When to apply Ice or Heat for a Muscle Pain?

When to use ICE:

Ice should ALWAYS be used after an acute injury or trauma to any other area of the body.
Ice is a potent vasoconstrictor: cold causes the muscles of the body those lining the walls of our blood vessels, to constrict decreasing the swelling and pain associated with the body’s inflammatory response. As the vessels constrict, fewer inflammatory mediators seep into the area. In the case of musculoskeletal injuries, decreasing the inflammatory response decreases pain and prevents hyperimmune Une response in the area.
Ice should be applied at 15-20 minute intervals only, with at least an hour and a half in between icings.
Ice should be used for the first 48-72 hours following injury. Never use heat during this time.
Ice can also be used to alleviate pain associated with chronic back pain. Ice should be used after exercise, especially strenuous exercise, but NEVER before stretching or exercising. As ice causes increased muscle constriction and tension, its use before physical activity can lead to injury.

When to use HEAT:

Heat is used to relax and relieve tension associated with muscle stiffness and tension. Heat is best used to treat chronic, consistent back, neck and/or other musculoskeletal pain.
Heat can be applied before stretching and exercising to eliminate muscular stiffness and spasms. Warm towels or compresses work best.
These are just basic rules of thumb for treating back pain with heat or ice. If you have been diagnosed with an auto-immune disease, always discuss heat and ice therapies with your specialist. If you find that ice and/or heat seem to intensify your pain, avoid its use and consult with treating practitioner.

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Top 10 reasons to confirm Physiotherapists are the real Heroes.

1. Physiotherapist spends more time with the patients and listens to the problem carefully and tries to find the underlying cause by asking several questions from the patient.

2. Physiotherapist participates along with patient recovery with possible inputs throughout for a speedy recovery

3. The physiotherapist has to do physical treatment as well as gives the psychological boost to the patient.

4. A physiotherapist works with great team spirit, the physiotherapist works with coordination with the surgeon and physicians along with the whole medical team.

5. Physiotherapist respects other team members - Like a hero physiotherapist always respects other team members like a surgeon, physicians nurses, occupational therapists, speech therapists, prosthetic engineer and social workers of his team.

6. Physiotherapist ensures Slow, Steady and Sustainable Repair of the Body without harming the body.

7. Physiotherapist can maximize your movements

8. A physiotherapist helps to regain balance and coordination of mind with the body.

9. Physiotherapist offers safer ways to eliminate pain and improve functionality.

10. Physiotherapists avoid millions of invasive and expensive surgeries.

Doctors can give years to a life: but a Physiotherapist can give life to those years.

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For Athletes, the Risk of Too Much Water

Are we, with the best of intentions, putting young athletes at risk when we urge them to drink lots of fluids during steamy sports practices and games?
A new report about overhydration in sports suggests that under certain circumstances the answer is yes and that the consequences for young athletes can be — and in several tragic cases already have been — severe and even fatal.

Visit a practice for high school football, soccer or other team sports at this time of year, when temperatures can be high and early-season fitness marginal, and you are likely to see repeated water breaks and exhortations by the coaches and parents to drink up.

“A lot of people, including coaches, think that it is dangerous for athletes to get dehydrated, even a little dehydrated,” said Kevin Miller, an associate professor of athletic training at Central Michigan University in Mount Pleasant, Mich., and co-author of the new report.

The coaches and others worry that dehydration leads to muscle cramping and possibly heat illnesses, including serious heat stroke. So, hoping to keep their athletes healthy and safe, they press them to drink fluids before, during, and after a practice, whether the athletes feel thirsty or not.

And if an athlete should develop cramps or feel excessively hot during the workout, they are told to down even more fluids, and if the cramps continue, still more, “until, before you know it, a player will have drunk a gallon or two of fluid or even more,” Dr. Miller said, “which is something that we know actually happens.”

The problem with this situation is that, according to the latest science, dehydration during sports is rarely if ever dangerous, but overhydration undeniably is.

Last year, for instance, in a heartbreaking incident, a high school football player in Georgia experienced cramps during practice, and hoping to alleviate them, began gulping large amounts of water and Gatorade. By the end of the practice, he had swallowed about four gallons of fluid, according to media reports. Not long afterward, he collapsed at home and was rushed by helicopter to the hospital, where, several days later, he died.

At least two other high school football players are known to have died since 2008 from drinking too much fluid during and after a practice, Dr. Miller said. These players had developed a rare condition, he said, known formally as exercise-associated hyponatremia and less technically as water intoxication.

