Guillain-Barré Syndrome (GBS)

What is a Guillain-Barre syndrome?

Guillain-Barré syndrome (GBS)

Guillain-Barré syndrome (GBS) is a rare autoimmune neurological disease that damages the peripheral nervous system. It is characterized by a rapidly progressive weakness and tingling in the extremities, often starting in the feet or hands. This weakness can spread quickly, sometimes leading to paralysis.

Usually, the initial signs are tingling and weakness in the hands and feet. These emotions might become paralyzing very quickly. When Guillain-Barré syndrome reaches its most severe stage, it is regarded as an emergency. The majority of those who have the illness require hospital treatment.

The precise cause of Guillain-Barre syndrome remains unknown, despite its rarity. Yet, in the six weeks before the onset of Guillain-Barre symptoms, two-thirds of individuals experience infection-related symptoms. Respiratory and gastrointestinal infections, such as COVID-19, are examples of infections. The Zika virus can also result in Guillain-Barre.

The cause of Guillain-Barre syndrome is unknown. Numerous therapeutic approaches can reduce symptoms and expedite healing. Guillain-Barre syndrome is usually fully recovered from, although certain extreme conditions can be deadly. Most patients can walk again six months after their symptoms start, though recovery can take up to several years. Long-term effects including fatigue, numbness, or weakness may occur for some people.

Epidemiology

An uncommon but dangerous autoimmune disorder of the peripheral nervous system is called Guillain-Barré syndrome (GBS). The epidemiology of GBS is characterized by its relatively low incidence, typically ranging from 0.8 to 1.9 cases per 100,000 person-years globally. GBS affects all age groups, although its prevalence rises with age, with a minor peak in young adults and a higher peak in the elderly. Men are more commonly affected than women, with a male-to-female ratio of approximately 1.5:1. The syndrome does not show a strong seasonal pattern in most regions, although some studies have reported slight increases in winter months. GBS is observed worldwide, with similar incidence rates across different geographic regions, suggesting that environmental factors may play a limited role in its etiology.

Notably, GBS often occurs following an infectious illness, with about two-thirds of patients reporting symptoms of an infection in the six weeks preceding the onset of neurological symptoms. Campylobacter jejuni, CMV, Epstein-Barr virus, and Mycoplasma pneumonia are the most common associated infections. In recent years, GBS has also been associated with Zika virus infections and, more recently, some cases have been reported following COVID-19. Vaccines, particularly influenza vaccines, have been scrutinized for a potential link to GBS, but large-scale studies have shown that if there is an increased risk, it is very small and outweighed by the benefits of vaccination. The epidemiology of GBS continues to be an area of active research, particularly in light of emerging infectious diseases and global health events.

Pathogenesis

The pathogenesis of Guillain-Barre syndrome (GBS) is a complex process that typically begins with a triggering event, most commonly an infection. Campylobacter jejuni is the most frequently associated pathogen, but other bacterial and viral infections can also precede GBS. The key mechanism underlying GBS is thought to be molecular mimicry, where epitopes on infectious agents share structural similarities with components of peripheral nerves. The immune system becomes confused by these similarities and launches an assault on the body’s nerve tissues.

Humoral and cell-mediated immunity play crucial roles as the misguided immune response progresses. Autoantibodies, primarily targeting gangliosides and other components of peripheral nerves, are produced. These autoantibodies can directly damage nerve structures and activate the complement system, leading to the formation of membrane attack complexes on nerve surfaces. T-cells are activated concurrently and have a role in the inflammatory process.

Peripheral nerve injury is the outcome of the autoimmune assault, and the type of damage determines the GBS subtype. In acute inflammatory demyelinating polyneuropathy (AIDP), the most common form in Western countries, the primary target is the myelin sheath surrounding nerve fibers. Macrophages remove the myelin, resulting in segmental demyelination. On the other hand, direct assaults on the axons themselves occur in acute motor axonal neuropathy (AMAN) and acute motor-sensory axonal neuropathy (AMSAN), which are more prevalent in Asia.

As the disease progresses, the blood-nerve barrier becomes compromised, allowing further infiltration of immune cells and inflammatory mediators. This influx exacerbates local inflammation and damage. The resulting nerve injury leads to slowed or blocked nerve conduction, manifesting as the characteristic weakness and sensory abnormalities seen in GBS.

The clinical presentation is determined by the degree and severity of nerve injury. In milder cases, only the myelin may be affected, allowing for relatively rapid recovery as remyelination occurs. In more severe cases, especially those involving axonal damage, recovery can be prolonged and potentially incomplete. The most severe cases can involve autonomic nerves, leading to dysfunction of involuntary processes like heart rate and blood pressure regulation.

It’s important to note that GBS is not a single entity but a spectrum of disorders. The specific autoantibodies produced, the extent of complement activation, the degree of T-cell involvement, and the precise targets of the immune attack can all vary. This variability contributes to the diverse clinical presentations and outcomes observed in GBS patients.

Recent research has also highlighted the role of molecular and cellular events within the axons themselves. Disruption of ion channels, particularly sodium channels, at Ranvier nodes, can cause conduction failure even in the absence of significant demyelination. Additionally, axonal degeneration can occur as a secondary process, even in primarily demyelinating forms of GBS.

Understanding this complex pathogenesis is crucial for developing targeted therapies. Current treatments like intravenous immunoglobulin and plasma exchange aim to modulate the immune response broadly. Future therapies may target specific aspects of the pathogenic process, such as complement inhibition or more selective immunomodulation, potentially leading to more effective treatments for this challenging disorder.

Symptoms of Guillain-Barré Syndrome (GBS)

Guillain-Barre syndrome typically manifests as numbness and paralysis in the legs, which within a few hours or days spreads to the trunk and arms. Both sides of the body are equally affected by this symmetrical disorder.

Before the weakness sets in, people with Guillain-Barré syndrome may feel strange sensations like tingling in their legs. There are multiple variations of the syndrome, each with slightly different symptoms, and there are various definitions for the variants.

Among the Guillain-Barré syndrome variations that are most frequently reported are:

Classical, generalized: This kind severely weakens the respiratory muscles, which regulate respiration, and both arms and legs.

Pure sensory variant: This kind can result in a significant loss of feeling without causing weakness.

Acute dysautonomia: This form can induce an erratic heart rate, altered blood pressure, and stomach issues.

