Author: Dr Dharam

Ankylosing Spondylitis : Back Pain

Posted on by Dr Dharam

A chronic inflammatory disease that mostly affects the axial skeleton, ankylosing spondylitis (AS) can cause pain, stiffness, and even spinal fusion. To effectively manage AS, we at Elite Physiotherapy and Sports Injury Centre provide individualized, evidence-based physiotherapy interventions.

Understanding Ankylosing Spondylitis

The hallmark of ankylosing spondylitis, a form of axial spondyloarthritis, is inflammation in the spine and sacroiliac joints. Parts of the spine may fuse as a result of the new bone that forms as a result of this inflammation over time. Although the precise reason is yet unknown, genetic factors—specifically, the presence of the HLA-B27 gene—have a significant impact. Environmental variables may also influence the start and progression of disease.

Causes and Classification

AS is under the category of inflammatory rheumatic diseases known as spondyloarthritis. An autoimmune reaction, in which the body’s immune system targets its own tissues, is thought to be the main cause. One known risk factor is genetic predisposition, particularly the HLA-B27 gene. Infections and other environmental causes may also contribute to the development of disease.

Clinical Features and Symptoms

Common symptoms of AS include:

  • Persistent stiffness and discomfort in the lower back, particularly in the morning or after extended periods of inactivity.
  • Peripheral joints such as the shoulders, knees, and hips may experience pain and swelling.
  • Inflammation where tendons and ligaments connect to bones is called enthesitis.
  • Fatigue and decreased mobility.
  • A stiff spine may result from spinal fusion in more advanced stages.

Diagnostic Methods

Diagnosis of AS involves:

  • Clinical Evaluation: Evaluation of medical history and symptoms.
  • Imaging: MRI or X-rays to identify alterations in the spine and sacroiliac joints.
  • Laboratory Tests: Blood tests to look for the HLA-B27 gene and indicators of inflammation.

Physiotherapy Management at Elite Physiotherapy and Sports Injury Centre

At Elite Physiotherapy and Sports Injury Centre, we provide a comprehensive physiotherapy approach tailored to the needs of AS patients:

1. Assessment Techniques

  • A comprehensive evaluation is carried out utilizing:
  • Postural Analysis: Finding any anomalies or compensatory patterns.
  • Range of Motion (ROM) Measurements:  Evaluating joint mobility and flexibility.
  • Strength Testing: It is the process of assessing the endurance and strength of muscles.
  • Special Tests: To evaluate spinal and sacroiliac joint involvement, particular orthopedic tests are used. such as the Schober test, the SI compression test, and Gaenslen’s test, etc.

2. Treatment Modalities

To improve therapeutic results, we use cutting-edge modalities:

  • Shock Wave Therapy: Using acoustic waves, shock wave therapy helps musculoskeletal tissues repair.
  • Super Inductive System: Reduces pain and inflammation by stimulating deep tissues with high-intensity electromagnetic fields.
  • High-Intensity Laser Therapy: Reduces inflammation and speeds up tissue repair by using concentrated light.
  • Dry Needling and Cupping Therapy: Uses specific procedures to relieve pain and tightness in the muscles.

3. Exercise Therapy

A personalized exercise program focusing on:

  • Exercises for Spinal Mobility: To preserve and enhance flexibility.
  • Strengthening exercises: These support spinal alignment by focusing on the postural and core muscles.
  • Aerobic Conditioning: To lessen tiredness and increase general fitness.

Why Choose Elite Physiotherapy and Sports Injury Centre?

Our center offers:

  1. Expert Physiotherapists: Specialized in managing complex conditions like AS.
  2. State-of-the-Art Equipment: Utilizing advanced therapeutic modalities.
  3. Holistic Approach: Addressing physical, emotional, and lifestyle aspects of AS.
  4. Personalized Care: Tailored treatment plans to meet individual needs.

If you’re experiencing symptoms of Ankylosing Spondylitis or seeking specialized care, contact Elite Physiotherapy and Sports Injury Centre today. Our dedicated team is here to support you on your journey to better health and mobility.

Sciatica – Culprit for your long running lower back pain

Posted on by Dr Dharam

A common condition that causes pain, numbness, or weakness along the sciatic nerve is sciatica. This nerve travels down each leg from the lower back through the buttocks. Our goal at Elite Physiotherapy and Sports Injury Centre is to improve function, reduce pain, and enhance quality of life through individualized treatment strategies.

What is Sciatica?

Pain that travels along the sciatic nerve route is referred to as sciatica. Usually, it impacts one side of the body. The pain might hamper everyday activities and ranges from mild to severe. Even while it usually goes away on its own, persistent cases need professional attention.

Causes of Sciatica

  • Herniated Disc: The nerve root is compressed by a slipped disc.
  • Spinal Stenosis: The nerve is compressed when the spinal canal narrows.
  • Degenerative Disc Disease: Nerve discomfort is caused by disc wear.
  • Spondylolisthesis: A nerve is pinched when one vertebra slides across another.
  • Piriformis Syndrome: The piriformis muscle irritates the sciatic nerve.
  • Trauma or Injury: Nerve damage can result from accidents.
  • Infections or tumors are uncommon but possible causes.

Clinical Features, Signs, and Symptoms

  • Sharp, shooting pain from the lower back to leg.
  • Tingling or numbness in the foot or leg.
  • Weakening of the leg muscles.
  • Prolonged standing or sitting causes the pain to worsen.
  • walking or carrying out regular tasks with difficulty.

Diagnostic Methods and Special Tests

An accurate diagnosis is essential for successful treatment. We conduct a comprehensive evaluation at Elite Physiotherapy and Sports Injury Centre by integrating a physical examination and patient history.

