Neck pain is one of the commonest conditions that large number of people suffer through at some point in their life.It can affect a person in ways that can make it difficult to engage in your daily life and that is why it becomes very important to treat it.

Common causes of neck pain can be whiplash injury, poor posture, desk job, faulty sleeping posture, degenerative changes in cervical spine, disc herniation etc.

Pain is usually in the neck and arm, tingling and numbness, headaches, sharp pain, burning sensation.

A physiotherapist will assess you to find out the right cause of neck pain and will perform combination of physiotherapy techniques such as electrotherapy, joint mobilization, exercise therapy and educate you as needed.

Back is a part of body which is constantly under strains during our daily activities if it is not cared for. There are 3 areas on the back upper, middle and lower. Every area is prone to have specific issues depending on the strains it is subjected to.Back pain can be very debilitating and affect large number of people.If it is not given proper care, it can significantly affect quality of life.

Common causes of back pain can be soft tissue injury, poor posture, desk job, faulty sleeping posture, degenerative changes in spine, disc herniation etc.

Usually the pain is in the back radiating to thorax or hips or legs, tingling and numbness, sharp pain, burning sensation, difficulty performing daily activities such as walking, carrying weights, sitting etc.

A physiotherapist plays a crucial role in your recovery from back pain. A physiotherapist will assess you to find out the right cause of back pain and will perform combination of physiotherapy techniques such as electrotherapy, joint mobilization, exercise therapy and educate you as needed.

Sciatica is a term used to explain pain in the course of sciatic nerve which is due to irritation or compression of sciatic nerve or portion of it resulting from herniated disc or degenerative changes in the lumbar spine.

Causes can be disc herniation, Degenerative changes in lumbar spine, bone spur on the lumbar spine

It causes pain in the buttock area or radiating to the thigh and leg. Pain usually occurs on the one side of the body.

A physiotherapist performs a thorough assessment incorporating special test for sciatica. Most of the sciatica casesrespond well to few weeks of physio treatment without any surgical intervention. Depending on the cause a physiotherapist employs several techniques such as electrotherapy, Dry needling, mechanical traction, exercise therapy as needed for your fast recovery.

Arthritis is a condition of joints which can be very debilitating and restrictive for an individual. It can happen in different forms degenerative arthritis, gouty arthritis, rheumatoid arthritis.

Arthritis occurs due to overuse or age-related degenerative changes in the joints, history of trauma, gout, autoimmune disease such as Rheumatoid arthritis, post-surgically some individuals are prone to have arthritis

Arthritis causes pain in the joint which can radiate as well, restricted movements, swelling, redness, warm joints, deformities in later stage, difficulty in walking, carrying weights, climbing stairs.

Conservative treatment of arthritis can include pain management, improve the health of the joint by performing exercises, using physiotherapy techniques to improve mobility and maintaining the function. It is crucial to continuously take care of the joints to prevent further damage which can significantly stretch the time for the need of a knee replacement surgery. A physiotherapist can help you significantly in this process of improving and maintaining the health of your joints.

Stroke is: “rapidly developing clinical signs of focal (or global) disturbance of cerebral function, with symptoms lasting 24 hours or longer or leading to death, with no apparent cause other than of vascular origin.

Common complications in post-stroke are,
Paralysis on the right side of the body, Speech/language problems, behavioral problems, Memory loss, Vision problem.

When to approach Physiotherapist for Neuro rehab?
As early intervention starts, the prognosis will be good. Physiotherapist works to get you as mobile and as independent as possible. They help to improve major physical and sensory deficits. Physiotherapist will be focusing on gross & fine movements, walking, balance and coordination.

A mild traumatic brain injury induced by biomechanical forces. It could be caused by either a direct blow to the head, neck, face or elsewhere on the body with an spontaneous force transmitted to the head, that could results in the rapid onset of short-lived impairment of neurological function that resolves spontaneously.  In some cases, signs and symptoms evolve over a number of minutes to hours.

Common Symptoms:
Headache, DizzinessandBalance problems, Cognitive Disturbance, Memory/ConcentrationImpairment, Visual Disturbance, Fatigue, Psychological Distress, Nausea, 12.6% have neck pain.