Miller Fisher syndrome: This uncommon form results in ophthalmoparesis (weak eye movements), areflexia (loss of reflexes during a physical examination), and ataxia (issues with coordination). Two common signs of poor eye movements are double vision and blurry vision.

Localized: This kind may only affect specific muscles, like those in the face, bladder, or throat, which impair swallowing.

Types of Guillain-Barré Syndrome (GBS)

The symptoms of Guillain-Barre syndrome might vary depending on the kind. Guillain-Barre syndrome manifests in various ways.

The primary kinds are:

Acute inflammatory demyelinating polyradiculoneuropathy (AIDP) is the most common kind in North America and Europe. A common sign of AIDP is upper-body muscle weakness that starts in the lower body.

The paralysis in Miller-Fisher syndrome (MFS) begins in the eyes. Moreover, an unstable stride is associated with MFS. MFS is more common in Asia than in the U.S.

Acute motor axonal neuropathy (AMAN) and acute motor-sensory axonal neuropathy (AMSAN) are less common in the United States. On the other hand, AMAN and AMSAN frequencies are higher in China, Japan, and Mexico.

Causes of Guillain-Barré Syndrome (GBS)

It is unknown what specifically causes Guillain-Barre syndrome. It often manifests for many days or weeks following a respiratory or gastrointestinal ailment. Guillain-Barré syndrome can occasionally be caused by a recent immunization or surgery.

Your immune system, which typically exclusively targets invasive pathogens, starts attacking your nerves when you have Guillain-Barre syndrome. AIDP damages the myelin sheath, the neurons’ protective coating. You may have weakness, numbness, or paralysis as a result of the damage, which stops nerves from sending messages to your brain.

• Campylobacter infections are most commonly found in undercooked chicken.
• Virus caused by influenza.
• Cytomegalovirus.
• Virus Epstein-Barr.
• Zika infection.
• Acute, B, C, and E hepatitis.
• AIDS is brought on by HIV.
• Pneumonia is caused by Mycoplasma.
• Surgery.
• Trauma.
• Lymphoma Hodgkin.
• Childhood immunizations and influenza vaccinations are rare.
• COVID-19 pathogen.

Diagnosis and Tests

Medical professionals frequently diagnose Guillain-Barré syndrome based on your medical history and symptoms. They’ll inquire about the timing and kind of your symptoms as well as any recent illnesses. To check for symptoms of muscle weakness and weak or absent deep tendon reflexes, they will also perform neurological and physical examinations (hyporeflexia or areflexia).

Nevertheless, many distinct neurological conditions manifest with symptoms that are similar to those of GBS. Thus, to rule out any other potential illnesses, your provider will probably run additional testing. These examinations could consist of:

Neuroconduction tests and electromyography (EMG): These examinations evaluate the function and health of your skeletal muscles and the nerves that control them.

Spinal tap or lumbar puncture: During this procedure, your doctor will insert a needle into your lower back to collect a sample of cerebrospinal fluid (CSF). The sample is transported to a laboratory, where a pathologist examines its contents. White blood cell counts are normal, while CSF protein levels are elevated in around 80% of GBS patients. Additional CSF anomalies could indicate different medical issues.

Imaging test: A magnetic resonance imaging (MRI) of your spine may be suggested by your healthcare professional.

Complications

In Guillain-Barre syndrome, nerves are affected. People with Guillain-Barre syndrome may experience the following since their movements and bodily processes are controlled by nerves:

Trouble breathing. Muscles controlling your respiration can become weak or paralyzed. This might be deadly. Within the first week of being admitted to the hospital for treatment, up to 22% of patients with Guillain-Barre syndrome require temporary breathing assistance from a machine.

Lingering numbness or additional feelings. Patients with Guillain-Barré syndrome often recover completely or have minimal residual weakness, numbness, or tingling.

Issues with the heart and blood pressure. Blood pressure fluctuations and irregular heart rhythms are common symptoms of Guillain-Barre syndrome.

Anguish. Nerve pain is experienced by one-third of those with Guillain-Barre syndrome, and it can be managed with medication.

Issues with the bladder and bowel movements. Guillain-Barré syndrome is defined by two symptoms: reduced bowel movements and urinary retention.

Thrombi. Blood clots can occur in people with Guillain-Barre syndrome who are immobile. You might need to take blood thinners and wear support stockings to enhance blood flow until you can walk on your own.

Sores caused by pressure. If you’re unable to move, you may be in danger of getting bedsores, also called pressure sores. Changing postures often might help avoid this problem.

Give in to temptation. Relapses are uncommon in Guillain-Barré syndrome patients. Even years after symptoms have subsided, a recurrence might result in muscle weakness.

Treatment of Guillain-Barré Syndrome (GBS)

You will probably need medical care in a hospital’s critical care unit if you have Guillain-Barré syndrome. This will let your medical team keep an eye out for potential GBS issues, such as breathing difficulties or blood pressure swings.

The cause of Guillain-Barre syndrome is unknown. On the other hand, certain therapies can lessen the severity of your condition and hasten your recovery. One of two main approaches is used to treat GBS:

Plasma exchange, also known as plasmapheresis, is a medical procedure in which your blood and plasma are separated, treated, and then returned to your body by a machine. Plasma exchange removes the antibodies in your plasma that are assaulting your nerves.

Intravenous immunoglobulin therapy (IVIG): Immunoglobulins are proteins that your body produces on its own to fight foreign invaders. These injections are administered intravenously (IV). The source of the immunoglobulins is thousands of healthy donors. IVIG can decrease the assault on your nerves by your immune system.

Rehabilitation

Your medical team may move you to a rehabilitation facility once you feel better. Here, you’ll collaborate with other therapists and physical therapists to restore your strength and return to your regular activities. Therapy can take several forms, including:

Physical therapy: This enhances your body’s range of motion. You can manage symptoms including pain, stiffness, and discomfort with the assistance of a physical therapist. They will also assist you with exercises to build up your muscle mass again.

Occupational therapy: This kind of treatment enhances your capacity to do daily duties. You can engage in your activities safely by learning how to move, stand, sit, and utilize various tools with the assistance of an occupational therapist.

Speech therapy: A speech-language pathologist can assist you in regaining the ability to swallow and talk if GBS affects the muscles in your mouth or throat.

Mobility aids: You can increase your mobility and reduce your risk of falling with the use of devices including wheelchairs, walkers, braces, and canes. They may lessen weariness as well.