Common Diagnostic Techniques:

  • The Straight Leg Raise (SLR) test: Involves raising the straightened leg to assess nerve root irritation. Pain reproduction suggests sciatica.
  • Slump Test: The patient sits with their knee extended and their spine flexed. If sciatic symptoms show up, it’s positive.
  • Crossed Straight Leg Raise Test: Lifting the unaffected leg while replicating symptoms indicates a disc herniation.
  • Neurological Examination: Assesses strength, reflexes, and sensory abilities.
  • Doctors may recommend imaging tests such as MRIs or CT scans to confirm disc herniation or stenosis.

Physiotherapy Management of Sciatica

At Elite Physiotherapy, we aim to reduce discomfort, increase range of motion, and stop recurrence. We emphasize individualized, evidence-based strategies with premium modalities.

1. Manual Therapy

  • To increase spinal mobility and lower nerve pressure, we use soft tissue methods and joint mobilization.

2. Therapeutic Exercises

  • Stretching: To relieve tension, focus on the piriformis and hamstrings.
  • Exercises for Stabilization: Use low-load core strengthening to enhance spinal support.
  • Exercises for Nerve Mobilization: Encourage sciatic nerve mobility without making symptoms worse.

3. High-End Modalities

A. Shock Wave Therapy

  • Efficient in promoting blood flow and nerve regeneration to lessen chronic pain.

B. Super Inductive System (SIS)

  • Provides deep electromagnetic pulses to the afflicted area to increase circulation and decrease inflammation.

C. High-Intensity Laser Therapy

  • Reduces inflammation, discomfort, and promotes healing by penetrating deep tissues.

D. Dry Needling & Cupping Therapy

  • Physiotherapists target trigger points and relieve tense muscles, which is especially beneficial for sciatica caused by piriformis syndrome.

4. Postural Correction and Ergonomic Exercises

  • We provide home home-based exercise program for your posture correction that will help to minimize nerve compression.

Why Choose Elite Physiotherapy and Sports Injury Centre?

For sciatica, we offer a comprehensive, patient-focused therapy. Our skilled therapists and cutting-edge methods guarantee a quicker, secure recovery. We ensure long-term relief by tailoring each plan to each client’s unique demands.

At Elite Physiotherapy, we think that in order to assist patients properly heal from sciatica, we need to combine science, technology, and compassionate treatment.

Piriformis Syndrome and its Elite Management

Posted on by Dr Dharam

What is Piriformis Syndrome?

Behind the gluteus maximus, deep in the buttocks, is a tiny, flat muscle called the piriformis. It joins the apex of the femur to the sacrum. Its main function is to support the pelvis and aid in hip rotation when walking or running. The sciatic nerve that passes through or beneath the piriformis muscle may be compressed if it gets tense, swollen, or spasms. The result of this is Piriformis Syndrome.

Causes of Piriformis Syndrome

  • Overuse of muscles from repetitive sports like cycling or jogging
  • Damage or trauma to the gluteal area
  • Extended periods of sitting, particularly with bad posture
  • Variations in anatomy, where the piriformis is where the sciatic nerve travels
  • Piriformis muscle inflammation or spasm
  • Conditions affecting the lumbar spine that lead to transferred sciatic pain

Classification of Piriformis Syndrome

Although there is no strict classification system, it is commonly categorized based on the cause:

  • Primary Piriformis Syndrome: brought on by congenital defects or anatomical variances.
  • Secondary Piriformis Syndrome: Caused by inflammation, misuse of the muscles, or trauma.

Clinical Features / Signs & Symptoms

  • An excruciating, deep buttock pain
  • Often misdiagnosed as sciatica, pain radiating down the back of the thigh
  • Along the sciatic nerve distribution, numbness and tingling
  • Increased discomfort when sitting or moving the hips
  • The piriformis muscle is painful.
  • Having trouble walking or climbing stairs, for example

Diagnostic Methods, Tests, and Physical Examination

Physical Examination and Special Tests

  • Palpation: Potential involvement is indicated by tenderness over the piriformis muscle.
  • Piriformis Muscle Stretch Test: The patient is in a supine position while the examiner passively rotates, adducts, and flexes the hip. Piriformis involvement is suggested by pain reproduction.
  • Freiberg Test: Pain occurs when the extended thigh is forced to rotate internally.
  • Pace Test: Pain in the piriformis region is caused by outward rotation of the hip and resisted abduction.
  • Straight Leg Raise Test: It may be positive in certain situations; however, it aids in ruling out lumbar disc herniation.
  • Imaging and Other Investigations: MRI or Ultrasound Imaging

Physiotherapy Management at Elite Physiotherapy and Sports Injury Centre

1. Manual Therapy and Soft Tissue Techniques

  • Piriformis Muscle Release: Expert soft tissue release eases sciatic nerve constriction and eases tense muscles.
  • Trigger point therapy: It reduces pain and spasms by applying direct pressure to muscular knots.

2. Therapeutic Exercises

  • Stretching exercises that target the hamstrings, hip adductors, and piriformis to release tension.
  • Strengthening exercises: To increase pelvic stability, strengthen your gluteus medius and core muscles.
  • Exercises for Postural Correction: Focusing on spinal alignment and good sitting posture.