How to predict the recovery?
Symptoms = Unreliable
Imaging? – couldn’t be investigate by any imaging or lab testing.

• Absolute rest is no longer the best approach.
• 2-3 days of rest is max, then start pushing back into cognitive & physical activity that doesn’t provoke symptoms.
• Concussion can result in various symptoms and problems, and can be coupled with concurrent injury to the cervical spine and peripheral vestibular system.
• Treatments includepsychological, cervical, and vestibular rehabilitation

Bell's palsy includes sudden weakness in your facial muscles. The weakness is temporary and significantly improves over weeks. The weakness makes half of your face appear to droop. Your smile is one-sided, and your eye on that side resists closing.
Bell's palsy, also well-known as acute peripheral facial palsy of unknown cause, can occur at any age. The exact cause is unknown. It's believed to be the result of swelling and inflammation of the nerve that controls the muscles on one side of your face. Or it might be a result that occurs after a viral infection.
For the majority people, Bell's palsy is short-term. Symptoms usually start to get better within a few weeks, with complete recovery in about six months. A small number of people continue to have some Bell's palsy symptoms for life. Rarely, Bell's palsy can recur.

Symptoms
Weakness to total paralysis on one side of your face — occurring within hours to days
Loss of facial expressions, such as closing your eye or smiling
Drooling
Pain around the jaw or in or behind your ear on the affected side
Increased sensitivity to sound on the affected side
Headache
A loss of taste
Changes in the amount of tears and saliva you produce

Causes
Exact cause of Bell's palsy is not clear, it's often associated to having a viral infection.

Role of Physiotherapist
Paralyzed muscles can shrink and shorten, causing permanent contractures. A physical therapist can teach you how to massage yourself on face and exercise your facial muscles to help prevent this from occurring. And will help the paralyzed muscles to facilitate to bring it back to the normal.

Intricate in design and function, the hand is an amazing work of anatomic engineering. Form follows function in the hand; therefore, any injury to the underlying structures of the hand carries the potential for serious handicap. To reduce this risk, even the smallest hand injuries require proper medical evaluation. The most common cause of the injuries was blunt trauma, followed by injury from a sharp object

Hand Injury Causes- lacerations (cuts), fractures and dislocations, soft tissue injuries and amputations, infections, burns, and high-pressure injuries (grease and paint guns).

Common symptoms of hand injuries

• Lacerations - Tenderness (pain), bleeding, numbness, decrease range of motion (difficulty moving), weakness, pallor (pale or bloodless)
• Fractures and dislocations – tenderness, deformity, swelling and discoloration, decrease range of motion, numbness, weakness, bleeding
• Soft tissue injuries and amputations – tenderness, deformity, swelling and discoloration, bleeding, weakness, numbness
• Infections – Tenderness, local warmth, redness, swelling, fever, deformity, decrease range of motion
• Burns - Tenderness or complete numbness, deformity, discoloration, loss of tissue, change in texture of skin, redness, blistering, black areas of tissue
• High pressure injuries - Pain, swelling, occasional skin discoloration

When to Seek Medical Care for Hand Injury
Injuries to the hand causing the following symptoms generally require emergency medical attention at a hospital's emergency department. - severe bleeding, numbness, loss of motion or strength, severe pain, obvious deformity or amputation, any of the signs of infection, such as tenderness, local warmth, redness, swelling, pus, or fever, exposure of underlying structures, such as tendons, bones, joints, arteries, veins, or nerves

After the initial care, may require physiotherapist to:
Restore the movements of the hand, to reduce pain and swelling, to improve muscle power of hand and arm, to improve functional activities, will be referred to specialist if required.

Patellar tendonitis is an inflammation on patellar tendon which is in front of the knee. It is a very common condition in physically active population as well as in people who does activities which can irritate the patellar tendon.

Patellar tendonitis occurs due to overuse of patellar tendon, Injury to patellar tendon, excessive running or jumping or stair climbing or kneeling. In teenagers, it can be in the form of Osgood Schlatter disease which occurs in teenage due to growth spurt or excessive activities which can irritate the tendon. 

Patellar tendonitis causes pain in the front of the knee, limping, difficulty walking or running or jogging or jumping or negotiating stairs, swelling in front of the knee etc.

