Sometimes misleading concepts without logical reasoning

We also have been taught about gliding of humerus over glenoid surface. The demonstrator use to teach us that pure isolated gliding of humerus can be done in various grades, if proper stabilization is done. If you watch his maneuver closely, he will be using the mobility of the sternoclavicular joint [including scapulothoracic joint]. This is because; naturally pure gliding of humerus [without angular motion of humeral head] may not be possible. As shown schematically in figure-1, a specific point of humeral head [A] cannot be rubbed or glided on the glenoid surface as shown in figure-2. If pure gliding of humerus is possible, then there would be damage to the hyaline articular cartilages.

This type of scrutiny and connotation is not meant for criticizing our honorable researchers and their research reports, but for our own brain to be used which also has huge logically thinking potential.

Not always the concepts are taught to us with logical reasoning

Vertebral pressures on the spinous process have been taught to us, as if it would produce anterior translation of that vertebra. Sometimes it also has been taught to us as if pure anterior translation of a single vertebra is possible. Pure anterior translations [pure gliding] of a vertebra while the vertebrae above and below to it remains stationary, may traumatize the spinal cord or its related structures by narrowing the canal for the spinal cord or its related structures.

Perhaps, application of manual pressure on the spinous process would lead to angular deviation of the vertebrae from each other. As shown schematically in figure-1, if pressure is applied on the spinous process of a vertebra, the resultant effect will be as shown in figure-2, but not just pure isolated gliding or translation of a vertebra under pressure. [The same mechanism may take place at cervical, thoracic and lumbar vertebral complex].

This type of scrutiny and connotation is not meant for criticizing our honorable researchers and their research reports, but for our own brain to be used which also has huge logically thinking potential.

Forward motion of Indian Physical Therapy is IRRESISTIBLE !!

Little professional endeavors I have taken so far

1. ‘Biomechanical behavior of orthopedic implants imparting rigidity at fractured bone segments’, in South India Physiotherapy meet during the year 2002, organized by Saveetha college of Physiotherapy, Chennai, Tamilnadu.

2. ‘To explore the cryptic benefits of Pelvic floor exercises in relation to Menstruation’, in fifth scientific meeting of the Asian society for Female Urology during the year 2003, held at Bangalore conducted by Indian Continence Foundation.

3. Selected core of an article and guided BPT students, Vivekanandha institute of medical science and research {VIMSAR}, Tiruchengode, Tamilnadu to present the following articles [ Six articles ] in a district level Physiotherapy conference of I.A.P. during the year 2003, held at Erode, Tamilnadu.

[a] ‘Gravity as a stimulant to set a balanced muscle tone in Upper motor neurone neurological disorders’ – This paper presented by second year BPT students {VIMSAR}, won second prize out of 19 student papers.

[b] ‘To explore the cryptic benefits of Pelvic floor exercises in relation to Menstruation’- This paper presented by Final year BPT students {VIMSAR} won third prize out of 19 student papers.

[c] ‘Whether Platysma muscle exercises prevent the incidences of Breast cancer and become an adjunct measure to limit the breast cancer metastases?’ – This hypothetical article presented by Final year BPT student {VIMSAR}, yielded appreciation from various Physiotherapy professionals which basically dealt with the anatomical linkages between Platysma muscle, Pectoral fascia and Suspensory ligaments of Astley cooper.

[d] ‘Utilization of biomechanical principles to control the arthrokinematic aberrations in orthopedic shoulder problems’- This paper was presented by second year BPT students {VIMSAR}.

[e] Whether Laryngeal muscle exercises develop endurance and melliflousness in singing? – This article was presented by second year BPT students {VIMSAR} which speculated Valsalva maneuver and reverse Valsalva maneuver to improve the quality of singing.

[f] ‘Physiotherapeutic pain killers’ – This paper was presented by second year BPT student {VIMSAR} and explained about the analgesic effects in Physiotherapy like Cryoanalgesia, Thermoanalgesia, Electroanalgesia and Mechanalgesia.

4. ‘To explore the ulterior advantages of bilateral chain system in bicycles’ – applied for L-RAMP award [grass-root innovation] organized by Indian Institute of Technology, Chennai, but had not won it although the technical reasons I stated were quite logical.

'EVERY SCIENTIFIC IDEA OF MAN IS ACTUALLY THE INTELLECTUAL PROPERTY OF GOD'.

Dr.R.Vinodh Rajkumar,
Physical Therapist.

Biomechanics - The nucleus of Physiotherapy

The shoulder girdle may get depressed with depression of clavicle and downward rotation of scapula. This biomechanics is evident when we are carrying heavy loads with arm hanging by side [carrying suitcases, buckets filled with water, wearing a heavy bag whose straps run around the top the shoulder]. Figure-1 shows the position of scapulae before application of load on shoulder girdle and figure-2 shows the position of scapulae after application of load on shoulder girdle. The disadvantages of this activity are;

[1] Restriction to respiratory biomechanics and becoming habitual to such activity can set new respiratory levels as a result of hypomobility of costoverterbral joints.
[2] Neuropathy in upperlimbs.
[3] Arthropathy of joints pertaining shoulder girdles.