3. High-End Physiotherapy Modalities

  • At Elite Physiotherapy and Sports Injury Centre, we employ advanced modalities for effective treatment:
  • Shock Wave Therapy (SWT): High-energy waves stimulate tissue repair, reduce inflammation, and improve circulation.
  • Super Inductive System (SIS): Provides deep heating, enhancing muscle relaxation and reducing spasms.
  • High Intensity Laser Therapy (HILT): Accelerates tissue healing and reduces nerve-related pain by penetrating deep tissues.
  • Dry Needling: Thin needles target trigger points to release muscle tension and improve blood flow.
  • Cupping Therapy: Increases circulation and releases fascial restrictions in the piriformis and surrounding tissues.

4. Education and Lifestyle Modification

  • Educating patients on avoiding prolonged sitting, proper stretching, and regular exercise prevents recurrence.

5. Home Exercise Program

  • We provide personalized home exercise programs, including stretching and strengthening exercises, to maintain progress.

Why Choose Elite Physiotherapy and Sports Injury Centre?

At Elite Physiotherapy and Sports Injury Centre, we provide highly individualized physiotherapy service together with cutting-edge diagnostic methods. Utilizing cutting-edge technologies and evidence-based techniques, our skilled team specializes in treating Piriformis Syndrome. We guarantee that each patient gets a comprehensive evaluation and a customized treatment strategy.

Combining manual therapy, therapeutic exercises, and state-of-the-art techniques like Shock Wave, SIS, HILT, Dry Needling, and Cupping improves our outcomes. We provide patients with the information and resources they need for long-term recovery in addition to treatment.

Understand Spondylolisthesis

Posted on by Dr Dharam

What is Spondylolisthesis?

The sliding of one vertebral body relative to the next, known as spondylolisthesis, results in pain, radicular symptoms, or mechanical symptoms. It may result from idiopathic, acquired, or congenital causes. The degree of slippage (Meyerding Classification) of one vertebral body on the next vertebral body determines the grade of spondylolisthesis.[1]

What Causes Spondylolisthesis?

  • Congenital weakness, stress fractures, and spinal degeneration are common reasons.
  • Athletes’ recurrent stress or aging-related deterioration may potentially be the cause.
  • Traumatic accidental injuries
  • Pathological factors, such as connective tissue disorders and neoplasms.
  • Following a laminectomy.
  • Early-life decline in neural arch strength

Clinical Presentation

Pain presentation

  • Low back pain (lumbar) or neck pain (cervical)
  • Can mimic radiculopathy
  • Worsens with spinal extension or palpation
  • Improves in flexed or supine posture

Neurological involvement

  • Radicular pain due to nerve root compression (foraminal narrowing, disc protrusion, or canal stenosis)
  • Reduced spinal ROM
  • Possible neurological deficits

Musculoskeletal findings

  • Hamstring tightness or spasm
  • Muscle weakness and atrophy
  • Crouched gait (Phalen-Dickson sign) due to postural compensations

Functional impairments

  • Disturbed coordination and balance
  • Difficulty walking

Elite Physiotherapy’s Personalized Approach

At Elite Physiotherapy & Sports Injury Centre, we value your unique needs. We start with careful evaluation. Design a plan that fits your lifestyle and pain level. We blend manual therapy, therapeutic exercises, and advanced modalities to restore function and strength.

Assessment Technique & Specialized Physiotherapy Test

To fully assess spondylolisthesis, we use a multi-step approach:

Postural Analysis

  • Observe spinal alignment, pelvic tilt, and posture during standing and movement.
  • Look for abnormal lumbar curves or forward displacement.

Movement Testing

  • Test active and passive spine flexion, extension, and side-bending.
  • Note pain levels and movement restriction.

Specific Segmental Move Test

  • Applying targeted mobilization to each lumbar segment while feeling for resistance or movement.
  • This reveals the precise vertebra level that has shifted or lacks stability.

Functional Load Assessment

  • Observe how the spine responds under gentle compressive load in neutral or extension.
  • Assess pain response and stability under real-life stress.

Neurological Screen (if needed)

  • Check reflexes, muscle strength, and sensation in lower limbs.
  • Rule out nerve compression from the shifted vertebra.

Personalized Physiotherapy Management

1. Pain Relief and Initial Stabilization

  • Begin with gentle manual therapy targeting the affected vertebral level.
  • Use soft-tissue release to ease muscle tightness.
  • Apply electrotherapy (like TENS or ultrasound) to relieve pain and reduce muscle spasm.

2. Core Stabilization and Neutral Spine Control

  • Teach deep abdominal bracing in neutral spine position.
  • Guide pelvic tilts and glut activation exercises to reduce spinal load.
  • Progress into bird-dog, focusing on spine control with limb movement.

3. Lumbar Segmental Mobilization

  • Apply controlled mobilization at the specific slipping segment.
  • Use directional preference movements to encourage vertebral alignment.
  • Reassess after each session to ensure progress.

4. Flexibility and Paraspinal Strengthening

  • Stretch tight hamstring and hip flexor muscles without forcing movement.
  • Incorporate side-planks and modified bridges to strengthen trunk and glutes.
  • Progress with Swiss-ball control exercises for added stability.

5. Functional Training and Movement Re-education

  • Advise and train safe movement patterns for daily tasks.
  • Use squat-to-stand drills with neutral spine emphasis.
  • Incorporate dynamic balance work, such as single-leg stance with trunk rotation.

6. Gradual Return to Sport or Activities

  • Include sport-specific drills with controlled spine posture.
  • Gradually increase intensity, speed, and complexity.
  • Monitor form to prevent shear forces on the lumbar spine.

7. Education and Prevention

  • Teach proper posture and body mechanics for activities such as bending, lifting, and sitting.
  • Provide a personalized home exercise program for spinal stability.
  • Schedule periodic follow-ups to track progress and adjust treatment.