Physiotherapy Treatment for Guillain-Barre Syndrome:

Goals in Brief:

Exercise for mobility and strengthening muscles can increase muscle strength.

Stretching exercises might help to lessen spasms and stiffness in the muscles.

Postural instability and balance issues can be addressed by core stability and balance training activities.

Retraining one’s posture and using various mobility aids

Fall prevention techniques include balancing exercises, gait retraining, and reeducation.

Advice and management of fatigue.

Improve life quality and freedom.

Physiotherapy exercise:

Range of motion exercises:

1. Ankle Joint ROM Exercises:

Patient Position: Supine (lying on back) with legs extended.

Steps:

a. Dorsiflexion and Plantarflexion:

Grasp the heel with one hand.

Put your second hand over the foot.

Slowly push the foot up towards the shin (dorsiflexion).

Then point the foot downward (plantarflexion).

Repeat 10-15 times.

b. Inversion and Eversion:

Support the ankle with one hand.

Use the other hand to gently tilt the sole inward (inversion).

Then tilt the sole outward (eversion).

Repeat 10-15 times.

2. Knee Joint ROM Exercises:

Patient Position: Supine with a small pillow under the knee.

Steps:

Put a hand beneath each knee and an additional hand beneath the ankle.

Slowly bend the knee, sliding the heel towards the buttocks.

Hold for a few seconds, then slowly straighten the leg back to the starting position.

Repeat 10-15 times.

Hip Joint ROM Exercises:

Patient Position: Supine with legs extended.

Steps:

a. Flexion and Extension:

Put a hand beneath each knee and an additional hand beneath the ankle.

Slowly raise the leg, bending at the hip and knee (flexion).

Lower the leg back down, extending it fully.

Repeat 10-15 times.

b. Abduction and Adduction:

Support your leg at the knees and ankles.

Slowly move the leg out to the side (abduction).

Bring it back to the midline (adduction).

Repeat 10-15 times.

c. Internal and External Rotation:

Bend the knee to 90 degrees.

Keeping the knee stable, rotate the lower leg inward, then outward.

Repeat 10-15 times.

Shoulder Joint ROM Exercises:

Patient Position: Supine or seated, depending on the patient’s condition.

Steps:

a. Flexion and Extension:

Support your arm at the elbow and wrist.

Raise the arm flexionally, slowly, up and forward.

Then lower it back down and slightly behind if possible (extension).

Repeat 10-15 times.

b. Abduction and Adduction:

Assist the arm at the wrist and elbow.

Raise and stretch the arm sideways slowly (abduction).

Then bring it back down to the side (adduction).

Repeat 10-15 times.

c. Internal and External Rotation:

Bend the elbow to 90 degrees.

Keeping the upper arm stable, rotate the forearm inward, then outward.

Repeat 10-15 times.

5. Elbow Joint ROM Exercises:

Patient Position: Supine or seated.

Steps:

Both below and above the elbow should be used to support the arm.

Bring the hand to the shoulder by bending the elbow slowly.

Then straighten the arm back out.

Repeat 10-15 times.

6. Wrist Joint ROM Exercises:

Patient Position: Seated with the forearm supported.

Steps:

Hold the forearm with one hand.

Gently bend the wrist forward (flexion) and backward (extension) using the opposite hand.

Sideways wrist motion (radial and ulnar deviation).

Repeat each movement 10-15 times.

7. Hand and Fingers Exercises:

Patient Position: Seated with the hand supported.

Steps:

Gently bend each finger towards the palm, then straighten.

Spread your fingers apart and then draw them together.

Touch the thumb to each fingertip.

Repeat each movement 10-15 times.

8. Neck ROM Exercises:

Patient Position: Seated or supine, ensuring proper support for the head.

Steps:

Gently flex the neck forward, bringing the chin towards the chest.

Extend the neck backward slightly.

Rotate the head to see over each shoulder.

Raise one ear toward the shoulder and tilt one’s head to either side.

Perform each movement slowly, repeating 5-10 times.

In implementing these exercises,

Frequency: Exercises are typically performed 2-3 times daily, with 10-15 repetitions for each movement, as tolerated by the patient.

Progression: As the patient regains strength, exercises transition from passive to active-assisted, and finally to active movements.

Pain management: Exercises are performed within pain-free ranges to avoid exacerbating symptoms or causing undue stress on weakened muscles and joints.

Monitoring: Close observation for signs of fatigue, pain, or autonomic instability is crucial, especially in the early stages of recovery.

Education: Patients and caregivers are taught how to perform these exercises safely, encouraging continued practice outside of therapy sessions.

Adaptation: Throughout the patient’s recuperation, the exercise regimen is continually modified in light of the patient’s development and evolving demands.

Static Quadriceps:

Patient Position: Supine (lying on back) with legs extended.

Steps:

Lie flat on your back, legs straight.

As you push the rear of your knee into the bed, the muscles in the front of your thigh will stiffen.

Hold this contraction for 5-10 seconds.

Relax the muscle.

Repeat 10-15 times for each leg.

Cat and Camel Exercises:

Patient Position: In a quadrupled position, on hands and knees.

Steps:

With your back in a neutral position, start on your hands and knees.

Slowly arch your back upwards, tucking your chin to your chest (Cat position).

Hold for 5-10 seconds.

After that, assume a camel posture by elevating your head and tailbone and progressively lowering your back.

Hold for 5-10 seconds.

Return to the starting position.

Repeat 5-10 times.

Bridging:

Patient Position: Supine with knees bent and feet flat on the bed.

Steps:

Lay down on the bed with your knees bent and your feet flat.

Tighten your abdominal and buttock muscles.

Slowly lift your hips off the bed, creating a straight line from your knees to your shoulders.

Hold this position for 5-10 seconds.

Slowly drop your hips back to their original position.

Repeat 10-15 times.

Knee to Chest:

Patient Position: Supine with legs extended.

Steps:

Lie on your back, legs straight.

One knee should be bent slowly and brought to the chest.

With your hands, gently move the knee closer to your chest.

Hold this position for 15-30 seconds.

Return the leg to its initial position slowly.

Repeat with the other leg.

Perform 5-10 repetitions for each leg.

Chair Stand:

Patient Position: Sitting on a chair, feet flat on the floor.

Steps:

Sit in a chair with your feet level on the floor and hip-width apart.

Lean slightly forward, keeping your back straight.

Push through your heels and gently stand up.

Pause briefly in the standing position.

Lower yourself back to a sitting posture.