Patellar tendonitis is managed by a physiotherapist by using electrotherapy for pain management and to speed up the healing process, exercise therapy to improve function of quadriceps muscle and knee joint, education to prevent further occurrence, finding out any malalignments in the body which may put you at risk of having patellar tendonitis.

Ligament sprains are very common and it can be really painful and disruptive to our day to day life. We sometimes try to be active to become healthy. In some instances, we end up injuring ourselves due to a wrong move or just by bad luck. Some ligament sprains are prevalent in human population such as ligaments surrounding Ankle, Knee and Wrist.

Ligament sprains can occur due to injury to the joints, wrong movements, overuse of the joint, poor fitness, poor joint stability due to weakness in the muscles etc.

It can cause pain, swelling, redness, movement restrictions, weakness in the muscles due to disuse.

Ligament sprain can be managed conservatively or surgically depending on the extent of injury. Most ligament sprains are managed conservatively. A physiotherapist can perform thorough assessment of your injury and determine the specific structure involved. Then several physiotherapy techniques can used to manage pain, improve healing, increase range of motion, strengthen muscles and eventually improve your function so that you can go back to your routine day to day life.

Fracturehappens quite often due to injuries of different nature. It can be either a full blown fracture or sometimes hairline fractures. Elderly population is prone to have fractures due to the age factor, reduced density of bones. Fractures tuned to cause significant amount of disabilities and it can affect the daily life adversely. It is very important to treat it properly to prevent complications and return back to normal function.

Causes can be trauma, falls especially in elderly population, reduce density of bones makes person prone to have fractures, sedentary life style is also a factor that plays a big role in the occurrence of fractures.

It can cause pain, swelling, redness, warmth on the fracture area, deformities, loss of function of the fractured area

The physician is the perfect person to diagnose the fracture but a physiotherapist can also provide you an insight and refer you further as necessary. Depending on the nature of fracture, it can be managed either conservatively or surgically. In both options a physiotherapist can help you immensely in recovery. A physiotherapy helps to speed up the healing process, the exercise programs to improve the mobility and strength and eventually to return to function as soon as possible.

Rotator cuff injury involves injury to one or multiple muscles which forms the rotator cuff. There can be a partial or complete tear. Partial tears are mostly managed conservatively but complete tears need surgical interventions whichdepends on specialist's decision.

The common causes are sports injury, heavy lifting or overloading the joint, soft tissue injury due to MVA etc.

It causes pain, swelling, loss of mobility, painful movements, weakness in the muscle, difficulty using the Shoulder.

Partial tears are managed conservatively and physiotherapy can help to manage pain, improve mobility, improve strength and eventually function to return to daily activities.
Full tears may need surgical intervention and then a post-surgical physiotherapy to return to daily activities.

Plantar fasciitis is a condition where the plantar fascia which is a muscle under foot gets inflamed and it causes pain and walking difficulties due to pain.

Causes are tight plantar fascia, flat foot, improper footwear, injury to plantar fascia due to excessive running or jumping, sudden changes in physical training.

Pain on the heel or sole, difficulty in walking, limping.

Physiotherapist assesses your condition and decides which physiotherapy techniques to use to ease the pain. Shockwave is one of the effective treatments for plantar fasciitis depending on the condition. Home exercise program is also a very crucial part of the recovery process. In some cases, Orthotics also plays a big role in the management of plantar fasciitis.

Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by stiffness and pain in your shoulder joint. Signs and symptoms typically begin gradually, worsen over time and then resolve, usually within one to three years.

Symptoms
Frozen shoulder typically develops slowly, and in three stages.
Freezing stage: Any movement of your shoulder causes pain, and your shoulder's range of motion starts to become limited.
Frozen stage: Pain may begin to diminish during this stage. However, your shoulder becomes stiffer, and using it becomes more difficult.
Thawing stage: The range of motion in your shoulder begins to improve.

Causes
The bones, ligaments and tendons that make up your shoulder joint are encased in a capsule of connective tissue. Frozen shoulder occurs when this capsule thickens and tightens around the shoulder joint, restricting its movement.

