Can Physiotherapists Perform Dry Needling? A Discussion

Subhanjan Das performing Dry Needling

If you practice dry needling in India as a physiotherapist, you must have faced this question in one form or another: can a physiotherapist perform dry needling? Is it within the scope of your practice?

Let us try to answer these questions based on facts.

First, can a physiotherapist perform dry needling? The concern here is, most of the physiotherapy treatments approach the body from the surface, so many people think that physiotherapists are not allowed to perform anything invasive. Is that the truth? Let’s take a closer look. Let’s find out what invasive procedure means.

An invasive procedure is defined as “A medical procedure that invades (enters) the body, usually by cutting or puncturing the skin or by inserting instruments into the body.” (National Cancer Institute, US State Govt.)

Another definition, by Sian Cousins et al, which they derived after analyzing 3946 papers, describes “An invasive procedure is one where purposeful/deliberate access to the body is gained via an incision, percutaneous puncture, where instrumentation is used in addition to the puncture needle, or instrumentation via a natural orifice.”

Essentially, both definitions state the same thing. Whether you use an incision/puncture or enter through a natural orifice, it is invasive.

When it comes to natural orifices, we have always been doing invasive procedures. Whether it is using suction tubes through nose-mouth-tracheostomy or mobilizing the coccyx through an anal orifice or even mobilizing the TMJ through the mouth. (Side note: Is using just a hand through the orifice without any instrument count as an invasive procedure? Apparently so. The digital rectal examination is considered invasive). So, the argument, that physiotherapy as a branch of healthcare is noninvasive doesn’t hold true.

Of course, one may argue that inserting a finger in the mouth and inserting a needle in the body are two completely different skills. I agree. Then, let us have a look at how other professionals use needles in their practice. Apart from physicians, surgeons, and nursing professionals, phlebotomists, EMG technicians, radio technicians, etc also use needles in their daily practice. Without belittling any professionals, physiotherapy education in India ensures that the physiotherapist’s knowledge of the human body is at par with the highest levels.

Tattoo artist using needle
Tattoo artist using needle
Ear piercing is being done in traditional fashion
Ear piercing is being done in traditional fashion

It is interesting to note that there are another set of professionals who use needles on the body day in and day out. They are tattoo artists and body-piercing artists. While tattoo artists also insert a dye into the skin, body piercing passes the needle straight across the skin. Pretty invasive, isn’t it?

Now that we have settled that a qualified (BPT) Indian physio has enough training, skills, and knowledge to handle needles safely, it is time to put our focus on, is needling within the scope of our practice. To answer this, I would bring the reference to World Confederation of Physical Therapy. The “WCPT guideline for physical therapist professional entry-level education” was released in 2011. In this document, under physical agents and mechanical modality dry needling is listed. This should settle the argument of scope, however many other physiotherapy organizations of national and international repute (like APTA) have recognized dry needling as one of the physiotherapeutic interventions.

So to sum up,

  1. Physiotherapy involves an invasive procedure
  2. Many professionals, healthcare and otherwise, use needles throughout the body. Physiotherapists have equal, if not way better knowledge, skill, and training.
  3. Dry needling is well within the scope of a physiotherapist’s practice.

Ref:

  1. National cancer institute definition of invasive procedure: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/invasive-procedure
  2. Cousins S, Blencowe NS, Blazeby JM. What is an invasive procedure? A definition to inform study design, evidence synthesis and research tracking. BMJ Open. 2019 Jul 30;9(7):e028576. doi: 10.1136/bmjopen-2018-028576. PMID: 31366651; PMCID: PMC6678000.
  3. WCPT guideline for physical therapist professional entry level education. World Confederation for Physical Therapy. 2011, p. 1-42 p. http://www.wcpt.org

Guest Blog: Dry Needling approach to a patient of ankle swelling and pain – A Case study

Hi!  I am Arghya a physiotherapy student who is about to start my internship. I am from Burdwan, West Bengal. I joined the dry Needling workshop of Physilife academy by Dr. Subhanjan Das on May, 22 at Durgapur.

In this blog, I want to talk about my uncle who is 74 years old and a retired school teacher suffering from chronic ankle pain and swelling eventually he was dealing with these symptoms for a year! His complaint was pain & swelling at a right angle and unable to bear weight through the right limb. This was hampering his daily life activities.