Repeat 5-10 times, or as tolerated.

Gait Training:

Patient Position: Standing, with appropriate assistive device if needed.

Steps:

Start in a standing position, using parallel bars, a walker, or other appropriate support.

Focus on maintaining good posture with your head up and shoulders back.

Take a step forward with one foot, placing the heel down first.

Bring your other foot forward, passing the stance foot.

Repeat this process, alternating legs.

Practice walking in a straight line, then progress to turning and navigating obstacles as your ability improves.

Gradually increase the distance walked and decrease reliance on support as strength and balance improve.

Recovery

Recuperation might take many months or even years. However, this is the typical chronology that most Guillain-Barre syndrome sufferers encounter:

For roughly two weeks following the onset of symptoms, the illness worsens.

The symptoms subside after four weeks.

Recovery starts and typically lasts six to twelve months. For some people, the healing process might take up to three years.

When an adult with Guillain-Barre syndrome is recuperating:

Half of them can walk on their own within six months of diagnosis.

More than 60% of people regain full motor strength a year following diagnosis.

Five to ten percent heal very slowly and incompletely.

Rarely does Guillain-Barre syndrome strike children. When they do, their recovery is typically more complete than that of adults.

Lifestyle Modification and Home Care for Guillain-Barre Syndrome

Adaptive Equipment and Home Modifications:

Install grab bars in the bathroom and beside the bed to provide support.

Transferring is easier when a higher toilet seat is used.

To wash securely, think about utilizing a seat or shower chair.

Rearrange furnishings to provide open paths for mobility aids.

Use a reacher or grabber tool for picking up objects

Use flexible utensils and equipment in the kitchen.

Energy Conservation:

Plan activities to balance rest and activity throughout the day

Prioritize essential tasks and delegate when possible

Use energy-saving measures, such as sitting while conducting work.

Take frequent rest breaks to avoid fatigue.

Nutritional Considerations:

Eat a diet that is well-balanced and full of fruits, vegetables, and lean meats.

Stay hydrated by drinking plenty of water

Consider nutritional supplements as recommended by healthcare providers

Use adaptive utensils if hand weakness persists

Skin Care:

Change positions frequently to prevent pressure sores

Use pressure-relieving mattresses and cushions

Keep skin clean and moisturized

Inspect skin daily for any signs of breakdown or irritation

Respiratory Care:

Practice deep breathing exercises as instructed by therapists

Use an incentive spirometer if prescribed

Maintain good posture to optimize lung expansion

Follow any specific instructions for tracheostomy or ventilator care if applicable

Emotional and Mental Health:

Practice stress-reduction strategies like deep breathing or meditation.

Keep up social ties by making calls, sending videos, or going in person.

Consider joining a support group for GBS patients

Seek professional mental health support if experiencing depression or anxiety

Sleep Hygiene:

Establish a regular sleep schedule

Create a comfortable and quiet sleep environment

Avoid stimulating activities before bedtime

Use positional aids for comfort if needed

Exercise and Physical Activity:

Observe the at-home workout regimen that your physical therapist has recommended.

Gradually increase activity levels as strength improves

Use assistive devices correctly for safety during mobility

Pain Management:

Take prescribed medications as directed

Use non-pharmacological pain management techniques like gentle massage or heat/cold therapy

Practice relaxation techniques to manage pain

Infection Prevention:

Practice good hand hygiene

Maintain a clean and well-ventilated living space.

Avoid close touch with unwell persons.

Stay up to date with recommended vaccinations.

Continued Medical Care:

Attend all follow-up appointments with healthcare providers

Note any symptoms, developments, and worries in your record.

Learn to monitor vital signs if instructed by your healthcare team

Family Education and Support:

Educate family members about GBS and how they can assist in care

Involve family in therapy sessions to learn proper techniques for assistance

Encourage open communication about needs and limitations

Return to Work/School Planning:

Create a strategy with occupational therapists for going back to work or school.

Consider gradual return options or accommodations as needed

Communicate with employers or educators about necessary adjustments

Stress Management:

Employ methods of relaxation such as guided visualization and gradual muscle relaxation

Engage in hobbies or activities that provide enjoyment and distraction

Set realistic goals and celebrate small achievements in recovery

Summary

The article on Lifestyle Modification and Home Care for Guillain-Barre Syndrome (GBS) provides a comprehensive guide for patients and caregivers managing this challenging neurological condition. It emphasizes the importance of adapting the home environment to enhance safety and independence, including the installation of supportive equipment like grab bars and shower chairs. The guide also stresses the significance of energy conservation, proper nutrition, and meticulous skin care to prevent complications associated with limited mobility. These foundational aspects of care are crucial for creating a supportive recovery environment and preventing secondary issues that could impede progress.

The article delves into the multifaceted nature of GBS recovery, addressing not only physical but also emotional and mental health needs. It highlights the importance of respiratory care, sleep hygiene, and a tailored exercise program designed by physiotherapists. Pain management strategies, combining both pharmacological and non-pharmacological approaches, are discussed to help patients cope with the discomfort often associated with GBS. The guide also emphasizes the critical role of infection prevention and the need for continued medical follow-ups to monitor progress and address any emerging issues promptly.

Finally, the paper emphasizes the need for family engagement and education during the care process. It provides guidance on how to support patients in their gradual return to work or school, recognizing that recovery is often a slow but steady process. The importance of stress management and maintaining a positive outlook is emphasized throughout, encouraging patients and caregivers to celebrate small achievements along the recovery journey. The article’s overall goal is to assist patients’ route to recovery while enhancing their quality of life through a comprehensive approach to GBS care.

Breathing Exercises for The Lungs

Introduction

How much air your lungs can contain is indicated by your lung capacity. You may progressively increase the capacity of your lungs by using the right breathing methods.

Breathing Exercises

Breathing is one of the most fundamental bodily processes and usually happens without conscious thinking. As you breathe in, oxygen is taken in by blood cells, and carbon dioxide is exhaled. Carbon dioxide is one waste product the body produces and accumulates over time.

The interplay between oxygen and carbon dioxide can be disturbed by inappropriate breathing, which can result in fatigue, anxiety, panic attacks, and other issues with mental and physical health. With time, our lung function and capacity will unavoidably diminish.Buy vitamins and supplements

Asthma is one of the illnesses that can severely accelerate lung capacity reduction and impair normal functioning. This suggests dyspnea and breathing problems.