Risk factors

• Age and sex - People 40 and older, particularly women, are more likely to have frozen shoulder.
• Immobility or reduced mobility - People who've had prolonged immobility or reduced mobility due to rotator cuff injury, broken arm, stroke, recovery from surgery are in high risk for frozen shoulder.
• Systemic diseases - Diseases that might increase risk include: Diabetes, overactive thyroid (hyperthyroidism), underactive thyroid (hypothyroidism), cardiovascular disease, tuberculosis, parkinson's disease

Treatment
Physiotherapist teaches you range-of-motion exercises to help recover as much mobility in your shoulder as possible. Physiotherapist will be mobilizing your shoulder joint and releasing soft tissue to reduce pain and to improve mobility.

Achilles tendonitis involves inflammation of the Achilles tendon close to the ankle joint. It is one of the very common condition seen in the population.

Causes can be running injuries, trauma to the tendon, overstretching of the tendon, improper footwear, malalignments in the foot and ankle which can make the Achilles tendon prone to injury or overstretching

It causes pain in the back of the ankle (Achilles tendon or insertion of Achilles tendon on heel bone), Difficulty walking, swelling, redness, loss of mobility in the ankle, weakness in the calf muscles.

Physiotherapist assesses your condition and decides which physiotherapy techniques to use to ease the pain. Electrotherapy such as Ultrasound or Laser therapy is used to help the healing of the tissue. Shockwave is one of the effective treatments for Achilles tendonitis depending on the condition. Home exercise program is also a very crucial part of the recovery process. In some cases, Orthotics are prescribed either by your physiotherapist or you are referred to an Orthotist to manage of Achilles tendonitis.

Runners knee is a layman term for Patellofemoral pain syndrome. It is a condition where structures around the knee are injured due to running or activities which involves running. There are several structures around the knee which are prone to have injuries or can get irritated due to running.
It may be due to overuse of quadriceps, tightness in the IT band, malalignment of the knee, tightness in the hamstrings, wrong tracking of knee cap etc.
It can cause pain in the Knee (front or sides), limping while walking, sometimes swelling, difficulty negotiating stairs, clicking or rubbing or grating sound of knee cap.
A physiotherapist can perform specific test to confirm this condition and can help you to manage the pain through electrotherapy and well to heal the tissues faster. You may have to reduce or stop the running activity until it gets better because it slows down the recovery process and makes it worst. A physiotherapist determines what is the source of the problem and helps to manage it by using physiotherapy techniques and providing you education and home exercise program to speed up the recovery.

Lumbar disc herniation is a common low back disorder. It is one of the most common disorder that produces low back pain or leg pain in adults.A herniated disc is a displacement of disc material (nucleus pulposus or annulus fibrosis) away from the intervertebral disc space.

The initial treatment should be conservative, unless a patient has severe neurological disorder. Surgery is usually the last resort as it does not always result in expected results.
Physical therapy is the key in this disorder.

Cause
The most common cause is a degenerative process such as aging, the disc materials becomes less hydrated and weakens. This process will lead to progressive disc herniation that can cause symptoms.
The second most common cause is trauma.
Other causes include connective tissue disorders and congenital disorders such as short pedicles.
Disc herniation is most common in the low back followed by the neck.

Physical Examination
A careful neurological examination can help in localizing the level of the compression. The sensory loss, weakness, pain location and reflex loss associated with the different level.

Physiotherapist roles are:
Ambulation and resumption of exercise
Pain control
Improving the mobility of spine
Improving the functional activities
Education re maintaining healthy weight

Shoulder dislocations happen sometimes when the shoulder is pushed violently in certain direction and it can cause significant damage to the tissues around the shoulder. Sometimes it gets relocated itself and sometimes you need medical attention to put it back in the right place. In some cases, it causes damage to some specific structure in the joint which need surgical intervention. After the relocation, the shoulder stays painful and less functional for most of the individuals. In order to recover it to its highest function, physiotherapy becomes very necessary.

Shoulder dislocation occurs due to a fall on the hand in certain positions, sudden force on the shoulder in certain position, violent movement of the shoulder, laxity of the shoulder joint etc.

It can cause pain, swelling, weakness in the muscles, loss of function or reduced function.

Conservative management includes pain management, protection of the joint using a sling, electrotherapy to spend up the healing process, home exercise program to strengthen the muscles and improve function.
Sometime you need a surgical intervention following which, you go through post-surgical physiotherapy.