On observation, he was walking in an antalgic gait pattern with the help of a cane. I also observe that he had swelling near the medial malleolus and subtalar joint.

On examination, I got a VAS of 8 with a tenderness grade of 3. He also had a history of high uric acid for the past 8 years.

On the first day of treatment, I needled around the swelling zone. I also neeldled the Extensor Digitorum Brevis, Extensor Digitorum Longus, and Extensor Hallucis Longus based upon my palpation (not shown in the picture). After 2- 3 minutes of Needling the swelling rapidly came down and the tenderness decreased to grade 1.

I also asked him for the VAS score post needling and he reported it was 4.

On the next day, he came to me without a cane but his gait was a mild antalgic pattern. I planned to do a treatment session with PENS with a frequency of 25 Hz and the treatment time was 10 minutes.

Application of PENS

Post-treatment he claimed that his pain was totally abolished; he can also be able to work properly without any difficulties.

After a week he came to me for a review and he was amazed by this new treatment tool he told me that he is totally fine and can able to do his daily activities.

Conclusion

What I experienced is that Incorporating Dry Needling in day-to-day practice helps to improve the quality of treatment and also gives instant relief to the patient. I thank Dr. Subhanjan Das for teaching me this lovely technique. This helps to enhance my knowledge and skill.

Physilife thanks the guest blogger, a wonderful physiotherapist in the making, for sharing his success story.

Arghya Mallick

Ph: +91 7031201430

Guest Blog: Management of Plantar Fasciitis Pain with Kinesiology Tape- A Case Report

Hello everyone, myself Ashish Paul, Physiotherapist. In this post, I would like to share my success story, which is about one of my patients, who is significantly better with kinesiology taping, in just one session. The patient is a 57 years old lady, a teacher by occupation who complained of pain in both her feet.  

Upon assessment I found the condition to be plantar fasciitis, with the hallmark symptom of maximum pain in the first few steps in the morning present. The patient marked VAS pain rating as 8. She said that the pain increased in the morning and gets adapted while daily activities. It again tends to increase in the evening. The present episode was going on for 10 days. Because of this pain, the patient was unable to walk properly and couldn’t stand for a prolonged time.

Plantar fasciitis is caused by a number of factors, and management needs multiple sessions. However, in the first session, it was important for me to focus on analgesia in order to enable her to perform her daily activities with minimal discomfort. This also helps to gain the patient’s confidence and results in better compliance.

For immediate pain relief, I decided to tape the patient’s foot. Taping for plantar fasciitis has a lot of evidence base. A review by Podolsky & Kalichman (Ref 1) studied a number of articles on taping for plantar fasciitis and concluded taping is beneficial in the short term. The RCT by Ordahan et al showed (Ref 2) that kinesiology tape is as effective as shockwave therapy in improving pain, function, and quality of life.

Although the review mentions most no evidence exists in favor of rigid taping of the foot, I chose to apply kinesiology tape in this patient as it is more comfortable for the patient.

I applied the kinesiology taping techniques learned from Dr. Subhanjan Das. Sir., in a workshop in Bangalore, June 2022. The aim of my taping was to support the plantar fascia. I anchored one end at the 1st and 2nd phalanges through two windows cut into the tape, while the other end was anchored at the calcaneus. The KT stretch was given a stretch of about 50%.

Overnight application of this taping resulted in a significant reduction of the pain. The patient felt better and relieved the next day. When re-accessed, I found that the VAS of pain is 3.

Also, she was able to walk properly without any pain, but standing for a prolonged time was still somewhat difficult, yet it was better than before.

I really appreciate Sir’s workshop, because my patient got relieved very fast and the pain decreased significantly in a single session. With the short-term goal of analgesia achieved, I am working to restore the normal biomechanics of her foot to achieve a long-term solution. As of now, the patient is pain free and happy, Thus, a happy ending of this story.

Dr Ashish Paul, PT

+91 8087804010

Iyer Orthopedic & Physiotherapy Centre

Solapur, Maharashtra 413001

References

1.Podolsky, Roman and Kalichman, Leonid. ‘Taping for Plantar Fasciitis’. 1 Jan. 2015 : 1 – 6.