Certain workouts assist in maintaining lung function, making it simpler to keep your lungs healthy and provide your body with the oxygen it requires. If you’re feeling worried, try a variety of breathing exercises. Learn how to use breathing techniques to relieve anxiety and tension.

What are the Breathing Exercises?

Breathing exercises are workouts intended to enhance certain respiratory control mechanisms. They are widely used to improve lung function, ease tension, and promote relaxation.

Breathing exercises are deliberate, controlled modifications to breathing patterns that offer certain health benefits. They go beyond just holding your breaths longer; they entail utilizing various breathing techniques and patterns to impact your body and mind in several ways.

A breathing exercise is a straightforward yet effective method that deliberately regulates your breathing by enhancing your physical and emotional health. It functions as a sort of mini-exercise for the neurological system and lungs.

What is Normal Lung Capacity?

It is essential to your ability to breathe healthily. Individual variations in lung function and capacity may still arise throughout our lives.

An adult’s lung capacity is typically six liters. Age, gender, height, and weight can all affect this.

Exercise may cause dyspnea or shortness of breath if you have poor lung capacity. 

How to measure Lung capacity?

A spirometry test is often performed to determine the average lung capacity.

Spirometry Test for Lung Capacity

A standard test for lung function called spirometry measures how quickly and effectively you can breathe in and out. Lung illnesses are monitored and diagnosed with their help.

You must breathe through a mouthpiece that is connected to a spirometer to do a spirometry test. The test findings will be contrasted with typical values according to your age, gender, height, and weight.

A spirometry test involves three key measurements:

• Forced expiratory volume in one second (FEV1): the amount of air that can be released in the initial moments after taking a deep breath.
• Forced vital capacity (FVC): A measurement of the most air that a person can yank out of their mouth with force after taking a deep inhale.
• FEV1/FVC ratio: This is a gauge for how fast you can release air.

Spirometry is one simple, non-invasive test that doctors might run in a clinic.

The following should be considered both before and during a spirometry test:

• At least eight hours should pass before the exam if you smoke.
• Sport loose-fitting clothing that will assist you in carrying deep breaths.
• Avoid having a heavy lunch just before the test.
• Any medications you take should be disclosed to your doctor since some medications have the potential to alter test findings.

Your exhalations’ quantity and frequency will be noted by the spirometer. To obtain the most accurate results, you might be required to retake the exam many times.

Together with discussing the findings with you, they will suggest any additional tests or care that might be required.

The following are a few advantages of spirometry testing:

• The test is painless and non-invasive.
• It’s a quick and simple way to check lung function.
• For lung problems, early diagnosis might be helpful.
• It may be useful for tracking how lung conditions develop.
• Therapy decisions may be guided by it.

If you have concerns regarding the condition of your lungs, discuss with your physician if a spirometry test is right for you.

Causes of Low Lung Capacity

Low lung capacity can have several reasons, from chronic illnesses to lifestyle choices.

• Smoking: The primary avoidable cause of lung diseases, such as emphysema and chronic obstructive pulmonary disease (COPD), is smoking. Breathing becomes difficult as a result of smoking’s damage to the lungs and airways.
• Air pollution: Both indoor and outdoor exposure to air pollution can harm the lungs and lower lung capacity. Air pollution may occur from many sources, including autos, industry, and power plants.
• Respiratory infections: Certain respiratory illnesses, including bronchitis and pneumonia, can harm the lungs and lessen lung capacity.
• Asthma: Airway irritation and constriction are symptoms of asthma, a chronic respiratory disease. This might reduce lung capacity and cause difficulty breathing.
• COPD: Emphysema and chronic bronchitis are two terms used to describe the long-term respiratory disease known as COPD. Both conditions can reduce lung capacity.
• Cystic fibrosis: One hereditary disorder that causes thick mucus to be generated in the lungs and other organs is cystic fibrosis.
• Lung cancer: Radiation therapy and surgery are two lung cancer treatments that can harm the lungs and lower lung capacity.
• Obesity: Breathing might become challenging due to the pressure obesity puts on the lungs. This may lower lung capacity.

The following are some other factors that may be involved with reduced lung capacity:

• Age: Our lungs lose some of their elasticity and breathing ability as we become older.
• Gender: Men are usually able to breathe deeper than women.
• Height: Greater lung capacity is associated with greater height in comparison to lower lung capacity.\
• Weight: Obese or overweight people may have diminished lung function due to the extra weight on their chest and diaphragm.
• Environmental factors: Exposure to dust, smog, and other irritants can damage the lungs and airways, resulting in reduced lung capacity.

Signs of Low Lung Capacity

The following are a few indications and symptoms of limited lung capacity:

• Shortness of breath or dyspnea: Dyspnoea, or shortness of breath, is the most common indicator of decreased lung capacity. It might happen when you’re at rest or even when you’re doing anything. If you have dyspnea, consult a physician since it may indicate a significant medical issue.
• Wheezing: You could whistle in a high tone as you breathe. An obstruction of the lung airway might be the reason. A wheezing fit may suggest COPD, asthma, or other respiratory problems.
• Tightness in the chest: Tightness can be uncomfortable or oppressive. Lung inflammation or blockage of the airways might be the reason. Tightness in the chest may indicate asthma, COPD, or other respiratory issues.
• Cough: A cough is a short-lived lung exhalation of air. Numerous factors, including allergies, allergens, and infections, might be the reason. A cough that lasts longer than a few weeks may be indicative of a significant medical condition.
• Mucus production: Mucus production is one of the most common symptoms of respiratory infections. However, it could also be a sign of a more serious condition like COPD or pneumonia.
• Fatigue: Low lung capacity is only one of the several potential reasons. It might be difficult to do daily duties while tired.
• Loss of weight: Weight loss may be a sign of several illnesses, including lung weakness. People with diminished lung function could eat less food or find it harder to exercise, which leads to weight loss.

Breathing Exercises to Improve Lung Capacity

Diaphragmatic Breathing

The primary respiratory muscle, the diaphragm, is used in diaphragmatic breathing, which is also referred to as breathing from the abdomen or deep breathing. This activity can help you enhance your lung function, reduce tension and anxiety, and get better sleep.

Diaphragmatic Breathing

Take the following actions to engage in diaphragmatic breathing:

• Grip your tummy with one hand and your chest with the other.
• Gently inhale through your nose, allowing your stomach to grow.
• As you gradually exhale through your lips, feel your stomach constrict.
• For 10 to fifteen minutes, keep going.