Iliotibial band syndrome is a condition where the irritation of IT band cause pain on the outer side of the Knee. It can cause significant pain while walking, running.

The common cause is tightness in the IT band which cause rubbing on the outer side of the knee while running or walking and that is how the IT band gets irritated or inflamed and causes pain.

It causes pain on the outer aspect of the knee, limping, difficulty in running and sometimes walking.

IT band syndrome can bee treated with physiotherapy by using combination of techniques such as stretches, Shockwave therapy, Myofascial release, electrotherapy, IMS.

Good posture of the body is very important for the efficient functioning of the body as well as to prevent impairments which can be caused due to poor posture. Poor posture in different part of the body can cause some specific ailments. Poor posture can cause some complication in the later stages of the life which can be very disabling. So it is very important take care of the posture and ailments that is caused by it at an early stage.

Neck pain can be caused by bad posture on the upper body. Poor posture on the upper body can be due to long duration sitting or desk job or just a bad habit of staying in a stoop posture. Low back pain can be caused because of the tightness or weakness in certain structures of low back and legs. Poor fitness or sedentary lifestyle has a big role to play as well.

It causes pain in the Neck, Low back, hips, Knees, Feet. Reduced function or difficulty doing some activities.

Postural syndromes can be treated by using number of physiotherapy techniques to reduce pain, tightness and improving mobility in joints and strength in the muscles. Physiotherapist educates youon how to prevent bad posture.

In a total hip replacement (also called total hip arthroplasty), the damaged bone and cartilage is removed and replaced with prosthetic components. The damaged femoral head is removed and replaced with a metal stem that is placed into the hollow center of the femur.

• Regular exercise before surgery can help your recovery.
• Exercise also helps to: Keep the movement in your hip, make your muscles strong, control your pain, build your knowledge of how to exercise after surgery, reduce your body weight, improve your sleep.

ExercisesBefore Surgery
Range of motion exercises - Leg slide out, hip stretches
Strengthening exercises - knee straightening, hip lift (bridge)
Stretching exercises - hamstring stretch, calf stretch, thigh stretch on belly

Exercise after surgery will help you to
Recover and regain movement and strength in your hip, reduce swelling, improve sleep, prevent blood clots, improve balance, control pain, increase activity tolerance, prevent constipation.

Peripheral nerves send messages from brain and spinal cord to the rest of the body, helping to do things such as sensing that feet are cold and moving the muscles so that can walk. Made of fibers called axons that are insulated by surrounding tissues, peripheral nerves are fragile and easily damaged.
A nerve injury can affect brain's ability to communicate with muscles and organs. Damage to the peripheral nerves is called peripheral neuropathy.

Symptoms
With a peripheral nerve injury, may experience symptoms that range from mild to seriously limiting daily activities. Symptoms often depend on which nerve fibers are affected:

• Motor nerves. These nerves regulate all the muscles under conscious control, such as walking, talking, and holding objects. Damage to these nerves is typically associated with muscle weakness, painful cramps and uncontrollable muscle twitching.
• Sensory nerves. Because these nerves relay information about touch, temperature and pain, you may experience a variety of symptoms. These include numbness or tingling in hands or feet, may have trouble sensing pain or changes in temperature, walking, keeping your balance with your eyes closed or fastening buttons.
• Autonomic nerves. This group of nerves regulates activities that are not controlled consciously, such as breathing, heart and thyroid function, and digesting food. Symptoms may include excessive sweating, changes in blood pressure, the inability to tolerate heat and gastrointestinal symptoms.

Causes

• Injury from an accident, a fall or sports can stretch, compress, crush or cut nerves.
• Medical conditions, such as diabetes, Guillain-Barre syndrome and carpal tunnel syndrome.
• Autoimmune diseases including lupus, rheumatoid arthritis and Sjogren's syndrome.
• Other causes include narrowing of the arteries, hormonal imbalances and tumors.

Restoring function
A number of treatments can help restore function to the affected muscles.

• Braces or splints. These devices keep the affected limb, fingers, hand or foot in the proper position to improve muscle function.
• Electrical stimulator. Stimulators can activate muscle served by an injured nerve while the nerve regrows.
• Manual Therapy. Therapy involves specific movements or exercises to keep your affected muscles and joints active. That can prevent stiffness and help restore function and feeling.
• Exercise. Exercise can help improve your muscle strength, maintain your range of motion and reduce muscle cramps.