Why Elite Physiotherapy Excels

  • We offer expert, hands-on care tailored to each slip’s severity.
  • We maintain a safe, progressive plan built on spinal mechanics.
  • We combine manual therapy, movement control, and sport readiness.
  • We stress patient education, empowering long-term spine health.
  • We monitor closely and adapt therapy as you improve.

Conclusion

At Elite Physiotherapy & Sports Injury Centre, we guide healing from spondylolisthesis with precision, compassion, and progression. We blend assessment with active treatment, core retraining, and safe return to activity. We help you reclaim pain-free movement with strength, control, and confidence.

Cross Bracing Protocol (CBP) for ACL Rehab

Posted on by Dr Dharam

What is the Cross Bracing Protocol?

For certain acute ACL ruptures, the Cross Bracing Protocol (CBP) is a time-sensitive, non-surgical treatment option. For the first four weeks, the knee is in a 90° flexion position. After that, the brace is gradually unlocked to restore motion, to mimic the remaining ACL so that the native ligament can repair. Early results from prospective cohorts report high rates of MRI continuity at 3 months; clinical trials are still being conducted to determine suitable individuals and longer-term outcomes.

Why it matters

A totally ruptured ACL was formerly thought to be incapable of healing, necessitating early repair or conventional rehabilitation without bracing. Recent data casts doubt on that belief. In a secondary analysis of the KANON trial, approximately one-third of ACLs treated solely with rehabilitation had MRI evidence of healing at two years (and roughly one-half when those who underwent surgery were excluded), and the healed group had better patient-reported outcomes. By purposefully placing the knee to encourage tissue apposition as soon as possible after injury, CBP enhances this healing potential.

Who is (and isn’t) a Candidate?

The best candidates typically show up early (preferably within 10 days after the injury), have an MRI showing an acute ACL rupture, and can follow bracing and follow-up instructions to the letter. MRI morphology (such as remnant quality, displacement, and gap distance) and patient characteristics (sport demands, support, and comorbidities) are progressively taken into account during the selection process.

Not suitable for all: Clinicians are frequently pushed onto alternative approaches due to multi-ligament injuries, displaced bucket-handle meniscal tears/loose bodies requiring urgent surgery, extremely delayed presentation, or enhanced thrombosis risk. (CBP-using programs typically sort them out in the early stages of MRI-guided decision making.)

How the Protocol Works

The basic idea is to protect the healing ACL from anterior tibial translation and pivoting by initially reducing and immobilizing (similar to a fracture) and then gradually restoring motion every week.

Weeks 1–4

  • Brace: locked at 90° (24/7; sleep in brace).
  • Weight-bearing: Non-weight-bearing (NWB) with crutches.
  • Goals: protect the healing zone, maintain patellofemoral mobility, prevent deconditioning (safe isometrics).

5th Week

  • Brace 60–90°. Continue NWB. Begin gentle, brace-permitted ROM drills; progress isometric hamstring/quadriceps sets in allowed angles.

6th Week

  • Brace ~45–90°. Still NWB. Add stationary bike within brace limits if permitted.

7th Week

  • Brace 30–120°. Partial weight-bearing begins; gait retraining within brace range. Light closed-chain work in safe angles.

Week 8

  • Brace 20–120°. Progress PWB loading, proprioception in brace.

Week 9

  • Brace 10–120°. Full weight-bearing as tolerated in brace; advance strength, balance, conditioning tasks (pool if available) without pivoting/cutting.

Weeks 10–11

  • Unrestricted brace during the day; remove for sleep. Continue progressive strengthening, linear conditioning, and landing mechanics in straight plane.

Week 12

  • MRI and clinical review. The brace is taken off, and criterion-based rehabilitation continues if the MRI reveals sufficient continuity and clinical stability. If not, a “cross-over” to surgery or an extension of bracing may be part of the collaborative decision-making process.

Beyond 12 weeks (typical milestones)

  • Weeks 16–17: Start straight-line running (criteria-based).
  • ~6–12 months: Athletes gradually return to training and then progress to sport-specific change of direction once they achieve goals for strength, symmetry, hop testing, and movement quality. Many programs plan for nine to twelve months before a complete return to pivoting sports.

Rehabilitation Priorities

Protection & monitoring (0–12 wks)

  • Teach people to use crutches, wear braces strictly, and refrain from twisting or pivoting.
  • Ankle pumps, hip/glute/hamstring isometrics, and early patellar mobilization (knee maintained within brace limits).
  • Some programs aggressively monitor DVT risk (local techniques vary; some reported early DVTs spurred teams to embrace pharmacologic prophylaxis).

Strength & motor control (weeks 5–12)

  • Avoid anterior shear (no open-chain knee extension in vulnerable ranges) and increase closed-chain strength in safe arcs.
  • Brace ROM connects directly with balance, trunk/hip control, and graded conditioning (bike, pool, and later treadmill).

Run-jump-cut reconditioning (post-brace)

  • Linear running → decel/accel → low-level plyometrics → planned change-of-direction → unplanned COD and sport skills after meeting patient-reported outcomes targets and ROM/strength/hop/movement benchmarks.

To prevent vasoconstriction during the initial healing window, some CBP teams prohibit the use of NSAIDs, knee aspiration, and even cryotherapy.

What Does the Evidence Say (so far)?

  • High MRI early healing with CBP: Three months after CBP, a prospective cohort reported ~90% ACL continuity, and patients with greater early MRI healing achieved better results. Researchers still need randomized longer-term results.
  • In certain situations, ACLs can heal without surgery: In the KANON dataset, MRI showed healing in around 30 to 50% of patients who underwent rehabilitation alone, independent of CBP.. The KOOS results of the healed groups were better than those of the non-healed/reconstructed groups.
  • Risk-benefit balance: Although reviews point to encouraging healing, they also emphasize the danger of stiffness, the necessity of careful selection and adherence, and the possibility that some patients will require surgery.