Pursed-Lip Breathing

Taking slow, deep breaths with your lips pursed may help open up your airways and slow your breathing rate. This exercise could be helpful for those with COPD, asthma, or other respiratory conditions.

pursed-lip-breathing

Pursed-lip breathing involves the following steps:

• Sit up straight and with relaxed shoulders.
• Inhale deeply and calmly through your nose.
• Breathe out slowly through squeezed lips.
• For 10 to fifteen minutes, keep going.

Alternate Nostril Breathing

You might try inhaling through the opposite nostril to help calm the nervous system and promote relaxation. This practice could be helpful for people who have allergies, congestion, or headaches.

Alternate Nostril Breathing

The following are the stages involved in doing alternate nostril breathing:

• Sit up straight and maintain your back straight.
• Put your left ring finger over your left nose and your thumb over your right nostril.
• Inhale from your left nostril.
• Seal your left nostril with your ring finger, then open your right to release the trapped air.
• Inhale from your right nostril.
• While opening your left nostril to allow air to escape, use your thumb to close your right nose.
• For 10 to fifteen minutes, keep going.

4-7-8 Breathing

Using 4-7-8 breathing methods can help reduce stress, anxiety, and insomnia. This kind of exercise may also be beneficial for people with high blood pressure.

4-7-8 Breathing

To practice 4-7-8 breathing, follow these steps:

• Close your mouth and give a loud whooshing noise.
• Shut your mouth and inhale four slow, deep breaths via your nose.
• Take seven deep breaths and release them.
• Breathe out deeply and produce a whooshing sound with your mouth as you count to eight.
• Proceed with four or eight more rounds.

Benefits of Breathing exercise in lung capacity

Numerous benefits can result from regular breathing exercises, including improved lung capacity and general respiratory health.

These are a few benefits:

• Improved Lung Function: The diaphragm, intercostals, and accessory muscles—all of which are a part of the respiratory system—can be strengthened using breathing exercises. The lungs can expand to their full capacity and these muscles can work more efficiently if they are strengthened.
• Increased Oxygen Intake: By strengthening the respiratory muscles, breathing exercises promote deeper, longer breaths. This leads to higher oxygen intake, which is important to give the body the oxygen it needs to perform as designed.
• Improved Lung Elasticity: Regular breathing exercises help maintain the suppleness of the lungs, which allows the airways to extend and expand during expiration and to contract and expand as needed during inhalation. This flexibility is necessary for both healthy lung function and efficient gas exchange.
• Decreased Respiratory exhaustion: Breathing exercises can help reduce respiratory tiredness, a common side effect of respiratory illnesses including asthma and COPD in people. By strengthening the respiratory muscles, breathing exercises improve breathing and reduce the effort required for normal breathing.
• Increased Respiratory System Effectiveness: Breathing exercises improve total respiratory system performance. They enhance the lungs’ ability to take in oxygen, release carbon dioxide, and supply oxygen-rich blood to every part of the body.

In addition to these benefits, breathing exercises can have several other advantages. such as:

1. reduced worry and tension
2. improved sleep quality
3. enhanced physical capacities
4. increased vigor
5. Increased focus and attentiveness

Summary

Lung capacity can be lowered by a sedentary lifestyle, age, obesity, and certain medical diseases. However, there are several things you can do to keep your lungs healthy. Maintaining a healthy diet, exercising regularly, and quitting smoking can all improve lung function.

Exercises involving breathing are a good method to enhance lung function and overall respiratory health. Breathing exercises regularly can improve overall health, respiratory effectiveness, and lung function.

See a doctor if you have signs of diminished lung capacity, such as dyspnea, to rule out any underlying medical conditions.

Posterior Pelvic Tilt

What is a Posterior Pelvic Tilt?

posterior pelvic tilt

A posterior rotation of the innominates is indicative of a posterior pelvic tilt. As a result, the person will typically appear to have a relatively flat back and "tucked under" buttocks. Even while the posterior tilt is less frequent than the anterior tilt, it still has many negative effects.

Because of the limited flexibility at the sacroiliac joints, the sacrum and lumbar spine move together with the pelvis when it moves. The vertebrae will stack more vertically on top of one another as a result of the posterior rotation, which will also lessen the lumbar lordosis. Reduction of compressive stresses in the spine and adequate shock absorption are two of the main purposes of lumbar lordosis.

Therefore, the spine's overall capacity to absorb shock is diminished when lumbar lordosis is lost. The intervertebral discs will experience greater compression stresses due to the vertebral bodies' more vertical placement on top of one another. Lumbar disc disease may be influenced by the intervertebral discs' increased degree of compression.

There are a number of causes of posterior pelvic rotations, but the majority result from long-term overuse of one's posture, such as slouching while sitting. If inadequate body mechanics, such as slouching, are repeatedly reinforced, it could worsen posterior pelvic rotation. Therefore, training good body mechanics and postural re-education are necessary in addition to short-term Physical therapies.

Causes of Posterior Pelvic Tilt

The posterior pelvic tilt may be caused by a number of muscle imbalance related causes. The pelvis may rotate posteriorly due to stiffness in the hamstrings and/or abdominal muscles. But because the hamstrings and abdominals are also phasic muscles, as they get tired, they lean toward weakening rather than hypertonicity.

Thus, this postural distortion cannot be caused by hamstring or abdominal tightness alone; rather, it requires a considerable degree of both. More often than not, posterior rotation is an adaptive habit continued by bad sitting and standing Body mechanics.

Posterior Pelvic Tilt Symptoms

Your lower back is under a lot of strain when you have a posterior pelvic tilt. Sciatica, or pain running down the back of one's thigh or glute, is one type of pain that might eventually result from this.

• Weak and tight leg muscles
• Shortened tendons around the pelvic bones
• Feeling of tightness in abdominal muscles
• Hamstring tightness
• Improper balance
• Poor posture
• Reduced Lumbar Lordosis
• Lower Back pain with or without Radiating pain in lower limb
• Sciatica Pain
• Hip Pain with or without Knee pain

A posterior pelvic tilt can be present by any of these variables. This is the moment when your upper body rounds back and your glutes tuck inward.

Long term Side Effects of Posterior Pelvic Tilt

Your entire posture is impacted because your neck and upper back are forced forward in an attempt to correct the improper pelvic position.

A forward head position and a more rounded shoulder, often known as thoracic kyphosis, are common symptoms of posterior pelvic tilt.