Carpal tunnel syndrome is caused by pressure on the median nerve. The carpal tunnel is a narrow passageway surrounded by bones and ligaments on the palm side of your hand. When the median nerve is compressed, the symptoms can include numbness, tingling and weakness in the hand and arm.

Symptoms
Tingling or numbness - fingers or hand, might feel a sensation like an electric shock in thumb, index and middle fingers.
Weakness in your hand and drop objects. This may be due to the numbness in your hand or weakness of the thumb's pinching muscles, which are also controlled by the median nerve.

Causes
Anything that squeezes or irritates the median nerve in the carpal tunnel space may lead to carpal tunnel syndrome.  Such as in wrist fracture can narrow the carpal tunnel and irritate the nerve, as can the swelling and inflammation have caused by rheumatoid arthritis.

Risk factors

• Wrist fracture or dislocation, or arthritis that deforms the small bones in the wrist, can alter the space within the carpal tunnel and put pressure on the median nerve.
• More common in women, may be because the carpal tunnel area is relatively smaller in women than in men.
• Nerve-damaging conditions such as diabetes, increase your risk of nerve damage, including damage to your median nerve.
• Inflammatory conditions such as Rheumatoid arthritis and other conditions that have an inflammatory component can affect the lining around the tendons in your wrist and put pressure on your median nerve.
• Obesity.
• Body fluid changes.
• Other medical conditions. Certain conditions, such as menopause, thyroid disorders, kidney failure and lymphedema, may increase chances of carpal tunnel syndrome.
• Workplace factors. Working with vibrating tools or on an assembly line that requires prolonged or repetitive flexing of the wrist may create harmful pressure on the median nerve or worsen existing nerve damage, especially if the work is done in a cold environment.

Prevention
There are no proven strategies to prevent carpal tunnel syndrome, but you can minimize stress on your hands and wrists with these methods:

• Reduce your force and relax your grip, take short, frequent breaks, improve your posture, change your computer mouse, keep your hands warm.

On examination: Physiotherapist will test the feeling in your fingers and the strength of the muscles in your hand, bending the wrist, tapping on the nerve or simply pressing on the nerve can trigger symptoms in many people.

Physiotherapy treatment
1 Joint Mobilization
2. Soft tissue release
3. Wrist splinting
4. Ultrasound therapy / LASER / Electrotherapy

Piriformis syndrome is a condition where the tightness in the piriformis muscle can either cause pain in the hip or can irritate the sciatic nerve which can causeradiating pain in the leg.

It can be caused by the tightness or trigger point in the piriformis muscle

It causes pain in the hip area or radiating pain in the leg, limping while walking, difficulty is sitting or sitting with crossed legs.

Piriformis syndrome can be treated by using physiotherapy techniques such as stretching, electrotherapy, IMS and also by working on the postural aspects of it.

High arch/Pes cavus
Pes cavus/High arch is a condition where the arches under the foot are higher than the normal. High arches can cause pain under the foot and make walking painful and difficult. It also causes compensations in the body which can cause pain in the other parts of the body.

Cause can be congenital, inherited structural abnormality, neurological disorder such as cerebral palsy, muscular dystrophy, stroke etc.

High arches can cause pain under the foot, painful and difficult walking, abnormal posture of the foot and can in turn affect the posture of the limb as well.

It is crucial to get assessed to find out if you have high arches or not in order to decide on further steps to be taken. Your physician or physiotherapist can assess you to find out if you have high arches or not. First line of treatment would be custom orthotics to support the arches to reduce the stress on the structures of the foot. Physiotherapist can help you to manage pain and work on the compensations that happens due to high arches so some corrections can be made.

In flatfeet, the arches on the inside of feet are flattened, allowing the entire soles of feet to touch the floor when stand up. A common and usually painless condition, flatfeet can occur when the arches don't develop during childhood. In other cases, flatfeet develop after an injury or from the simple wear-and-tear stresses of age.
Flatfeet can sometimes contribute to problems in ankles and knees because the condition can alter the alignment of legs. If no pain, no treatment is usually necessary for flatfeet.