2. Ordahan B, Türkoğlu G, Karahan AY, Akkurt HE. Extracorporeal Shockwave Therapy Versus Kinesiology Taping in the Management of Plantar Fasciitis: A Randomized Clinical Trial. Arch Rheumatol. 2017 Apr 17;32(3):227-233. doi: 10.5606/ArchRheumatol.2017.6059. PMID: 30375530; PMCID: PMC6190955.

Guest Blog:  Electro Dry Needling Management of a Post Hip Decompression IT band tightness- A Case report

Hello! I am Manoj, A physiotherapist from Kurnool. I attended the Dry needling workshop of Physilife academy by Dr. Subjanjan Das sir in September 2021 Hyderabad.

In this guest blog, I want to talk about one of my patients, a 31 years old Male, who was diagnosed with bilateral avascular necrosis of the femur.

The patient underwent bilateral core decompression surgery 7 weeks ago and he started to ambulate last week. For the last four days, the patient experienced severe pain in the right lateral thigh. On examination, it was found that the pain was because of the IT band tightness.

The iliotibial tract is a major lateral stabilizer. It provides attachments to Tensor Fasciae Latae and Gluteus maximus and prevents buckling of the knee in standing. As reported by the patient, the IT band was involved prior to the surgery, presumably as the hip biomechanics was compromised. Post operatively with the weight-bearing this was manifested as pain in the lateral thigh. Post-surgery IT band tightness is not uncommon (Ref 1.) Left untreated scar tissues can build up on the undersurface of the ITB, tethering it to the underlying structures(Ref 2).

The pain was intense, with a VAS score of 7 and tenderness of grade 3. Because of this pain, the patient was demonstrating an antalgic gait. The orthopedic surgeon advised the patient to undergo Dry Needling, instead of prescribing a muscle relaxant.

I have applied electro dry needling ( ETOIMS- Electrical Twitch Obtaining Intra Muscular Stimulation) for the IT band which has documented efficacy in producing analgesia in musculoskeletal (Ref 3) and post operative (Ref 4) conditions. After one session the tightness was reduced significantly, the pain score came down to 5 and the tenderness came down to 1. After the second session, the patient’s gait also became normal.  At the same time, the pain got completely resolved and the patient had no further complaints over the IT band.

 This patient is an emergency physician by profession. He was highly impressed with the needling technique as he had great relief. He continues his rehab and is recovering steadily.

I thank Dr. Subhanjan Das sir and Physilife for helping me in incorporating these advanced techniques into my practice.

Dr. ANDELA MANOJ KUMAR, PT
+91 7207250304

Consultant Physiotherapist

Medicover Hosptial, Kurnool, AP

References:

1. Takagi K, Inui H, Taketomi S, Yamagami R, Kono K, Nakazato K, Kawaguchi K, Kage T, Tanaka S. Iliotibial band friction syndrome after knee arthroplasty. Knee. 2020 Jan;27(1):263-273.

2. Papavasiliou A. V. and Bardakos N. V. Complications of arthroscopic surgery of the hip. Bone & Joint Research 2012 1:7, 131-144

3. Chu J, Yuen KF, Wang BH, Chan RC, Schwartz I, Neuhauser D. Electrical twitch-obtaining intramuscular stimulation in lower back pain: a pilot study. Am J Phys Med Rehabil. 2004 Feb;83(2):104-11. doi: 10.1097/01.PHM.0000107485.86594.8B. PMID: 14758296.

3. Hyung Sun Kim, Jinyoung Park, Joon Seong Park, Jung Hyun Park, Sang Hoon Shin, Jae Eun Park, Sang Won Hwang, Do Young Kim,

A new treatment modality for the postoperative muscular pain management in pylorus preserving pancreaticoduodenectomy: a double-blind randomized control trial, HPB, Volume 21, Supplement 2,2019,Pages S350-S351

How long will you live? 5 physical performance measures that predict longevity.

People who believe in astrology often spend huge amounts of money to know their future. Especially the question, “how long will I live?” intrigues most people. I do not have much regard for the roadside fortune tellers. But there are more scientific ways to predict life expectancy. In this article, I have listed 5 physical tests that had been found to predict longevity.

Sitting rising exercise


The most popular test for longevity, the sitting rising test involves sitting in a cross leg from standing and getting up from that position without taking any support. For both halves of the test 5 marks are assigned. One mark is cut each time you use a hand on a knee support. Half mark is deducted if you wobble.
The researchers grouped the performances in four different categories. They found people who scored between 8 to 10 had the least chances of mortality. On the other hand, who scored between 0-3 were most vulnerable.