CBP vs. Traditional ACL Management

DimensionCross Bracing ProtocolTraditional Reconstruction / Standard Non-Op
Primary goalHeal the native ACL (biologic healing)Replace with graft (surgery) or compensate via neuromuscular rehab
Early positioningImmobilize at 90° flexion for 4 weeks, then staged ROMPrioritize full extension early; brace often locked in extension initially post-op; no prolonged flexion immobilization
Weight-bearing (early)NWB first weeks; add load as brace range increasesWBAT early after ACLR; progress as swelling/quad control allow
ROM strategyDelayed extension; weekly unlock scheduleImmediate mobilization, especially regain full extension to avoid arthrofibrosis
Cryotherapy & NSAIDsSome programs limit early NSAIDs/icing (program-specific)Commonly used to control pain/effusion post-injury/surgery
MonitoringScheduled MRI at ~3 months to confirm continuityImaging usually not required once post-op course is stable
Time to pivot sportsTypically ≥9–12 months and criteria-basedAlso ≥9–12 months and criteria-based (graft maturity & testing)
Key risksStiffness/extension loss if mishandled; non-healing → cross-over to surgeryGraft failure, donor-site morbidity, cyclops lesions, and surgical risks
Time to pivot sportsMotivated, early-presenting patients willing to adhere strictly; favorable MRI patternGraft failure, donor-site morbidity, cyclops lesions, surgical risks

At Elite Physiotherapy and Sports Injury Centre, we integrate the latest evidence-based approaches, such as the Cross-Bracing Protocol (CBP), alongside traditional ACL rehabilitation and surgical recovery programs. With our advanced facilities—including Super Inductive Stimulation (SIS), Class 4 Laser Therapy, CRET Therapy, Shockwave Therapy, and Hydrotherapy—we ensure that every patient receives a personalized, high-end rehabilitation plan. Our focus is not just on healing the ligament but also on restoring strength, balance, and performance, so athletes and active individuals can safely return to their sport or lifestyle with confidence.

Lumbar Spinal Stenosis

Posted on by Dr Dharam

Introduction

Our specialty at Elite Physiotherapy & Sports Injury Centre is helping discerning people regain their range of motion, lessen their pain, and improve their function. Lumbar spinal stenosis requires a thorough, scientifically supported physical therapy regimen that is administered with accuracy, compassion, and clarity.

What Causes Lumbar Spinal Stenosis?

Lumbar spinal stenosis is caused by narrowing of the spinal canal or nerve-exit tunnels. Therefore, typical contributors consist of:

  • Degenerative changes: facet joint overgrowth, disc bulging or herniation, and thicker ligaments (ligamentum flavum) all contribute to canal narrowing.
  • Nerve roots inside the canal are pinched by bone spurs and facet hypertrophy.
  • One vertebra slides forward in degenerative spondylolisthesis, which reduces neural space.
  • In rare cases, the cause is congenital spinal canal constriction.

Neurogenic claudication is characterized by symptoms such as leg discomfort, numbness, and weakness that get worse when standing or walking and get better when bending forward or sitting.

Physiotherapy Assessment Techniques

To properly customize treatment, a comprehensive physiotherapy evaluation is essential. Important actions consist of:

  • History: Examine the onset, postures that aggravate and relieve the condition, and any functional restrictions in the detailed history.
  • Observation and gait analysis: take note of antalgic movements, flexed postures, walking patterns, and posture.
  • Range of Motion (ROM): Assess both active and passive lumbar flexion and extension using range of motion (ROM); restricted extension may be a sign of facet involvement.
  • Palpation: Static or dynamic palpation can be used to identify segmental dysfunction, muscular spasms, or soreness.
  • Neurological testing: strength, sensitivity, and reflexes (ankle, knee) aid in identifying nerve involvement.
  • Specific tests, such as the Kemps, slump, and straight leg lift, are used to identify nerve stress or root compression.
  • Functional treadmill or bicycle stress tests: Stress tests on a functional treadmill or bicycle mimic walking to elicit symptoms and validate neurogenic claudication.

Moreover, these results enable us to distinguish lumbar stenosis from other causes and identify patterns of neurogenic claudication.

Physiotherapy Management at Elite Physiotherapy Centre

Each client is given a customized program that combines functional integration, strengthening, mobility retraining, and manual treatment.

1. Neural decompression and pain relief

  • Flexion-based positions: utilizing assistive supports or sitting with your back flexed forward relieves pressure on your nerves.
  • Exercises that include lumbar flexion, such as knee-to-chest and pelvic tilts, help to relieve nerve compression and open up neural foramina.
  • When used properly, controlled lumbar extension exercises can decompress nerve roots and move disc material; use them only under close supervision.

2. Improvement in Mobility and Flexibility

  • To reduce stiffness and enhance functional capacity, gently stretch the hip flexors, hamstrings, and lower back.
  • Partial-weight support exercises or aquatic treatment can lower axial load, preserve mobility, and lessen pain.

3. Strengthening and Core Stabilization

  • exercises that support spinal alignment by activating the deep core (such as the transverse abdominis) with the pelvic tilt, dead bug, and bridge.
  • Gradually strengthening the lower limbs and glutes enhances balance, improves gait, and lowers lumbar demands.

4. Aerobic and Functional Conditioning

  • Walking, swimming, and recumbent cycling are examples of low-impact aerobic exercises that improve functional mobility and endurance.
  • Gradual advancement with an emphasis on endurance building and symptom-guided pacing.

