Physiotherapy

Our highly skilled physiotherapists will use specific exercise programmes, manual therapy, massage and electrical devices to help treat musculoskeletal conditions which can develop with diabetes. After assessing your specific condition, a personalised treatment plan will be outlined to address all your needs.

The best results in managing diabetes come from a combination of resistance and aerobic exercises. Aerobic exercise is effective in strengthening the heart and respiratory capacity. It burns stored calories to help reduce unwanted fat. Resistance exercises strengthen the muscles and bones. It increases the body’s metabolic rate over time and can contribute to the control of your blood sugar.

Diabetic foot care is extremely important as leg and foot problems are the most common reason for diabetes-related hospitalisation. Our physiotherapists work closely with our consultants to ensure you are receiving all the appropriate care you need. Diabetics often have pain from nerve impairment. Electrical stimulation, sensory desensitization and targeted exercise help manage pain and let patients perform physical activity.

Physiotherapy treatments contribute to the prevention of the complications that can occur in diabetic patients. Those patients who are at risk can benefit from the involvement of their physiotherapist in developing the programs that support their goals. By understanding how exercise and nutrition affect blood sugar regulation, you and your physiotherapist can develop an exercise program that supports your long-term health.

Frozen Shoulder Exercises

Frozen Shoulder Exercises aim to reduce pain, increase extensibility of the capsule, and improve strength of the rotator cuff muscles.

Restorative Programme

The basic aim of exercises are:

• To reduce pain.
• To increase extensibility of the thickened and contracted capsule of the joint at the anteroinferior border and at the attachment of the capsule to the anatomical neck of humerus.
• To improve mobility of the shoulder.
• To improve strength of the muscle. However it may be remembered that strengthening of muscle is secondary to mobilization.

Mobilization is attained by 3 basic approaches:

• Relaxation
• Passive mobilization technique
• Specific shoulder exercises to offer graduated stretching.

Relaxation

Though prior heating of the joint has been found to facilitate relaxation and mobilization, one may use the heat modality suitable to the patient's response. However ultrasound, beside deep heating, has the added advantages of increasing excitability of the contracted soft tissue and is therefore performed.

Relaxed Passive Mobilization

The patient is placed in supine position with the affected shoulder in maximum possible abduction and neutral rotation and elbow in 90 degree of flexion. The physiotherapist grasping the arm above the shoulder joint carries out relaxed passive gliding movement of head of humerus on glenoid. Axial traction and approximation is carried out along with antero-posterior glide and abduction- adduction glide. To induce relaxation, always begin with slow rhythmic movement.

Slow and rhythmic circumduction at the glenohumeral joint, in forward stoop position effectively induces relaxation and promotes mobility. Gentle relaxed passive movements reduces pain and pathologic limits of motion. The reduction in pain occurs because of the neuro-modulation effect on the mechanoreceptors with in the joint.

Mobilization by accessory movements of acromio-clavicular, sterno-clavicular and/or scapulo-thoracic joint articulation is also extremely helpful.

Exercise Programme

Frozen shoulder exercises plays an important role in management of the condition. While planning the frozen shoulder exercises one must give due importance to the fact that contracted soft tissue when objected to repeated prolong mild tension show extensibility and plastic elongation.

An increase in the movement following the session of prolonged stretching was usually associated with a corresponding increase in the other movements too. However improvement in the range of other movements is not always at the same rate.

The specific Frozen shoulder exercises should include the maximum number of combination of various movement by minimising the number of exercises. Graduated relaxed sustained stretching based on the PNF pattern are following types:

• Shoulder elevation with flexion, abduction and external rotation.
• Shoulder internal rotation with extension, adduction and elbow flexion i.e attaining "hand to lumbar position".

The above mentioned Frozen shoulder exercises can be done in two ways:

• By weight and pully- Tolerable weight must be used. This may be done in supine or sitting position.
• By self assisted stretching- Method of performing is, the patient uses his normal or contralateral arm for gradually stretching the affected shoulder.

Passive Mobilization Technique

For this, manipulation and mobilising techniques are given by"MAITLAND". By this patient respond very well for acquiring full range by properly guided simple and specific Frozen shoulder exercises which ensures relaxed graduated stretching of the contracted capsule.

Frozen Shoulder Exercises for Home and Cautions:

• The importance or necessity of regular stretching must be explained to the patient even after he had recovered from stiffness and pain to avoid the recurrence of periarthritis or stiffness.
• Patient having diabetes responds very slow to the treatment and also feel much more pain as compared to those who are non-diabetic.
• Patient who are complaining of pain in the night (nocturnal pain) should be treated by heat therapy or thermo therapy.
• The contralateral or normal shoulder should always be examined and given regular stretching exercise programme as a precautionary measure to maintain its functional capacity.

Exercises for Neuropathy of the Feet

Neuropathy is nerve damage that can result in pain, numbness or tingling. Injury or vitamin deficiencies usually cause this condition. According to MayoClinic.com, a number of medical conditions, including diabetes, may lead to foot neuropathy. Exercise can help reduce pain from this condition.