Push up as a predictor of longevity


It appears that how many times you can perform push-up continuously can predict your longevity. The scientific basis of this claim comes from a study on firefighters. In that study, it was found that people who were able to perform more than 40 push-ups at a go had a significantly lower risk of mortality compared to people available to perform less than 10 push ups. What increases the relevance of this piece of statistic is, the age of the population studied for this search was 18+ years while most other longevity studies were performed in an elderly population.

Walking fast to escape death
Looks like the elderly people who can walk fast will live longer than the average. The elderly population who have an average walking speed of point 8 metres per second will have a normal life expectancy. Walking speed of over one meter per second is associated with significantly higher life expectancy. Lifespan is predicted to be exceptionally high if the walking speed is greater than 1.2 metres per second.

Hand grip
Grip strength measure how much force one can produce through grasping. Grip strength varies among different types of populations. For example, the average Indian grip strength for the male is 37.8 kg, for females it is 22.1 2kg.
Various studies found higher the grip strength longer is the lifespan. This study measured the grip strength of the elderly population from Moscow, Denmark and England and they found 1 kg increase in grip strength increases survival by 5% in Moscow 6% in Denmark, and 3% in England.

Mid arm muscle circumference
This is the most direct measure. Simple inch tape measurement of mid-arm muscle circumference can predict lifespan. It means that elderly people who have preserved their muscle mass will survive longer.

All these five measures are research-based and all of them point towards one single direction that is, people who have maintained their physical ability and strength will live longer. If you have elderly people in your house encourage them to do regular physical activities in a safe environment.
If you are planning to use any of the above five tests on yourself or your near and dear ones, take all the precautions to prevent fall or injury.

About the author

This image has an empty alt attribute; its file name is IMG_20190415_114220_049_2.jpg

Dr Subhanjan Das (PT)

BPT, MPT (MSk & Sports), CMP(NZ), Diploma in football medicine (FIFA)

Consultant Physiotherapist of Apollo & Reliva Clinic, HSR Layout, Bangalore

Contact: +91 8967549104

Dr Subhanjan Das (PT) has over 14 years of clinical and 12 years of academic experience.  A friendly professional with lots of patience and skilful hands, Dr Subhanjan has worked with thousands of his patients for instant relief of pain and rapid return to activities.  He has treated elite athletes for recovery, injury prevention and performance enhancement.

Dr Das is specialized in Orthopaedic and sports physiotherapy and has keeps himself updated with the latest advancements in the field of physiotherapy. He has undergone training on advanced orthopaedic techniques such as Dry Needling, Mulligan Concept, McKenzie method, Pilates, Cupping therapy, McConnel and kinesio  taping from the best faculties around the world.

Dr Das has taught in 5 universities across India and has trained physiotherapists in 50+ workshops within and outside India.

Deskercize for the lazy ones: Diaphragmatic Breathing Exercise

Nobody disputes the fact that exercises can produce amazing health benefits. However, in practice we see only a few people performing regular physical activity. This is because exercises need effort and long-term commitment. On the other hand, human behavior by its very nature avoids anything that takes extra effort and does not produce immediately visible benefits. This is why most of our exercise plans get halted mid-way. Only those with an iron resolve can stick to their exercise plan around the year.
As a physiotherapist exercises are my bread and butter. Over the years what I have come to understand is the majority of us love the mental image of themselves exercising. Yet when it comes to actually performing those exercises, we cannot sum up the physical and the mental energy on a regular basis.

What if I tell you there is one exercise which you can perform during any time of the day in any position, has amazing health benefit in short as well as long term, which includes enhancing blood circulation, reducing blood pressure, reducing stress and anxiety improving the mobility of the lymph. The exercise that I am talking about is a diaphragmatic breathing exercise.

Diaphragmatic breathing
The diaphragm works like a piston. When it comes down the space inside our chest cavity increases and it gets filled with air.
Diaphragmatic breathing can be identified by the movement of the abdomen. As the diaphragm comes down during inhalation, the abdomen bulges out. That is why it is also termed abdominal breathing. While your normal breathing inflates your chest by half a liter of air, deep diaphragmatic inhalation I can feel your chest by three liters. This is the kind of breathing we are looking for.