The compression strain on the mid and lower back will gradually rise due to posterior tilt. Due to the uneven loading of the spine caused by this increased compression stress, problems such as disk prolapse or disk herniation may result.

In addition, the lumbar curve's rounding places undue strain on your spine and raises the risk of hip, back, and leg pain.

Treatment of the Posterior Pelvic Tilt

The hamstring and abdominal muscle groups should be treated while treating posterior pelvic rotations. They require to get their tightness and myofascial trigger point presence looked upon. On the rectus abdominis muscle, longitudinal stripping and sweeping cross-fiber techniques can be used. It is possible to address the hamstring muscles' role in posterior pelvic tilting.

Treatment for the posterior pelvic tilt must include postural re-education, as was previously described. If soft tissue manipulation is tried without any kind of reinforced and corrected movement patterns, the practitioner is likely to have little success.

Stretches to Fix Pelvic Posterior Tilt:

Stretching Your Hamstrings While Seated

Long periods of sitting and standing can cause hamstring tightness, which can result in bad postures such a posterior pelvic tilt. Your hamstring will lengthen as a result of stretching, which will help your body maintain a more neutral pelvic position.

How to do it:

Sit down on a firm chair at first - Extend your left leg in front of you

Aim for three repetitions on each side. Bend forward and reach for your toes until you feel a minor stretch. 

Hold nearby for 10 to 20 seconds. Slowly return to the starting position. Repeat on your right side.

Take caution: If you extend the stretch too far, you risk pulling a muscle in your back. Take care not to go overboard. Try transferring this exercise on the floor if sitting in a chair is too challenging for you.

Bhujangasana: Abdominal Press Up (Cobra Pose)

Your tightened abdominal muscles will extend and become more flexible with the help of this stretch, which will enable a more neutral pelvic position.

How to carry it out:

- Start by lying on the floor with your hands flat at shoulder level. - Gradually push your hands up to lift your shoulder off the floor until you feel a slight stretch.

Exhale as you push deeper into the lumbar extension to increase your range of motion.  

Try to complete five repetitions.

Piriformis Stretch

The piriformis muscle may tighten up after extended periods of sitting. Stretching this muscle will enable the hip to move normally, which aids in achieving a neutral pelvic position.

How to do it:

Start by lying on your back with your feet flat on the ground and your knees bent.

To begin, place your right ankle over your left knee. Then, grab your left knee and draw it in towards your chest for a few seconds, until your right gluteal muscles stretch. Repeat on the other side. Try to complete three repetitions on each side.

Exercises to strengthen Muscles of the posterior pelvic tilt

Lunges:

Lunges improve quadriceps strength. It may be possible to correct a posterior pelvic tilt by strengthening these muscles.

How to carry it out:

- Start by placing your feet together. Stretch out your left leg in front of you. When your left leg is bowed to a 90-degree angle, your right knee should come into contact with the floor. Resuming your initial position requires pushing up with your left leg. On your right side, repeat. Try to complete three sets of ten lunges on each side.

* When in the lunge position, make sure your knee does not go over your toe as this puts more strain on the knee.

Superman:

Superman assists with correcting improper pelvic alignment by strengthening your lower back and glutes, which are connected to your pelvis.

The exercise can be performed as follows:

Lay on your stomach on the floor with your arms extended in front of you
Slowly raise your chest off the ground and attempt to hold this posture for 30 seconds
Slowly return your body to the beginning position
Try to complete three repetitions.

Leg Lifts

Leg raises assist in strengthening your hip flexors, which become incredibly weak due to the pelvic posterior tilt.

How to carry it out:

- In Supine Position on the soft mat with your legs extended. Keeping your arms straight by your sides, slowly raise your legs off the ground by contracting your abdominal muscles.

– Return your legs to the beginning position slowly.

The secret to this exercise is to solely move your legs; this will help your core muscles grow.

This is a challenging workout; if you have trouble lifting your legs, consider bending your knees a little.

Adjustments to Sleeping

To help you sleep with appropriate posture:

• Stay away of sleeping on your stomach.
• Place a little pillow below your knees if you prefer to sleep on your back.
• A pillow should be placed between your knees if you are a side sleeper.
• Put a tiny pillow or rolled towel beneath your back's arch if you sleep on your back.
• Verify that the cushion and mattress suit the natural curve of your spine.

Correcting Posterior Pelvic Tilt While Sitting

Whether you sit all day at work or just a lot of it, it's important to make sure that:

• You are sat in a posture-supporting chair.
• Your choice of workstation or table should enable you to sit upright and prevent slouching.
• You can either utilise an integrated lumbar support chair or use a pillow for this type of assistance.
• You make the effort to move around and stretch, especially if you spend a lot of time seated.

Issues related to posterior pelvic tilt:

A posterior pelvic tilt puts more pressure on the lower back bones. This pressure can result in fatigue of the muscles as well as tension in the neck muscles.

• Soreness in the lower back.
• Rotation inward at the hip and knee.
• Knee ache and hip pain.
• Hip flexor tension is the cause of sciatica.

Summary

The tilting of the pelvis backward is called a posterior pelvic tilt. It mostly results from an imbalance in the muscles of the legs and the core, which has an impact on your body, activities, everyday posture, and work habits.

The symptoms can range in intensity and include low back pain, stiffness in the hamstring and abdominal muscles, and slouched posture, among others. Exercises that stretch and strengthen tense and weak muscles are the mainstay of treatment, along with changes to sitting and sleeping positions and other bad work habits.

Anterior Pelvic Tilt

What is Anterior pelvic tilt?

Anterior Pelvic Tilt

Anterior pelvic tilt is a postural issue where your pelvis tilts forward, causing an increased curve in your lower back. It's a common problem often linked to a sedentary lifestyle, particularly excessive sitting.

Running, walking, and picking up objects off the ground are all made easier by your pelvis. It also aids in keeping proper posture.

Long durations of sitting, bad posture, weak core muscles, tight hamstrings and hips, muscular imbalances, and even hereditary predispositions can all contribute to this.

Stretching frequently and doing core-focused strengthening exercises like Pilates or yoga can help treat APT. See a physical therapist for help with posture correction if you don't think you have the skills or knowledge to handle this on your own.

