Towards Wall And Flexed With Sand Bag is Most Common Exercise.

Home Based Stretching Exercise Of Hamstring Muscle 

Stretching Exercise :  Long Sitting Position And Toe Touch is One Of The Most Common Hamstring Stretching Exercise And This Position in Yoga Called " Paschimotanasan- Yoga Position ".

Hamstring Muscle Stretching In Supine Position

Related Article : 

Calf Muscle Detail

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Monday, 8 May 2017

Calf Muscle Detail And Exercise :

 Calf Muscle   : ( 2nd Heart ) Muscle Of Lower Limb.

Calf Muscle is Located On Back Side Of The Leg And Is Made Of 2 Large Muscle To Join Make Tendo Achiilis.

Muscle Detail Of  Back Side Of Leg

(1) Gastrocnemius Muscle :  is the larger Calf Muscle Forming The Bulge Of Muscle Mass And Visible Beneath the skin.

Gastrocnemius has 2 Heads Which Looks Like Diamond Shape.

Anatomy Of Calf Muscle

(2) The Soleus Muscle:  Small Muscle , Flatt And Underneath The Gastrocnemius Muscle.

A majority of soleus muscle fibers originate from each side of the anterior aponeurosis, attached to the tibia and fibula.

Insertion : 

        Both Muscle Insertion Merge Via Tendo Achiilis And The Achilles tendon inserts into the heel bone (calcaneus).

Nerve Supply : 

(Calf Area- Lumbar 4-5 and Sacral 1-5 is of the sacral plexus) 

The sciatic nerve branches off of the sacral plexus in which the tibial and common fibular(Peroneal) nerves are wrapped in one sheath. The tibial nerve eventually separates from the sciatic nerve and innervates the gastrocnemius muscle.

Action Of Calf Muscle :

Calf Muscle Stretching

 Calf Muscle is Strong Lower Limb Muscle Which Planter Flex From Ankle Joint. 

This Muscle is Anti Gravity Muscle And Normally All Anti Gravity Muscle Require High Power That's Why All Anti Gravity Muscle Are Bulky And Strong. 

Running, Jumping, Dancing , Cycling All This Activity Use Calf Muscle. 

Jumping is The Highest Uses Calf Muscle.

This Muscle is Also Called 2nd Hearst And Low Use Of This Muscle May Lead Vericose Vein And Oedema Around Ankle.

Sports Person Usually High Use Of This Muscle May Lead Cramps.

Classical Dancers And Gymanatics Also Use Calf Muscle More And Require Special Attention To Develop , strenthen Calf Muscle.

Exercise Of Calf Muscle:

Calf Muscle Strengthening Exercise With Use Of Body Weight

Active Movement in Supine Position is  Simple Planter Flex From Ankle.

Resisted Exercise : Self Resisted Exercise is to High Hill Action In Standing Position.

Calf Muscle Exercise With Full Body Weight Single Leg-Tuff One

Gradually Increase Repetation And Jumping, Running, Cycling Are Other Exercise That Are Useful To Strengthen And Most Common Form Of Exercise.

Calf Muscle Strenthening Exercise With Weight 

Stretching Exercise : 

Use Of Belt Like And Wrap Around Ankle in Long Sitting With Stretch Towards Ankle is Home Made Calf Exercise.

Home Made Low Intensity Calf Stretching For Elderly

Standing Position :  Both Leg In Same Line Position With Around Minimum Foot Distance With Forward Leg Flexed From Knee And Back Leg Straight , You Will Feel Stretching in Back Calf Muscle And Then Change Leg Again Do Some Practice.

Calf Stretching In Standing Position

Medical Use Of Calf Muscle:

Use Of Calf Muscle in Medical Field is Too Important. Generally Blood Flow Upside Down is Easy But From Ankle To Up Towards Heart , It's Need Calf Muscle Active Exercise, In Paralysis And Other Bed Ridden Patient Ankle Swelling Are Most Common And That Cases Physiotherapist Start Active Exercise Of Calf Muscle With Elevation Of Ankle Joint.That's Why This Muscle Also Called 2nd Heart.

Related Article :

All About Quadriceps Muscle

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Sunday, 15 January 2017

Frozen Shoulder And Physiotherapy Treatment :

What is frozen shoulder? : 

Frozen Shoulder

Frozen shoulder (adhesive capsulitis) is stiffness, pain, and restricted R.O.M (range of movement) in your shoulder . It may happen after an injury or overuse or from a disease such as diabetes or a stroke,Post Operative surgeory Near to shoulder joint. The tissues around the joint stiffen, scar tissue forms, and shoulder movements become restricted & painful. The condition usually comes on gradually, then recover slowly over the course of a year or more.

 Causes Of frozen shoulder :

Frozen shoulder can develop when you stop using the joint normally because of pain, injury, or a chronic health condition, such as diabetes or a stroke. Any shoulder problem can lead to frozen shoulder if you do not work to keep full range of motion.

Frozen shoulder main cause:

post operative surgery near to sholder.
After surgery or injury.
Most often in people 40 to 70 years old.
More often in women (especially in postmenopausal women) than in men.cover
Most often in people with chronic diseases.
chest pain and diabetes are often associated with.

Frozen shoulder diagnoses : 

Your doctor specially phsiotherapist may suspect frozen shoulder if a physical exam reveals restricted shoulder movement. An X-ray may be done to see whether symptoms are from another condition such as arthritis or a broken bone.

Shoulder Joint movement( R.O.M) :

Flextion : 0-180 degree
Extension : 0-60 degree
Abduction:  0-180 degree
Adduction : 0-45 degree
Int.Rotation : 0-90 degree
Ext. Rotation : 0-90 degree

Treatment Of Frozen Shoulder :

Treatment for frozen shoulder usually starts with Analgesic Drugs,Hot Pack, followed by gentle stretching.  And physical therapy can help increase your range of motion. A frozen shoulder can take a 2 month to  year or more to get better.

Exercise Of Frozen Shoulder

Back Stretch with towel

shoulder ladder exercise

assisted back stretch with opposite hand

shoulder wheel and ladder exercise

If treatment is not helping, surgery is sometimes done to loosen some of the tight tissues around the shoulder. Two surgeries are often done. In one surgery, called under anesthesia Release, you are put to anaesthesize shoulder and then your arm is moved into positions that stretch the tight tissue. The other surgery uses an arthroscope to cut through tight tissues and scar tissue. These surgeries can both be done at the same time.

prevention and care :

Gentle, progressive range-of-motion exercises, stretching, and using your shoulder in day to day activity more may help prevent frozen shoulder after surgery or an injury. Experts don't know what causes some cases of frozen shoulder, and it may not be possible to prevent these. But be patient and follow your doctor's advice. Frozen shoulder nearly always gets better over time.

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