Diaphragmatic breathing as a deskercise

Sitting with a forward lean is a good position for diaphragmatic breathing


As mentioned earlier, you can perform diaphragmatic breathing in any position. But it is most efficient when the load of the abdomen is taken off. This is best done in desk sitting.
Sit like it is shown in the picture, leaning a bit forward. This ensures that the abdominal content is not pushing into the diaphragm.
Now take a slow sustained breath through your nostril while inflating the abdomen. Keep your chest still as much as possible. As you exhale the abdomen should deflate. Aim to achieve a breathing rate of fewer than 10 breaths per minute. Breathe slowly and comfortably for 1 minute. More than that and you may start to feel dizzy. Do this one-minute breathing exercise several times a day.

How does it help?
As the piston of the diaphragm descends, a vacuum is created inside the chest. This vacuum pulls the air from outside inflating the lungs. The same vacuum also pulls the blood from the legs towards the heart aiding the circulation. Movement of the lymph also happens because of this change of pressure.
Prolonging the breathing rate, on the other hand, activate the parasympathetic system which is the part of the nervous system in charge of rest and relaxation. This is why deep diaphragmatic breathing reduces blood pressure as well as anxiety.

Whether you are lazy or busy, active or sedentary, if you are looking to add one exercise that is low on effort but produces immediate as well as long term benefits, look no further than deep diaphragmatic exercise.

Keep following this space for more health related discussions.

Kindly take our survey for current trends in physical activity here!

About the author

This image has an empty alt attribute; its file name is IMG_20190415_114220_049_2.jpg

Dr Subhanjan Das (PT)

BPT, MPT (MSk & Sports), CMP(NZ), Diploma in football medicine (FIFA)

Consultant Physiotherapist of Apollo & Reliva Clinic, HSR Layout, Bangalore

Contact: +91 8967549104

Dr Subhanjan Das (PT) has over 14 years of clinical and 12 years of academic experience.  A friendly professional with lots of patience and skilful hands, Dr Subhanjan has worked with thousands of his patients for instant relief of pain and rapid return to activities.  He has treated elite athletes for recovery, injury prevention and performance enhancement.

Dr Das is specialized in Orthopaedic and sports physiotherapy and has keeps himself updated with the latest advancements in the field of physiotherapy. He has undergone training on advanced orthopaedic techniques such as Dry Needling, Mulligan Concept, McKenzie method, Pilates, Cupping therapy, McConnel and kinesio  taping from the best faculties around the world.

Dr Das has taught in 5 universities across India and has trained physiotherapists in 50+ workshops within and outside India.

The Invisible Deskercise: Kegel for men

Men’s Day special

Kegel exercises are very popular in women for issues with the pelvic floor. Can men perform these exercises too? Is there any benefit of Kegel exercises in men? In international men’s day let us discuss the pelvic floor and its exercises in men.

What is the pelvic floor?

Where is the pelvic floor?


If you consider your abdomen as the house of your internal organs like the gut, kidneys, and bladder, then the front wall of the house is made by your abdominal muscles. These are the same muscles which when trained enough sport a six-pack. Similarly, the spine and the muscles of the low back can be considered as the back wall. The roof would be the diaphragm which separates the chest from the abdomen. The foundation of this house will be made by the pelvic floor muscles. They are a group of muscles that (The pubococcygeus or PC muscle is the most well-known among them) bridge the gap between the bones of the lower abdomen and the tailbone.

The functions of the pelvic floor muscles

Pelvic floor supports the abdominal content like a hammock supports someone sitting on it


Pelvic floor muscles have multiple important functions. They support the abdominal contents like a hammock supports someone sitting on it. They are also responsible for erection ejaculation start and control of urination and passing of stool.

Problems faced by men with pelvic floor weakness
Most men with weakness of these muscles complain of two major problems, erectile dysfunction and a sudden frequent need to urinate. Other complaints include constipation and need of straining while passing motion, feeling of incomplete emptying during urination, or the passing of stool. Less frequent and severe problems include the ability to control the flow of urine and stool, diarrhea, etc.

What are Kegel exercises? What are its benefits?

Designed by Arnold Kegel these exercises involve contraction of the pelvic floor muscles. Like push up aims to strengthen your arms and chest, exercises target the pelvic floor muscles.
If a patient is suffering from the above complaints, Kegel exercises are prescribed as a part of their treatment plan. They can also be used as a precautionary measure for a healthy male to prevent pelvic floor muscle weakness. Many people also perform Kegel exercises to improve control over ejaculation.