Causes of Anterior Pelvic Tilt

Hip flexor tightness is mainly the cause of the anterior pelvic tilt. When walking or running, these muscles in the front of the hip assist in raising the leg. Tight Hip flexor can pull on the pelvis and cause it to tilt forward. Additional reasons for anterior pelvic tilt consist of:

• Weak abdominal muscles
• Weak gluteal (buttock) muscles
• Hip flexor tightness
• Poor posture
• Congenital

Abdominal Muscle Weakness

The pelvis may tilt forward as a result of weak abdominal muscles because they cannot sustain the weight of the body properly.

Weak gluteal muscles (buttocks)

A forward tilt of the pelvis can also result from weak gluteal (buttock) muscles. These muscles support and maintain the pelvis' neutral posture.

Poor Posture

Anterior pelvic tilt is also frequently caused by poor posture. This covers postures like hunching over or rounding the shoulders. Muscle imbalances caused by poor posture can pull on the pelvis, causing it to tilt forward.

Congenital

Rarely APT Present from birth as a Congenital deformity.

Symptoms of Anterior Pelvic Tilt

There are several symptoms. Among the most common are:

• Hip flexor tightness
• Abdominal muscle weakness
• Poor posture
• Lower back pain
• Sciatica Pain
• Herniated discs

Hip flexor tightness

The most typical sign of anterior pelvic tilt is this. When walking or running, the front of the hip's hip flexor muscles assist in raising the leg. Tight Hip flexor can pull on the pelvis and cause it to tilt forward.

Weak muscles in the abdomen

Weak abdominal muscles are another sign of anterior pelvic tilt. This may result in a forward leaning trunk, further tilting the pelvis.

Poor posture

Another sign of APT is poor posture. This is because a rounded back can result from the trunk leaning forward due to a tilted pelvis.

Lower back pain

Lower back pain is also caused by APT. This is as a result of the pelvic tilt placing additional strain on the lower back.

Sciatica

Sciatica is the term for the condition caused by the sciatic nerve, which travels from the lower back down the leg, being compressed by a tilting pelvis.

Herniated disc

An further consequence of anterior pelvic tilt is herniated discs. This APT leads to the possibility of disc herniation caused by the increased strain on the lower back area.

Risk Factor

There exist multiple risk variables that may increase the likelihood of anterior pelvic tilt development. Among them are:

• Having a sedentary lifestyle
• Being obese(overweight)
• Having tight hip flexor muscles
• Having weak abdominal
• Weak gluteal muscles
• Poor posture

Anterior Pelvic Tilt vs Posterior Pelvic Tilt

Similar to anterior pelvic tilt, posterior pelvic tilt involves a rotation or tilt of the pelvis rearward. Posterior pelvic tilt is the result of shortening the hip extensors and lengthening the hip flexors. Your movement patterns, posture, and other factors may contribute to these changes. 

You can improve posterior pelvic tilt by regularly stretching and strengthening the relevant muscles, just as you do with the exercises for anterior pelvic tilt (which are covered in detail below). Lunges, hamstring stretches, and leg raises are a few of the best exercises. To stretch shortened muscles, you can also use a foam roller.

How to Fix Anterior Pelvic Tilt?

The positive aspect is that most exercises intended to strengthen weak muscles and stretch tight ones can effectively correct anterior pelvic tilt. When you continue with these workouts, your pelvis will eventually return to its normal position.

This condition may also be treated with Osteopathic Manipulative Treatment (OMT/OMM) administered by an Osteopathic physician.

Anterior Pelvic Tilt Exercises

Anterior pelvic tilt can be corrected with the support of these exercises. 

Bridge

Your buttocks and hamstring muscles will get stronger from this exercise.

With your feet hip-width apart on the floor and your arms by your sides, assume a supine position.

When your upper body and thighs are in a straight line, press your heels into the floor and lift your pelvis.

Take a two-second hold, gently lower, and repeat eight to twelve times.

Hip flexor stretch performed half-kneeling

Your hip flexors will become more flexible as a result of this exercise.

With your foot flat on the ground, extend your left leg in front of you and bend it to a 90-degree angle, placing your right knee on the floor just below your pelvis.

Your pelvis will move forward if your buttocks and abdominal muscles are tight.

Step forward with your right leg until you feel tightness in your inner thigh and hip flexor. 

For 30 seconds, hold.

Before swapping legs, release and repeat as much as five times.

Plank

This workout strengthen the abdomen and back muscles. 

On the ground, lie face down.

Put your hands, palms down, on the ground. Hold them squarely beneath your shoulders.

Pull your legs and abdominal muscles tight, then slowly raise your upper body and thighs off the ground to perform a push-up. 

Make sure your body is tight and upright, and that the muscles in your abdomen are working. 

Attempt to hold the stance for as long as you can.

Lower yourself gently to the ground.

Leg lifts on a knee with a back stretch

This workout strengthens your abdominal muscles while stretching the muscles in back and Hip flexors.

Lie on your hands and knees, placing your hips exactly over your knees and your hands shoulder-width apart. 

Maintaining a neutral pelvic position.

Inhaling, pull your belly button in the direction of your spine, and arch your back.

For two seconds, hold.

Reposition your spine to its neutral position.

Raise one leg back until it is parallel to the floor and at the same height as your body. 

Repeat up to 10 times, holding for a maximum of 5 seconds before lowering the leg.

Change your legs.

Pelvic Tilt

This workout stretches the muscles in your lower back and improves your abs.

Place your feet flat on the floor and lie on your back. 

Push your pelvis toward the ceiling by pulling your belly button toward your spine.

Tilt your pelvis forward and contract your hip flexors and buttocks. Hold on for five seconds.

Perform 20 repetitions in 5 sets.

Squats

The hamstrings, quadriceps, buttocks, and other muscles are strengthened by this workout.

Your feet shoulder-width apart when you stand.

Place your slightly toes forward.

Gaze directly ahead and see yourself sitting down.  

As you lower yourself to a sitting position with your thighs parallel to the floor, maintain your abs firm. Maintain a neutral posture for your back and avoid allowing your knees to twist inward or move past your toes.

Resuming an upright posture, slightly advance your pelvis by contracting your buttock muscles. 

Do this fifteen to twenty times.

Anterior Pelvic tilt Treatment in Vastral Physiotherapy Clinic

Anterior pelvic tilt is a frequent condition that can lead to Back pain, disc prolapse, and other complications if not treated timely. Usually, it may be avoided by being active and keeping proper posture, and it can be treated with specific exercises. If, however, you still experience issues, Vastral Physiotherapy Clinic can assist!