Hyponatremia occurs when someone consumes so much fluid that his or her body can’t rid itself of the surplus through sweating or urination. As a result, water levels rise in the bloodstream and sodium levels, diluted, fall. Osmosis then draws water from the blood into the surrounding cells of the body to equalize sodium levels there, and those cells begin to swell like water balloons. If this process occurs in the brain, it can be lethal.

Until recently, hyponatremia had been associated almost exclusively with marathon races and other prolonged endurance events, especially among slow racers, who tended to sweat little but drink copiously, often for hours on end. But as the new report, which presents updated hydration guidelines developed by a consortium of scientific experts, points out, exercise-associated hyponatremia “is now being reported in a more diverse set of sporting activities,” including half-marathons, sprint triathlons, Grand Canyon hikes, Bikram yoga classes, and, of course, team sport practices and games, especially football, at the professional, collegiate, and now high school level.

“What is sad is that every case” of exercise-associated hyponatremia “is preventable,” Dr. Miller said.

The key, he said, is for athletes to drink when they feel thirsty — not before and not after they feel sated. “You do not need to ‘stay ahead of your thirst,’ as many people think,” he said.

Listening to your “innate thirst mechanism” provides a safe and reliable guide to hydration, the new report concludes.

This strategy also should not increase players’ risks for cramping or heat illness, Dr. Miller said, since, “based on current evidence, it does not appear that dehydration directly contributes” to those problems.

During recent telling experiments that he directed, for instance, volunteers who exercised and sweated in the heat until they had become severely dehydrated were no more prone to muscle cramps than they had been at the start.

Similarly, if perhaps more surprising, other studies have found that being dehydrated does not increase athletes’ susceptibility to heart problems and that athletes who collapse from heat illness often are quite well-hydrated.

Instead, both cramping and heat problems seem to result from athletes pushing themselves too hard. Muscles cramp, Dr. Miller said, when a muscle is fatigued and begins to spasm, not when an athlete is dehydrated, while heat illnesses generally occur in athletes who are not physiologically acclimated to hot weather (a process that requires slowly increasing the length and intensity of workouts in the heat) and who continue to exercise even as they start to feel awful.

So, he said, “the best advice” about how to keep young athletes healthy during warm-weather practices and games, “is common sense.” Don’t urge athletes to drink if they aren’t thirsty. And don’t make them keep playing if they aren’t feeling well, he said.

If they complain of feeling too hot, have them sit in the shade and remove clothing. Take their temperature if they remain lethargic, and seek medical attention if it is much above normal. Immerse them in an ice bath, too, to rapidly lower body temperature. (Dr. Miller and his colleagues recently completed a study in which they found that football players who overheated could be submerged wearing full pads and uniforms and cool off almost as quickly as players dressed only in T-shirts and underwear, which could save precious minutes when a player seriously overheats.)

Above all, remind them, and, if needed, yourself, that the point of this enterprise is to have fun.

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Why every athlete should do YOGA

As a private trainer and yoga instructor, I meet a lot of athletes and workout fanatics. When asked if yoga is part of their workouts, many athletes will tell me they don't have the time to add yoga to their already intense training schedules. Some say they don't see how "stretching and breathing" would be of any benefit to them. Others say they've discovered yoga while recuperating from an injury.

Why not enhance your performance and prevent injury by adding yoga to your training plan now? A well-rounded yoga practice includes dynamic flexibility training, core stabilization, strengthening and balance work. By focusing on these vital elements, yoga can help you recover faster after workouts, open up the tight areas that hinder performance, improve range of motion, and developmental focus and concentration.

"I've definitely noticed benefits in my triathlon training from yoga," said Heidi Resiert, a triathlete from San Diego. "My recovery time is much quicker, my shoulders feel stronger in the pool, and my muscles don't feel as tight after long runs or bike rides. I'm glad I found yoga and added it to my weekly workout routine. Not only do I feel stronger, but I also feel more confident that I will continue to be injury free."


Prevent Injury

Many sports, such as cycling and running, have very repetitive movements usually in one direction and in one plane of motion. These sports can develop certain muscle groups while ignoring others. Over time, this process causes imbalances in the muscles and joints leading to overuse injuries. For instance, tight hamstrings and hip flexors will cause the body to recruit from other joints, joints not intended for bearing extra loads.

Common overuse injuries among athletes include those involving the iliotibial band (ITB), knee, hamstrings, hip flexors, and shoulders. Often, these injuries are directly linked to lack of flexibility, poor core strength and misalignment. Yoga helps alleviate this tightness, builds a stronger center, and aligns the spine. In order to minimize and/or prevent injury, athletes should concentrate their efforts on these areas used most in endurance sports.