When I was examining a patient with bilateral shoulder problems, patient himself pointed out a depression or sulcus in one of his shoulder which was due to inferior subluxation of glenohumeral joint. The patient was used to carry buckets filled with water bilaterally [ his routine activity] and gradually developed bilateral shoulder pain. He also reported that the subluxed shoulder is not painful but producing sounds during motion of arm.

We know already that the stabilizing structure to prevent inferior subluxation of glenohumeral joint is only one or two [like superior capsule, coracohumeral ligament] and if they become lax after yielding to high magnitude of stress, inferior subluxation of glenohumeral joint become inevitable. It is also comparatively easier to shear off the humeral head inferiorly after changing the slightly superior orientation of glenoid fossa towards pure lateral orientation [downward rotation of scapula using depression at sternoclavicular joint] by application of inferiorly directed force on the shoulders.

'Love biomechanics. Biomechanics is the nucleus of Physiotherapy'

Dr.R.Vinodh Rajkumar,
Physical Therapist.

Cryptic benefits of Pelvic floor exercises

With an aim to find Physiotherapeutic solutions for menstrual ailments, I made a hypothesis, ‘Pelvic floor exercises to control the extent of endometrial necrosis’ to be conducted as a research. The title of this research was finally converted as ‘To explore the cryptic benefits of pelvic floor exercises in relation to menstruation’. The other expected advantage was drawing attention of the neuro-vascular structures to render sufficient blood and hormonal supply to orchestrate healthy menstrual events. The research divulged 16 different types of menstrual pain [based on onset, duration, alleviating factors] and any one of this type will belong to a woman. Different types of menstrual problems were documented and they were [i] Lower abdominal pain [ii] Low back pain [iii] Radiating pain to the back of thighs and calf [iv] Joint pain [v] Mastalgia [vi] Pre-menstral tension [vii] Head ache [viii] Anorexia [ix] Gastro-intestinal disturbances (either constipation or diarrhea) [x] Nausea [xi] Irregular menstrual cycles [xi] Burning sensation in the vaginal canal [xii] None of the above.

The following were the cryptic benefits of pelvic floor exercises [i] Reduction in the menstrual pain (includes lower abdominal pain, back pain, leg and calf pain) [ii] Decrease in the extent or days of menstrual bleeding [iii] Regulation of menstrual cycles [iv] Disappearance of pre-menstrual tension [v] Reduced gastro-intestinal disturbances during menstruation [vi] Improvement in confidence to confront menstrual event [vii] Ability to prevent leakage of menstrual contents during the activities that raises intra-abdominal pressure like coughing, sneezing, laughing etc.,

The entire research was done within the limits of physiotherapy. When the high statistical significance of this research was reported to FOGSI journal, their experts pointed out the lack of strength of the sample [only 31 subjects were used to provide reports after practicing pelvic floor exercises although countless number of subjects just frankly reported the actual nature of their menstrual pain with which I had concluded 16 different types of menstrual pain] and could not publish my research report. Amidst favorable doctoring actions of pelvic floor exercises, 3 out 31 participants of this research also had reported either no benefits or adverse reactions like excessive bleeding and unabated pain. I am very confident that every female has to become customary to pelvic floor exercises from puberty till menarche [a] to get rid of catamenial disorders [b] to enhance the labor kinetics [c] to overcome incontinence.

Dr.R.Vinodh Rajkumar,
Physical Therapist.

Developing neural tension

As shown schematically in figure-1, sit comfortably and bear weight symmetrically through your upper extremities. Now, transfer the weight to the left upper extremity and you will find at the end of this biomechanics that your left upper extremity adducted, right upper extremity abducted, shoulder level tilted downwards in the right side, trunk bent right laterally [figure-2].

In the same position, check the upper limb neural tension by extending the wrist of the weight relieved upper extremity [right upper extremity] by lifting the hand [right hand] from the surface it contacts. [ lateral flexion of neck on the side of weight accepting extremity can also be included].

FAT triangle orientation test

Dear Physios,

We may either invent assessment techniques or treatment techniques or both. I would like to share my innovative assessment technique ‘FAT’ triangle orientation test, with you all.

Figure-1 shows the formation of a triangle whose boundary is determined by forearm [F], arm [A], trunk [T]. This triangle can be regarded as FAT triangle. If an individual tries to bring the forearm behind the trunk, with the wrist level to coincide the midline of the trunk, with elbow bent, then one can see the formation of this FAT triangle oriented in coronal plane. To produce this task, shoulder has to move in three planes: [a] saggital plane – extension [b] frontal plane – abduction [c] transverse plane – medial rotation.

Patients with intra–articular and/or extra-articular shoulder pathology may not perform all the required motions adequately to form FAT triangle, especially due to lack of internal rotation of shoulder [figure-2]. He may be exaggerating shoulder extension while attempting to form FAT triangle that should be oriented in coronal plane. Exaggerated extension of shoulder can deviate the FAT triangle from coronal plane towards the saggital plane [figure-4 has to be compared with figure-3 {normal}].

Restoration of extensibility of the soft tissues, mitigation of pain, strengthening of muscles will be the goals of rehabilitation of affected shoulder. FAT triangle coronal plane orientation test can also be used as indicator to correlate the improvement or recovery of this triplanar motion produced by muscles with satisfactory elongation or extensibility of the soft tissues.