How to contract the pelvic floor
Before you learn to perform the Kegel exercise correctly, you must understand how the pelvic floor muscle contraction feels. This awareness is best developed in the toilet. You can do this in two steps.
Void your bladder completely. As you are urinating your pelvic floor muscles are completely relaxing. Now contract your lower abdomen as you would do to stop your urine in the mid-flow. This is the first step. The front of the pelvic floor muscles is now contracting. You may need to do this several times to get the correct understanding of the contraction. Step two involves contraction of the muscles around the anus like the way it is usually done to prevent the passage of gas. This activates the muscles around the back of the pelvic floor.

How to perform Kegel exercises
Because the muscles of the pelvic floor are small the best strategy to strengthen them is to perform repeated contraction throughout the day. These exercises do not need any equipment and can be performed in many positions including lying and standing. However, as many of us spend a lot of time sitting idle at our desk, my advice would be to perform them in a sitting position, as a deskercise, thankfully, an invisible one.
To do them sit in an upright position. Now simultaneously contract the front and back part of your pelvic floor and hold for a few seconds. Gradually try to build the hold time to 5 seconds. Similarly, over a period of time try to build your ability to produce 10 contractions simultaneously with a few seconds of rest in between. Be attentive to avoid contraction of the abdomen or buttock muscles; avoid breath-holding as well.
Like any other muscles, the pelvic floor muscles also take a minimum of six weeks to develop.
although this post was primarily intended towards men, these exercises can be performed as a deskercise by women too in the same manner.

Keep following this space for more health related discussions.

Kindly take our survey for current trends in physical activity here!

About the author

This image has an empty alt attribute; its file name is IMG_20190415_114220_049_2.jpg

Dr Subhanjan Das (PT)

BPT, MPT (MSk & Sports), CMP(NZ), Diploma in football medicine (FIFA)

Consultant Physiotherapist of Apollo & Reliva Clinic, HSR Layout, Bangalore

Contact: +91 8967549104

Dr Subhanjan Das (PT) has over 14 years of clinical and 12 years of academic experience.  A friendly professional with lots of patience and skilful hands, Dr Subhanjan has worked with thousands of his patients for instant relief of pain and rapid return to activities.  He has treated elite athletes for recovery, injury prevention and performance enhancement.

Dr Das is specialized in Orthopaedic and sports physiotherapy and has keeps himself updated with the latest advancements in the field of physiotherapy. He has undergone training on advanced orthopaedic techniques such as Dry Needling, Mulligan Concept, McKenzie method, Pilates, Cupping therapy, McConnel and kinesio  taping from the best faculties around the world.

Dr Das has taught in 5 universities across India and has trained physiotherapists in 50+ workshops within and outside India.

How to choose healthy shoes?

Gentlemen (and ladies too) are recognized by their shoes. But are your shoes gentle on your feet? Many of us choose the wrong shoes that produce pain in the feet, knee, or back. Here is a guide on choosing a safe pair of shoes.

Cut down on the heel

Heels are attractive and they make you look tall, but for a price. They tip the base of our body forwards and compromise the balance. To keep the body straight one needs to bend the knees and arch the back, leading to ankle, knee, and back pain. Moreover, they jeopardize the weight distribution, which may produce a flat foot or a bony spur on the heel. Platform heels are no good either. Avoid a negative heel though, where the toes sit higher than the back of the foot. It is best to wear a shoe with half an inch heel. If you must wear heels for an occasion, wear it for a short while and keep a comfy pair of shoes nearby.

Don’t wear pointed shoes

People who wear pointed shoes for a long time can be recognized by their big toe angling outwards. This causes pain on the base of big toes, corn, callus, and arthritis of the foot. It is best to wear a shoe with enough room in the front for all your toes.

Tie the laces

Most people do not untie their shoes. They keep the laces loose and slide in and out of their shoes. A shoe needs to fit snugly around the feet to be protective; a loose shoe will produce abnormal motion and result in foot pain. Try running with a loose shoe and you will realize how ineffective they are. If you wear push in shoes even then make sure they fit firmly around the ankle.

The soles

The outer sole should reasonably straight; the front upturned versions put pressure on the base of the toes. The front part needs to be bendable near the toe area for normal weight transmission. Running shoes or sports shoes have a springy cushion heel that helps in shock absorption, they are good.