Range of Motion

Range of motion exercises help stimulate nerve conduction and circulation to affected areas. Range of motion exercises are performed at joints. For example, a range of motion exercise for the foot will rotate the ankle joint. Sitting in a chair, lift the affected foot and circle in a clockwise motion, then a counterclockwise motion. Repeat this cycling of the joint between five and 10 times in each direction

Low-Impact Exercises

Walking, stationary bicycling and swimming are low-impact exercises that can help reduce complications and pain of foot neuropathy, according to the National Institute of Neurological Disorders and Stroke, and can increase muscle strength and coordination. When walking, keep the pelvis tucked slightly under and the lower abdominal muscles pulled in toward the base of the spine. Walk short distances at first, gradually increasing distance and duration. When biking or swimming, use full ankle joint function, working the joint to help prevent or reduce stiffness and pain.

Toe Tapping Exercises

Sit in a chair with your heels on the floor. Your feet can be touching or separated about hips-distance apart. Lift the toes of your feet off the floor, then lower them, creating a tapping motion. Repeat this exercise between 15 and 20 times. Another variation is to place your heels together, then lift your toes off the floor as high as you can. Turn your feet outward, so that you create a "V" shape with your heels still touching the floor. Touch your toes to the floor, then lift them again, bring them together, and touch them to the floor once more. Repeat this sequence between five and 10 times.

Sitting Leg Pointers

Sit in a chair with your back straight, knees together. Lift your right foot off the floor, straightening your right knee at the same time. Point your toes into the distance. Holding the leg out straight, point your toes toward your body in a deep flex. Circle your ankle joint clockwise, then counterclockwise five times. Lower your right foot to the floor and repeat the exercise with your left foot.

Exercise and Osteoarthritis Of Knee

Osteoarthritis : Osteoarthritis (OA) is the most common type of Arthritis and major cause of joint pains in the elderly. In India, Osteoarthritis of the knee is more common as compared to Osteoarthritis of other joints. Usually females are more effected than males. Osteoarthritis of the knee is often characterized by decreased joint space, joint pain, swelling, weakness and a lack of flexibility at the effected knee joint. Risk factors of Osteoarthritis of the knee include old age, obesity, Osteoporosis, previous injury, muscle weakness or dysfunction. Usually the inner side of the knee joint is more effected as compared to the outer side. Muscle weakness is associated with pain and loss of proper function and influences the progression of the disease in patients with Osteoarthritis of the knee.

Do’s in Osteoarthritis:

• If suffering from Osteoporosis along with Osteoarthritis, always consult your Doctor regarding which exercises should be done as Osteoporotic bones are prone to fractures even under normal stress.
• Knee joint should be properly supported by using a knee band.
• A walking stick should be used. When used it should be held in the hand opposite to the effected knee.
• If overweight, reducing weight helps in reducing the effects of Osteoarthritis.

Don’t in Osteoarthritis:

• Avoid sitting with both legs crossed.
• Avoid sitting in low chairs or chairs without arm rest.
• Avoid climbing stairs. If necessary, climb stairs using the good leg.
• Prolonged walking should be avoided.
• Avoid walking with heavy weights.
• Avoid repeated standing from sitting.
• Avoid over exercising.
• Don’t stop your medicines on your own. Always consult your Doctor before stopping your medicines.

How exercises help in Osteoarthritis:

Optimal management of patient with mild to moderate Osteoarthritis of the knee requires a combination of pharmacological and non-pharmacological therapies. The effects of high resistance strength training are not always greater than those of low resistance strength training in patients with OA of the knee. A combination of supervised exercises under a Physiotherapist and independent daily home-based exercises in addition to medicines should be provided to such patients. Guidance of a Physiotherapist is necessary because a Physiotherapist has knowledge as to which exercises are suitable for a patient of OA as some exercises can actually worsen OA. In addition to that a Physiotherapist has many techniques to improve joint mobility and suitable equipments such as Ultrasound and TENS which help in reducing pain and swelling around the knee joint.

Effects of exercise in Osteoarthritis of knee:

• It is effective in reducing pain.
• It helps in maintaining normal walking pattern.
• It improves blood circulation of the knee joint.
• It helps in improving range of motion of the effected knee joint.
• It strengthens the muscles around the knee thus improving its ability to carry weight properly.
• It improves flexibility of the muscles around the knee joint.
• It also provides a psychological sense of well being to the patient.
• Don’t stop your medicines on your own. Always consult your Doctor before stopping your medicines.

Common reasons of OA patients for failure to do exercise regularly:

• Attitudes towards exercise: Most patients don’t do exercise as they don’t consider it as important as other activities they do daily and find it difficult to take out time for doing exercise. Hence they develop a non committed attitude towards exercise.
• Perceived severity of Osteoarthritis: Patients who believe that OA is incurable find it hard to believe that doing exercise is going to help them and hence they develop a resigning attitude towards exercise.
• Expecting extra ordinary results: Some patients believe they will get immediate results by doing exercises. They do exercise for few days and then quit doing exercises when they don’t get results they thought they will get.
• Age: Most elderly patients find it difficult to carry out exercises and hence they don’t do exercise.
• Increase in pain: This usually occurs because of doing exercises incorrectly.

An important point to be noted is that most patients with Osteoarthritis of the knee demonstrate significant weakness of the hip musculature also. Therefore, not only the knee muscles but the hip joint muscles should also be exercised in order to maintain the effect of exercise on muscle strength in patients with Osteoarthritis of the knee.