5. Education & Manual Therapy

  • Specific manual procedures to move restricted joints and relieve segmental stiffness.
  • Teaching body mechanics, posture, and movement patterns to reduce symptom triggers and increase safe functional utilization.

However Every element at Elite demonstrates our commitment to accuracy and customer results:

Stress our practical manual treatment expertise in conjunction with top-tier, scientifically supported exercise regimens.

Emphasize our individualized treatment, careful observation, and alignment with functional goals in language that is clear, dynamic, and client-focused.

Conclusion

A focused, sympathetic, and function-driven physiotherapy approach is necessary for lumbar spinal stenosis. Additionally, the following are combined at Elite Physiotherapy & Sports Injury Centre:

  • Competent evaluation and customized treatment regimens,
  • Progressive training for strength, endurance, and mobility,
  • Manual interventions that are hands-on,
  • Under close observation, flexion-based and potentially extension-based therapies,
  • Instruction that promotes long-term recovery

This all-encompassing strategy aids in pain relief, increased walking tolerance, and the restoration of high-level function.

Understanding Disc Herniation

Posted on by Dr Dharam

What Causes Disc Herniation?

Disc herniation often begins with disc degeneration, where the central gel (nucleus pulposus) loses hydration and structural support. Aging makes discs brittle and prone to tears under stress.

Contributing factors include:

  • Trauma or sudden strain, such as lifting or twisting improperly.
  • Repetitive poor posture or prolonged sitting which shifts pressure unevenly across discs.
  • Genetic predisposition, from collagen or matrix gene variations.
  • Athletic activity or contact sport, which demands forceful spinal flexion or impact.

Elite Physiotherapy Assessment for Disc Herniation

1. Detailed patient history

  • We ask about onset, triggers, radiation, posture, prior treatments, and daily limitations.

2. Neurological and orthopaedic testing

  • We evaluate reflexes, muscle strength, sensation, and gait.

3. Special physiological tests

  • Straight Leg Raise (SLR): high sensitivity but variable specificity.
  • Cross-straight Leg Raise: low sensitivity, high specificity.

4. Red flag screening

  • We rule out fractures, infections, malignancies, or cauda equina syndrome.

5. Imaging when needed

  • MRI is the gold standard for confirming a disc herniation. X-ray or CT may rule out other issues.

Elite Physiotherapy Treatment of Disc Herniation

Acute Phase (First 24–48 Hours)

  • To lessen stiffness, promote gentle activity, such as quick strolls.
  • For pain management and inflammatory reduction, recommend cold therapy.
  • Encourage frequent postural changes and supportive seating.

Sub-acute and Improvement Phase

  • To assist with central discomfort, concentrate on directional preference exercises.
  • For lumbar support, introduce motor control and core stability activities.
  • Add cardio exercises like cycling or walking gradually.
  • Focus on strengthening and extending your hamstrings, hips, and back muscles.
  • Stretch your hamstrings, hip flexors, and back extensors.
  • Engage the quadratus lumborum and transversus abdominis.
  • Practice lunges, crawling movements, and bridging.
  • Start with five repetitions and work your way up to ten or fifteen.

Post-operative or Advanced Phase

  • Start treatment four to six weeks after surgery.
  • Pay attention to ergonomics and safe daily practices.
  • Make use of progressive training that is customized for every activity or sport.

Why Choose Elite Physiotherapy & Sports Injury Centre?

  • Superior diagnostics and state-of-the-art technologies such as new TR-Therapy, class 4 laser, CRET, and cryotherapy.
  • A welcoming, patient-centered setting managed by seasoned experts.

Final Words

For disc herniation, Elite Physiotherapy & Sports Injury Centre provides excellent, research-based care. You heal more quickly and effectively because to our comprehensive evaluation, individualized care, and skilled rehabilitation methodology. Whether you’re an athlete or just active, you can trust our cutting-edge techniques and caring staff to help you on your path to recovery.

Get in touch with Elite Physio to schedule a consultation or for additional information. You deserve the best treatment for your spine.

Lumbar Radiculopathy: Lower Back Pain

Posted on by Dr Dharam

Introduction

Nerve irritation or compression in the lower spine is known as lumbar radiculopathy. It results in weakness, tingling, or acute leg pain. In a compassionate, contemporary setting, Elite Physiotherapy treats it with cutting-edge diagnosis and premium physiotherapy. The causes, evaluation procedures, and treatment plan customized for our clients are explained in this blog.

Causes of Lumbar Radiculopathy

  • Herniated disc: A herniated disc occurs when a spinal nerve is compressed by mushy disc gel.
  • Spinal stenosis: Nerve roots become irritated by spinal stenosis, a narrowing of the spinal canal.
  • Degenerative changes: Arthritis or bone spurs may cause roots to become compressed.
  • Spondylolisthesis: Spondylolisthesis is a condition in which a vertebra slips and hits nerves.
  • Trauma or injury: Nerve symptoms may be brought on by an abrupt strain or impact.

Assessment at Elite Physiotherapy

Patient history

  • We start by asking specific questions on the location, onset, and nerve-related symptoms of pain.

Neurological screening

  • We assess sensations in dermatomal patterns, reflexes (knee, ankle), and muscular strength (e.g., foot dorsiflexion for L4).

Special test: Straight Leg Raise (SLR)

  • It evaluates inflammation of nerve roots. We raise the leg straight up while the patient is in a supine position. Nerve involvement is indicated by pain radiating below the knee.

Slump test

  • We ask the patient to straighten their leg, flex their neck, and sit up slumped. Nerve tension is confirmed by radiating symptoms that are reproduced.