Symptoms:
Most people have no signs or symptoms associated with flatfeet, but some people with flatfeet experience foot pain, particularly in the heel or arch area, pain may worsen with activity, swelling along the inside of the ankle can also occur.

Causes

• A flat foot is normal in infants and toddlers, because the foot's arch hasn't yet developed, some children have flexible flatfoot, in which the arch is visible when the child is sitting or standing on tiptoes, but disappears when the child stands. Most children outgrow flexible flatfoot without problems.
• Arches can also fall over time. Years of wear and tear can weaken the tendon that runs along the inside of ankle and helps support arch.

Risk factors – Obesity, injury to your foot or ankle, rheumatoid arthritis, aging, diabetes

Treatment

• Stretching exercises. Some people with flatfeet also have a shortened Achilles tendon. Exercises to stretch this tendon may help.
• Supportive shoes. A structurally supportive shoe might be more comfortable than sandals or shoes with minimal support.
• Arch supports (orthotic devices). Over-the-counter arch supports may help relieve the pain caused by flatfeet. Or might suggest custom-designed arch supports, which are molded to the contours of feet. Arch supports won't cure flatfeet, but they often reduce symptoms.

Shockwave therapy or Class IV LASER might help in this condition.

A knee replacement (also called knee arthroplasty) might be more accurately termed a knee "resurfacing" because only the surface of the bone is actually replaced. If you are planning to have knee replacement surgery, then preparing for surgery and actively take part in their care can recover quicker and with less pain.

Before Surgery

• Exercise helps to: Maintain the movement in your knee, make your muscles strong, control your pain, reduce/control your body weight, improve your sleep, increase your knowledge of how to exercise after surgery
• Exercises to do before surgery: Core Muscle Activation, knee Straightening, lower Buttock Squeeze
• After Surgery: Will be discharged from the hospital in couple of days, follow-up, you can visit nearby Physiotherapist to get assistance to improve knee range of motion and to regain muscle power and functional activities.
• Staying active will help to: Increase your fitness level and endurance, prevent or help you manage other chronic health conditions, increase your muscle strength and power, improve your bone quality and life of your joint replacement, keep your weight under control, improve your mood and help you sleep better.

ACL reconstruction is surgery to replace a torn anterior cruciate (KROO-she-ate) ligament, a major ligament in the knee. ACL injuries most commonly occur during sports that involve sudden stops and changes in direction — such as basketball, soccer, football, downhill skiing and gymnastics.

In ACL reconstruction, the torn ligament is removed and replaced with a piece of tendon from another part of the knee or from a deceased donor. This surgery is an outpatient procedure that's performed through small incisions around your knee joint.

Physiotherapy may successfully treat an ACL injury for individuals who are relatively inactive, engage in moderate exercise and recreational activities, or play sports that put less stress on the knees.

ACL reconstruction is generally recommended if

• An athlete and want to continue in sport, especially if the sport involves jumping, cutting or pivoting, more than one ligament or the meniscus in knee is injured.

Before your surgery the goal is to reduce pain and swelling, restore your knee's full range of motion, and strengthen muscles. people who go into surgery with a stiff, swollen knee may not regain full range of motion after surgery.

Progressive physiotherapy after ACL surgery helps.

• To strengthen the muscles around knee and improve flexibility, will teach how to do exercises that will perform either with continued supervision or at home.
• Following the rehabilitation plan is important for proper healing and achieving the best possible outcomes.

Benign paroxysmal positional vertigo (BPPV) is a disorder arising from a problem in the inner ear. Symptoms are repeated, brief periods of vertigo with movement, that is, of a spinning sensation upon changes in the position of the head.
Vestibular disorders can be caused by:
1. Head Trauma (whiplash, sports injuries, workplace injuries) is a frequent cause of vestibular disorders in people under age 50.
2. Vestibular system degeneration - primarily in an elderly population
3. Ear infections such as otitis media; inner ear infection such as labyrinthitis or neuronitis
4. Ototoxicity – high dosage or long term use of certain antibiotics
5. Acoustic neuroma
6. Barotrauma
7. Vascular insufficiency

How is it diagnosed?
Normal medical imaging is not effective in diagnosing BPPV, because it does not show the crystals that have moved into the semi-circular canals. However, when someone with BPPV has their head moved into a position that makes the dislodged crystals move within a canal, the error signals cause the eyes to move in a very specific pattern, called “nystagmus”.
The nystagmus will have different characteristics that allow a trained therapist to identify which ear the displaced crystals are in, and which canal(s) they have moved into. Tests like the Dix-Hallpike or Roll Tests involve moving the head into specific positions, which allow gravity to move the dislodged crystals and trigger the vertigo while the therapist watches for the eye movements, or nystagmus.