Even if athletes stretch pre- or post-workout, they are usually just stretching the muscles in the same direction and plane of motion in which they will be exercising. Yoga goes beyond simple stretching by working the muscles and joints through all ranges of motion--activating the little-used muscles that support the primary movers. The body must be worked through all three planes of motion in order to remain balanced and healthy. Yoga works not just in the sagittal plane but, in the frontal and transverse planes as well, ensuring well-rounded development.

Many yoga poses, such as Revolved Crescent, feature twisting motions in the transverse plane, essential to opening up tight obliques and lower backs. Balancing postures like Tree or Eagle are some of the most effective ways to correct muscle imbalances and poor body mechanics.


Another essential element in yoga is breath work or pranayama. The attention to breath during yoga can be considered one of the most important benefits to athletes. Learning to stay focused and centered through uncomfortable poses by concentrating on even inhalations and exhalations set up the athlete to stay focused during a race or challenging workout. The mind-body connection in yoga is essential to helping athletes develop mental acuity and concentration. In addition, yoga helps you to relax not just tight muscles, but also anxious and overstressed minds. Being more relaxed will also aid in athletic performance.

Where to Start

Yoga has been practiced for around 5,000 years and several schools of yoga have emerged over time. It can be overwhelming at first to find a style of yoga that resonates with you. If you are a competitive athlete, it is best to tailor your yoga practice to your training schedule. On a day where you are completing a long run, for example, you'll want relaxing, mellow yoga. If you have an off-day, a vigorous, dynamic class will help you build strength and endurance.

You can choose from dynamic styles like Ashtanga yoga and Power yoga that consist of a rigorous flowing series of poses synchronized with breath to produce internal heat and purifying sweat. Alternatively, Bikram yoga is a set series of 26 static poses performed in the 105-degree room. Iyengar focuses primarily on anatomical precision and alignment in poses, with an emphasis on healing the body and mind using postures. Anusara is a tantric-based system that combines alignment with awareness of energy flow in the body. Finally, there are restorative styles such as gentle Hatha and Yin yoga which feature longer holds.

Yoga helps the muscles, tendons, and ligaments move through a full range of motion, thus cultivating balance and core strength which is a huge benefit to athletes in their chosen sports. If you attend a few classes per week and/or a few 10-15 minute sessions at home, you will obtain fast results. A simple way to add in yoga is to perform your short sessions pre- or post-workout. Try it and see for yourself.

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Pacemaker: The Basic Info

Faulty electrical signaling in the heart causes arrhythmias. A pacemaker uses low-energy electrical pulses to overcome this faulty electrical signaling. Pacemakers can:

• Speed up a slow heart rhythm.
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• Help control an abnormal or fast heart rhythm.
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• Make sure the ventricles contract normally if the atria are quivering instead of beating with a normal rhythm (a condition called atrial fibrillation).
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• Coordinate the electrical signaling between the upper and lower chambers of the heart.
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• Coordinate the electrical signaling between the ventricles.
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• Pacemakers that do this are called cardiac resynchronization therapy (CRT) devices. CRT devices are used to treat heart failure.
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• Prevent dangerous arrhythmias caused by a disorder called long QT syndrome.

Pacemakers also can monitor and record your heart's electrical activity and heart rhythm. Newer pacemakers can monitor your blood temperature, breathing rate, and other factors and adjust your heart rate to changes in your activity.

Pacemakers can be temporary or permanent. Temporary pacemakers are used to treat temporary heartbeat problems, such as a slow heartbeat that's caused by a heart attack, heart surgery, or an overdose of medicine.

Temporary pacemakers also are used during emergencies. They're used until a permanent pacemaker can be implanted or until the temporary condition goes away. If you have a temporary pacemaker, you'll stay in a hospital as long as the device is in place.

Permanent pacemakers are used to control long-term heart rhythm problems. This article mainly discusses permanent pacemakers, unless stated otherwise.

Doctors also treat arrhythmias with another device called an implantable cardioverter defibrillator (ICD). An ICD is similar to a pacemaker. However, besides using low-energy electrical pulses, an ICD also can use high-energy electrical pulses to treat certain dangerous arrhythmias.

What Is a Pacemaker?

A pacemaker is a small device that's placed in the chest or abdomen to help control abnormal heart rhythms. This device uses electrical pulses to prompt the heart to beat at a normal rate.

Pacemakers are used to treat arrhythmias (ah-RITH-me-ahs). Arrhythmias are problems with the rate or rhythm of the heartbeat. During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm.

A heartbeat that's too fast is called tachycardia (TAK-ih-KAR-de-ah). A heartbeat that's too slow is called bradycardia (bray-de-KAR-de-ah).