Functional assessment

  • We look at spinal mobility, gait, posture, and movement patterns.

Physiotherapy Management at Elite Physiotherapy

A. Pain relief and nerve mobilization

  • To ease neurological tension, we employ mild nerve-gliding activities. To lessen inflammation and nerve discomfort, we might also use Class 4 laser, CRET therapy, and interferential therapy.

B. Core and spinal stabilization

  • To build deep stabilizers, we provide safe, focused activities. They prevent nerve inflammation and lower disc pressure.

C. Flexibility and posture correction

  • We stretch the hip flexors, piriformis, and hamstrings. Additionally, we use postural education and guided feedback to retrain posture.

D. Functional re-training

  • We provide ergonomics, walking mechanics, and sit-to-stand guidance. We restore safe, useful movement to everyday activities and athletics.

E. Gradual return-to-activity

  • Our procedures move slowly. Only after nerve sensations subside can we start low-impact aerobic or sport-specific exercises. After that, we work to fully recuperate.

F. Supportive environment

  • Our clinic offers a welcoming, therapeutic environment with state-of-the-art equipment and a knowledgeable staff. In a cozy environment, clients receive targeted treatment.

Why Elite’s Approach Stands Out

Feature Benefit for You
Advanced techFaster pain reduction and better nerve recovery
Personalized planTailored treatment for your unique condition
Active rehab focusBuilds strength, mobility, and functional ability
Warm care cultureSupportive healing vibe enhances recovery
Experienced team Skilled therapists guide every rehab step

Conclusion

Nerve irritation or compression in the lower spine causes lumbar radiculopathy. At Elite Physiotherapy & Sports Injury Centre, we use accurate diagnosis, proactive care, and customized physiotherapy to provide quick and long-lasting relief. In a contemporary healing environment, we integrate sophisticated therapy, soft-tissue flexibility, stability, and nerve-mobilizing procedures. Our clients regain function and resume optimal performance with careful progress.

Don’t wait if you have severe leg and back pain. Get in touch with Elite Sports Injury & Physiotherapy Center. Our goal is to get you moving again in a friendly, professional setting.

Frequent Upper Trapezius Tightness: And Headache

Posted on by Dr Dharam

Introduction

People with bad posture habits, office workers, and athletes frequently complain of upper trapezius tightness. Due to tight upper traps, we frequently see clients at Elite Physiotherapy and Sports Injury Centre who struggle with persistent stiffness, discomfort, and decreased neck-shoulder mobility. The causes, evaluation techniques, and our cutting-edge physiotherapy strategy for efficient and long-lasting relief are all explained in this article.

Understanding the Upper Trapezius Muscle

The trapezius muscle group, which extends from the neck to the shoulder, includes the upper trapezius. Its main purposes are to help with scapular upward rotation, neck extension, and shoulder elevation. Chronic tightness of this muscle can limit movement, produce pain, and possibly aggravate migraines.

Common Causes of Frequent Upper Trapezius Tightness

  1. Bad Posture: Round shoulders and a forward head put more strain on the muscles.
  2. Repetitive Overuse: Activities requiring prolonged computer use or frequent lifting.
  3. Tension and Stress: Involuntary muscular tightening is frequently brought on by emotional stress.
  4. Muscle Imbalance: The upper trapezius is overworked by weak deep neck flexors and lower trapezius.
  5. Compensatory Patterns: The upper traps may over-activate after neck or shoulder pain.
  6. Sports Overload: Repetitive shoulder elevation causes tension in overhead athletes (weightlifters, badminton players, and volleyball players).
  7. Cervical or Thoracic Dysfunction: Adaptive muscle shortening may result from spinal stiffness in cases of cervical or thoracic dysfunction.

Signs and Symptoms

  • Constant stiffness or tightness in the neck and upper shoulder
  • Pain that could radiate to the scapula or head
  • Decreased mobility in the shoulders and neck
  • The sensation of tenderness
  • Heightened discomfort from extended postures or stress
  • Potential headaches caused by tension

Assessment at Elite Physiotherapy and Sports Injury Centre

Our assessment combines functional analysis, postural evaluation, and special physiotherapy tests to identify the root cause.

1. History and Postural Observation

  • We look at ergonomic setup, sporting activity, and work habits. Shoulder symmetry, scapular posture, and cervical alignment are all observed.

2. Palpation

  • Gentle palpation helps identify trigger points, muscle spasm severity, and referred pain patterns.

3. Range of Motion (ROM) Testing

  • We assess active and passive cervical and shoulder movements to detect restrictions.

4. Special Physiotherapy Tests

  • The cervical flexion-rotation test finds restrictions in the upper cervical joints that cause tension.
  • Assesses if increasing scapular mobility lowers upper trapezius stress using the Scapular Assistance Test (SAT).
  • Upper Limb Neurodynamic Test (ULNT) to rule out nerve tension as a contributing factor.

5. Functional Movement Analysis

  • We assess shoulder elevation, scapular rhythm, and neck stability during sport-specific or daily tasks.

Physiotherapy Management at Elite Physiotherapy and Sports Injury Centre

Our treatment approach targets both symptom relief and prevention of recurrence. We use evidence-based manual therapy, advanced modalities, and corrective exercises.

1. Manual Therapy

  • Trigger Point Release: Direct pressure to deactivate activated myofascial points.
  • Soft Tissue Mobilization: Increases blood flow and lessens rigidity.
  • Cervical and Thoracic Mobilizations: Restoring spinal mobility with cervical and thoracic mobilizations lowers compensatory trap activation.