The insole has to be firm with some cushion. Many shoes have insoles that conform with the natural curvature of the foot, whereas others can be purchased separately. Silicone gel insoles that fit inside your shoes are a good option if you stand for a prolonged amount of time.

Keep multiple pairs

Shoes need to recover from the stresses that we impose on them throughout the day. If you wear shoes the whole day it is a smart idea to keep at least two pairs and alternate between them every day. Also, change your socks daily to keep the skin of the feet healthy.

Let it go…

Throw away the old pair of shoes once they are worn out, as they will do more harm to your feet than good. Watch the shoe from behind. Is it standing straight or is tilted in one direction? Other signs of aging are cuts and loosening of parts. Also, you can tell by the absence of comfort that your shoes now provide.

If you walk 30 minutes in a day at your normal speed then you probably take more than 1.2 million steps in a year and your shoes have to withstand that amount of load. It would be wise to invest in a good pair of shoes that can handle this pressure and protect your feet.

Keep following this space for more health-related discussions.

Kindly take our survey for current trends in physical activity here!

About the author

This image has an empty alt attribute; its file name is IMG_20190415_114220_049_2.jpg

Dr Subhanjan Das (PT)

BPT, MPT (MSk & Sports), CMP(NZ), Diploma in football medicine (FIFA)

Consultant Physiotherapist of Apollo & Reliva Clinic, HSR Layout, Bangalore

Contact: +91 8967549104

Dr Subhanjan Das (PT) has over 14 years of clinical and 12 years of academic experience.  A friendly professional with lots of patience and skilful hands, Dr Subhanjan has worked with thousands of his patients for instant relief of pain and rapid return to activities.  He has treated elite athletes for recovery, injury prevention and performance enhancement.

Dr Das is specialized in Orthopaedic and sports physiotherapy and has keeps himself updated with the latest advancements in the field of physiotherapy. He has undergone training on advanced orthopaedic techniques such as Dry Needling, Mulligan Concept, McKenzie method, Pilates, Cupping therapy, McConnel and kinesio  taping from the best faculties around the world.

Dr Das has taught in 5 universities across India and has trained physiotherapists in 50+ workshops within and outside India.

Deskercise: Stretches and self-massage for neck pain

Neck pain is a truly democratic clinical condition. Whether you are an IT professional or a physician, a student, or a teacher, you must have faced work-related neck pain. These pains usually happen due to poor posture, and (or because of) overuse. Postural neck pain can be easily identified by its nature: It occurs when poor posture is maintained for a prolonged amount of time, goes away fairly quickly once the poster is changed and movement almost always helps to ease the pain. If you have neck pain that lasts beyond 5 minutes even after correcting the poor posture, then your neck needs a check-up from a professional before you try these exercises.
In previous posts, I have discussed correct ergonomic techniques to prevent pain provoking postures and corrective exercises. In this article, I will describe a few ways to reduce pain and relax the muscles of the back of the neck to produce immediate relief. All of these qualify as deskercise because you can perform them sitting at your workstation.


Upper trapezius stretch


This muscle, when overused produces pain on the side of the neck and the back of the head. To stretch the right upper trapezius keep the right hand behind the left side back pocket. Now place the left hand over the right temple. Turn the head a little towards the left side. Finally apply stretch by bending the head towards the left using the left hand. Repeat on the other side.


Back of the neck stretch


Make a fist with your right hand. Place it on the top of your chest bone. Rest your jaw on this list. Use your left hand to grab the back of the head and pull it forward.


Trapezius self massage


Use your left hand to support the right elbow. Now bring your right hand towards the left trapezius area. Gently squeeze the back part from the neck to the shoulder. You should feel better immediately.

Back of neck massage


The GIF images are self-explanatory. Just be careful with going too much on the sides of the neck, as they produce some discomfort.

Most physiotherapists detest the word massage and for valid reasons. Massage is a broad term and can be used for various purposes, a lot of which fall outside the therapeutic context. The processes used here can be alternatively termed as muscle release.

Before finishing I would like to emphasize that all these exercises and massage techniques are designed to produce significant, but short term relief. For lasting benefits you must fall back to correct ergonomics, alignment correction, and remedial exercises.

Keep following this space for more health related discussions.

Kindly take our survey for current trends in physical activity here!