There are two types of BPPV: one where the loose crystals can move freely in the fluid of the canal (canalithiasis), and, more rarely, one where the crystals are thought to be ‘hung up’ on the bundle of nerves that sense the fluid movement (cupulolithiasis). With canalithiasis, it takes less than a minute for the crystals to stop moving after a particular change in head position has triggered a spin. Once the crystals stop moving, the fluid movement settles and the nystagmus and vertigo stop. With cupulolithiasis, the crystals stuck on the bundle of sensory nerves will make the nystagmus and vertigo last longer, until the head is moved out of the offending position. It is important to make this distinction, as the treatment is different for each variant.
BPPV can be corrected mechanically. Once the physiotherapist knows which canal(s) the crystals are in, and whether it is canalithiasis or cupulolithiasis, then they can take you through the appropriate treatment maneuver. The maneuvers make use of gravity to guide the crystals back to the chamber where they are supposed to be via a very specific series of head movements called Canalith Repositioning Maneuvers. In the case of cupulolithiasis, they would utilize rapid head movement in the plane of the affected canal to try to dislodge the ‘hung-up’ crystals first, called a Liberatory Maneuver,

After treatment:
90% gives better results by 1-3 treatments, particularly canalithiasis. But it could take longer in cupulolithiasis.  It is possible to have more than one canal involved, especially after trauma, in which case vestibular therapist would typically have to correct them one at a time. You may be advised to avoid certain head positions for a few days following treatment.

Peripheral neuropathy, a result of damage to the nerves outside of the brain and spinal cord (peripheral nerves), that could cause weakness, numbness and pain, usually in hands and feet. Peripheral nervous system sends information from your brain and spinal cord (central nervous system) to the rest of your body. The peripheral nerves also send sensory information to the central nervous system.

Peripheral neuropathy can consequence from traumatic injuries, infections, metabolic problems, inherited causes and exposure to toxins. One of the most familiar causes is diabetes.
People with peripheral neuropathy usually express the pain as stabbing, burning or tingling.

Symptoms
Every nerve in peripheral system has a specific function, so symptoms are depending on the type of nerves affected. Nerves are classified into:
Sensory nerves that receive sensation, such as temperature, pain, vibration or touch, from the skin.
Motor nerves that control muscle movement.
Autonomic nerves that control functions such as blood pressure, heart rate, digestion and bladder.

Signs and symptoms of peripheral neuropathy might include:
Gradual onset of numbness, prickling or tingling in feet or hands, which can spread upward into legs and arms
Sharp, jabbing, throbbing or burning pain
Extreme sensitivity to touch
Pain during activities that shouldn't cause pain, such as pain in your feet when putting weight on them or when they're under a blanket
Feeling as if you're wearing gloves or socks when you're not
Paralysis if motor nerves are affected
Lack of coordination and falling
Muscle weakness
If autonomic nerves are affected, signs and symptoms might include:
Heat intolerance, excessive sweating or not being able to sweat, bowel, bladder or digestive problems, changes in blood pressure, causing dizziness or light-headedness

Causes
Autoimmune diseases. Diabetes, infections, inherited disorders. such as Charcot-Marie-Tooth disease, tumors, bone marrow disorders.
Other causes of neuropathies include:
Alcoholism, exposure to poisons, medications. especially those used to treat cancer (chemotherapy), trauma or pressure on the nerve. vitamin deficiencies. - B vitamins — including B-1, B-6 and B-12 — vitamin E and niacin are crucial to nerve health.

Complications - Burns and skin trauma, infection, falls.

Physiotherapist role:
To improve muscle power
To educate how to prevent injuries and fall
Fall prevention strategies
Application of electrotherapy if required
To improve sensation over the affected areas