During an arrhythmia, the heart may not be able to pump enough blood to the body. This may cause symptoms such as fatigue (tiredness), shortness of breath, or fainting. Severe arrhythmias can damage the body's vital organs and may even cause loss of consciousness or death.

A pacemaker can relieve some arrhythmia symptoms, such as fatigue and fainting. A pacemaker also can help a person who has abnormal heart rhythms resume a more active lifestyle.

For more information: http://bit.ly/GVf9gu

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Acute Compartment Syndrome

Acute compartment syndrome of the leg is a surgical emergency which can lead to significant disability and even death if not diagnosed and treated early.

It is far more common in men than women, with a reported annual incidence of 7.3 per 100,000 and 0.7 per 100,000 respectively.

To understand the pathogenesis of compartment syndrome in the leg, one needs to appreciate that the deep fascia and long bones divide the leg into four distinct compartments - anterior, lateral, superficial posterior and deep posterior.

Under normal circumstances, the pressure inside each compartment is quite low (typically between 0 to 8 mmHg). This is well below the capillary closing pressure.

Unfortunately, the deep fascia is relatively inelastic, i.e. the volume of each compartment is fixed. Thus, even minor derangements in tissue homeostasis may result in rapid increases in compartmental pressure.

In this regard, elevation of tissue pressures may occur either because of increased compartmental contents (i.e. bleeding following trauma, edema secondary to nephrotic syndrome, or tissue destruction following snakebite); because of diminished compartment volume (i.e. after burns, or due to tight plaster casts); and very rarely, because of injuries to the microvasculature (i.e. in diabetes).

In practice, the commonest cause is a fracture of the tibial diaphysis, followed by blunt soft-tissue injury.

If the compartmental pressure rises above the capillary closing pressure, circulation shuts down, resulting in intra-compartmental ischemia and progressive necrosis of the muscles.

In turn, the skeletal muscles respond to the ischemia by releasing histamine-like substances which increase vascular permeability. Plasma leaks out of the capillaries, aggravating the tissue edema and worsening the ischemia.

Compartment syndrome of the leg is a clinical diagnosis, with the classical features being:

- Severe pain, typically increasing over time and often resistant to analgesics. In patients with a history of trauma, the pain is usually out of proportion to the apparent injury.

- Worsening of the pain when passively stretching the muscles within the affected compartment.

- A palpably tense compartment.

- Weakness and paresthesia of the areas supplied by nerves traversing the compartment. Note that these are late features and indicate the severe compromise.

It is uncommon for the compartment pressure to rise above the arterial pressure - thus pedal pulses and distal capillary filling are often normal. Pulselessness and diminished capillary filling are more likely due to arterial injury, or compression by a hematoma.

Note that non-classical presentations are common. In particular, pain is a highly unreliable symptom as it is subjective, difficult to elicit in patients with altered mentation, and sometimes absence in established compartment syndrome.

Where the clinical picture is equivocal, compartment pressure measurement may aid the decision-making process. Most authorities agree that an absolute resting pressure of over 30 to 45 mmHg, or within 30 mmHg of the diastolic blood pressure is suggestive of compartment syndrome.

Once the diagnosis is made, the most important step of the management is prompt decompression of the compartment via a fasciotomy.

All four compartments are usually decompressed, in order to avoid missing an affected compartment. This may be performed via a single incision or a double incision, which should extend across the entire length of the muscle and involve all layers of the skin to the deep fascia (as these may otherwise restrict expansion).

Following surgery, the wounds should be left open to allow the compartmental swelling to subside. In certain patients, repeated debridement to remove necrotic soft tissue may be necessary.

Wound closure may be achieved via several techniques. Split-thickness skin grafting is often employed. Delayed primary closure is an alternative, but may require an extended delay (to allow approximation with minimal or no skin tension). Vacuum-assisted wound closure is another option gaining popularity.

In the long term, these patients should receive physical therapy to regain function and facilitate rehabilitation.

During the acute stage, close observation for rhabdomyolysis, acute renal failure and sepsis is important.

The morbidity of acute compartment syndrome is directly related to the timing of decompression. When performed within 12 hours of onset, normal limb function is regained in 68% of patients. If delayed beyond this point, this declines to 8%.

Key long-term complications include residual numbness, peroneal nerve palsy, and limited motor function of the involved muscles.

Complications of fasciotomy include wound infections, decreased sensibility within the wound area, tethered tendons, and recurrent ulcerations within the wound closure area.



The main causes of mortality are sepsis and multiorgan failure.

Watch this video for more illustration.

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