About the author

This image has an empty alt attribute; its file name is IMG_20190415_114220_049_2.jpg

Dr Subhanjan Das (PT)

BPT, MPT (MSk & Sports), CMP(NZ), Diploma in football medicine (FIFA)

Consultant Physiotherapist of Apollo & Reliva Clinic, HSR Layout, Bangalore

Contact: +91 8967549104

Dr Subhanjan Das (PT) has over 14 years of clinical and 12 years of academic experience.  A friendly professional with lots of patience and skilful hands, Dr Subhanjan has worked with thousands of his patients for instant relief of pain and rapid return to activities.  He has treated elite athletes for recovery, injury prevention and performance enhancement.

Dr Das is specialized in Orthopaedic and sports physiotherapy and has keeps himself updated with the latest advancements in the field of physiotherapy. He has undergone training on advanced orthopaedic techniques such as Dry Needling, Mulligan Concept, McKenzie method, Pilates, Cupping therapy, McConnel and kinesio  taping from the best faculties around the world.

Dr Das has taught in 5 universities across India and has trained physiotherapists in 50+ workshops within and outside India.

Deskercises for shoulder

As human beings, our body is designed to move, assume different positions, and perform physical activities of various kinds throughout the day. All of these are severely restrained for the urban adult, more so for the desk worker. Over a period of time, they suffer from diseases of bone joint muscle (loss of calcium in the bones, stiffness of the joints, and weakness of the muscles are the most common ones) as well as diseases of other systems and organs like increase in blood sugar blood pressure, cholesterol, etc that have a significant health risk.

The ideal solution to this problem would be to get up at frequent intervals to perform physical activity and come back to the desk. Unfortunately, this is a luxury not everyone can afford for various reasons. Discus size can be a viable alternative.

 Isometric exercises

Isometric exercises involve contracting muscles to hold specific static poses. Isometric exercises do not involve movement. But let that not fool you into thinking isometric exercises are less effective. The recently popular plank exercise or the dreaded chair pose that my teacher used to punish me with are two examples of vigorous isometric exercises.

In this blog post I have described 5 isometric exercises for the shoulders. They can be done sitting right at the desk without utilizing any equipment.

All these exercises are meant to be performed by healthy individuals without any shoulder related problems. If you have any shoulder issues, please get it checked before you start these exercises. For all the exercises given below, use half of your maximum strength, hold for 10 to 15 seconds, and avoid breath-holding. There is no specific order of the number of repetitions. You may choose to do all of these exercises at one go break them down into multiple small bouts.

1. Outward pull

This exercise works on the outer side of the shoulder.

Interlock your hands as shown in the picture. Pull them out words with half of your strength and hold.

2. Inward push

This exercise activates the chest muscles.

Hold the hands into a namaste position. Now push them towards each other. Make sure your hands are not touching your chest. Should be able to feel the contraction of the chest muscle.

3. Biceps-Triceps contraction

Place the fist over one another. Push them with each other. The top hand triceps and the bottom and biceps will contract. Exchange the hand positions for the Other sides.

4. Shoulder rotator strengthening

While one hand tries to rotate the shoulder inwards or outwards the other hand prevents the motion-producing muscle contraction.

Try these exercises today and let us know how you feel! Keep following this space for more health-related discussions.

Kindly take our survey for current trends in physical activity here!

About the author

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Dr Subhanjan Das (PT)

BPT, MPT (MSk & Sports), CMP(NZ), Diploma in football medicine (FIFA)

Consultant Physiotherapist of Apollo & Reliva Clinic, HSR Layout, Bangalore

Contact: +91 8967549104

Dr Subhanjan Das (PT) has over 14 years of clinical and 12 years of academic experience.  A friendly professional with lots of patience and skilful hands, Dr Subhanjan has worked with thousands of his patients for instant relief of pain and rapid return to activities.  He has treated elite athletes for recovery, injury prevention and performance enhancement.

Dr Das is specialized in Orthopaedic and sports physiotherapy and has keeps himself updated with the latest advancements in the field of physiotherapy. He has undergone training on advanced orthopaedic techniques such as Dry Needling, Mulligan Concept, McKenzie method, Pilates, Cupping therapy, McConnel and kinesio  taping from the best faculties around the world.

Dr Das has taught in 5 universities across India and has trained physiotherapists in 50+ workshops within and outside India.