2. Advanced Modalities

At Elite Physiotherapy, we use high-end physiotherapy technology to accelerate recovery:

  • Super Inductive System (SIS): Stimulates deep tissue relaxation and pain relief.
  • CRET Therapy: Enhances tissue healing and reduces muscle spasm.
  • Class 4 Laser Therapy: Promotes blood flow, reduces inflammation, and accelerates recovery.
  • Dry Needling: Releases deep-seated muscle knots and improves flexibility.

3. Corrective Exercises

  • Scapular Retraction and Depression Drills: To balance muscular activity, strengthen your mid and lower traps.
  • Enhance neck alignment and lessen upper trap overactivation with chin tucks.
  • Stretches for the levator scapula and upper traps will help you stay flexible and avoid recurrence.
  • Wall Angels and YTWL Drills: Restore scapular control and shoulder mechanics.

Why Choose Elite Physiotherapy and Sports Injury Centre?

Our clinic successfully treats frequent upper trapezius tightness by combining precise diagnosis, individualized rehabilitation strategies, and cutting-edge technology. Because of our expertise in orthopaedic and sports physiotherapy, we not only treat pain but also address its root cause, guaranteeing long-term comfort and enhanced performance.

Conclusion

More than just a muscle problem, frequent upper trapezius tightness is frequently a sign of underlying biomechanical or lifestyle issues. In order to restore ideal muscle function and avoid recurrence, we at Elite Physiotherapy and Sports Injury Centre offer comprehensive, athlete-focused, technology-assisted care.

Scapular Dyskinesia: And Advanced Physiotherapy Management

Posted on by Dr Dharam

Introduction

Often disregarded, scapular dyskinesia is a major contributor to shoulder pain, dysfunction, and problems with athletic performance. Using thorough evaluations and evidence-based physiotherapy treatments, we at Elite Physiotherapy and Sports Injury Centre are experts at diagnosing and treating this issue. For the best recovery, our clinic uses a combination of manual therapy, functional training, and premium modalities like Class 4 High-Intensity Laser, CRET Therapy, and Super Inductive System (SIS).

What is Scapular Dyskinesia?

When the shoulder blade (scapula) moves abnormally during shoulder motion, it is referred to as scapular dyskinesia. If left unchecked, this abnormal movement can cause pain, decreased mobility, and even rotator cuff damage by upsetting the entire shoulder complex.

Causes of Scapular Dyskinesia

  • Muscle imbalances (tightness or weakness in the rhomboids, trapezius, or serratus anterior)
  • Round shoulders and bad posture
  • Overuse injuries, particularly in sports involving overhead
  • Disorders that impact the spinal accessory nerves or the long thoracic nerve
  • Prior shoulder surgeries or injuries
  • Lack of scapular stability exercises and improper training methods

Signs and Symptoms

  • Visible asymmetry in scapular motion
  • Medial or inferior border prominence during arm movement
  • Shoulder pain, particularly during overhead activity
  • Muscle fatigue and tightness around the neck or upper back
  • Audible clicking or snapping in the scapula
  • Reduced shoulder strength or performance
  • Postural imbalance or winging of the scapula

Clinical Assessment at Elite Physiotherapy

At Elite Physiotherapy and Sports Injury Centre, we prioritize thorough assessment using functional and physical evaluation techniques:

  • We begin with postural inspection to assess static scapular positioning.
  • Dynamic Scapular Movement Tests
    • Scapular Assistance Test (SAT)
    • Scapular Retraction Test (SRT)
    • Wall Push-Up Test
    • Lateral Scapular Slide Test
  • These special tests help us pinpoint scapular dysfunction patterns.
  • We assess the strength and activation of the serratus anterior, trapezius, and rotator cuff muscles.
  • Athlete-specific or daily movement tasks are analyzed using video-assisted feedback for real-time correction.

Personalized Physiotherapy Management

At Elite Physiotherapy, we offer individualized care based on the goals, activity level, and condition of each patient. We don’t employ a phase-based or general strategy. Rather, we use a combination of manual therapy, corrective exercise, and technology-assisted rehabilitation to directly treat the underlying reasons.

1. Manual Therapy

  • Overactive muscles such as the levator scapulae or pectoralis minor might leak soft tissue.
  • Joint mobilizations for the scapulothoracic or thoracic spine
  • Trigger point and myofascial release therapy

2. Neuromuscular Re-Education

  • Training in proprioception to enhance neuromuscular control
  • Using closed-chain scapular control exercises to integrate kinetic chains

3. Corrective Exercise Program

  • Using body weight and elastic resistance to stabilize the scapula
  • Rhomboids, serratus anterior, and lower and middle trapezius strengthening
  • Exercises for correcting posture
  • Using eccentric loading in conjunction with tendon retraining

Why Choose Elite Physiotherapy for Scapular Dyskinesia?

In addition to having cutting-edge modalities, our center is fueled by extensive clinical knowledge. What sets us apart is this:

  • Thorough functional evaluation tailored to sportsmen and busy people
  • Protocols for evidence-based physical therapy that address the underlying problem
  • Sports physiotherapists with experience who have worked in elite rehabilitation
  • Integration of contemporary technology for a quicker and more durable recovery
  • Individualized sessions that guarantee complete focus and customized development

Final Thoughts

If left untreated, scapular dyskinesia can impair shoulder health and sports performance. Our goal at Elite Physiotherapy and Sports Injury Centre is to restore mobility, function, and balance through accurate diagnosis and skilled physiotherapy care. We use cutting-edge technology and individualized treatment to help you heal more quickly, safely, and robustly.

Schedule an evaluation at www.elitephysiotherapy.in right now if you or someone you know suffers from scapular instability or shoulder trouble.