Author: Anjanaa Nishath

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Long Covid Symptoms

A brief background

It had started when a 26-year-old female who had recovered fully from a mild covid infection 4 months ago came to meet me. After complete recovery, she started getting back to her pre covid life and that’s when she realized that all was not the same.

Post covid syndrome

These are the residual effects of covid 19 infections. Even though one is tested negative and technically covid free these symptoms either persist or even occur new. So if you or your loved one has had covid this blog is for you…

Symptoms

A mild shortness of breath is noticed during exertional activities like stair climbing, playing with the child or pet, doing things in a hurry, or even brisk walking. She would feel that the breath stops at the upper chest level and would want to pause to take a deep breath.

Persistent irritation of the throat– A feeling that the throat was getting dry frequently and scratchy. It was more at night when she rested her head on the pillow.

Reduced appetite – A general lack of hunger drive and a feeling of bloating.

Restless nights- She felt that she was not sleeping deep and was getting up frequently.

Lethargy and fatigue– Lack of restful sleep made her feel more tired and irritable towards the evening. This had started to impact her personal and professional life.

What did we do

We set SMART GOALS

SHORT TERM GOALS (0-12 weeks)

Improve lung functions and overall aerobic capacity.

Posting few movement videos

Bear hug

https://www.instagram.com/p/CPcggsKg5i8/?utm_medium=copy_link

Swaying tree

https://www.instagram.com/p/CPfe2KqAvJ8/?utm_medium=copy_link

Brisk walking for 5 min every 2 hours

https://www.instagram.com/p/CPU5yYUM0Fz/?utm_medium=copy_link

Move to strengthen

We started with 15 min strength work. The focus was on the quality of movements and not the quantity.. Form first. I am posting 2 great videos by Dr Kristie Ennis on the same

Beginner workout.

https://youtu.be/S_WniP_WVLE.

Exercises to do everyday

Sleep hygiene

It’s not always about how much we do it’s also about how much time we give for repair and regeneration. This is where a good sleep routine is required. Sharing my short post on 5 useful tips to sleep like a baby

https://www.instagram.com/p/CRx6mJRAMWI/?utm_source=ig_web_copy_link

LONG TERM GOALS(3-12 months)

Regular walks 45-60 min at 60 -70%of the HR maximum

Breath work 3-5 times each hour and do 1 movement at a time. Exhale double of inhale.
Structured strength work as shared above ( reps 15 and 3 sets)
10 belly breathing before sleep.

Outcome

Currently she is in month 1 of long term goals and she is able to manage moderate exertion in her day to day activities with ease. Mood and fatigue have improved greatly. Sleep is longer 6-6.5 hours and fairly restful. And the work continues…

In the words of Thomas Edison” The Doctor of the future will give no medicine but will instruct his patients in care of the human frame,in diet and in the cause and prevention of disease”

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Forward head posture and low back pain

Post author By Anjanaa Nishath
Post date July 8, 2021
No Comments on Forward head posture and low back pain

Hi sharing an interesting case of forward neck and continual back pain.A 35year old software professional presented with repeated episodes of low back pain and stiffness making sitting, standing or even lying down painful . His first episode was 3 years ago and have been repeating since then ,each time with increasing severity every 4-6 weeks. He had consulted many doctors and physios . He would feel better with prescription 10 day courses of anti inflammatory and muscle relaxants with physical therapy till the next episode hit and the cycle started again.Multiple MRI scans had shown that the lumbar architecture was fine and the lordosis aka the curve in the low back had flattened out.

A detailed history and observation showed that he was a workaholic in long periods of chair sitting and screen time. Both of these had not been kind to the back. He had a visible Forward head position, rounded shoulders and flattened out low back

Pic courtesy physioqinesis.com

Chain of events

His habitual positioning had caused a weakening of the spinal muscles. This was made worse with the weak neck musculature.All of these had lead to poor core strength and a flat back. A flattened back is like a stretched out rubber band with poor shock absorption and flexibility. This caused repetitive microtrauma to the structures and tissue damage over a period of time. At this stage the body would respond to pain meds and passive pain management techniques like IFT and TENs but as the original faulty pattern was not addressed the tissues had never healed fully . Their ability to bear the loads in day to day life had come down and thus started another pain spasm episode. Repeated pain cycles had caused the brain to freeze or inhibit the painful part even now without actual tissue damage. This explained the constant stiffness without pain.

Solution

Phase 1( Repositioning forward head and strengthen upper back)

We started with these

Chin tucks

https://www.instagram.com/p/CRDiIPOgQLi/?utm_source=ig_web_copy_link

Standing arm reach

https://www.instagram.com/p/CRGRx2bA52W/?utm_source=ig_web_copy_link

Wall angels

https://www.instagram.com/p/CRFwSlzgQg6/?utm_source=ig_web_copy_link

Once he was comfortable repeating each movement 30 times per day painless we moved on to phase 2

Phase 2( Functional core muscle activation and improving hip flexibility)

Chair squats

Chair squat- stand facing the back of a sturdy chair. Place your palms on the back of the chair . Keeping the knee caps forward and bend the knee 5-8 cms keeping the weight on the heels . Breathe in as you go down and out as you come up. Repeat 3 to 5 times each hour. Make sure to keep the ribs in line with the hips .

Belly breathing

https://www.instagram.com/p/CPTj3FfB5N2/?utm_source=ig_web_copy_link

Toe raises with belly breathing

Stand with the feet shoulder width distance and the outer border parallel to each other. Breathe in and lift yourself up on the toes. Breathe out engaging the core and come down without touching the heels to the ground . Repeat this movement 3- 5 times each hour.

Outcome

Over a period of 8 weeks he reported no pain flare up. His pain at rest had gone down by 50 percent of the original reported and he had started walking at a comfortable pace outdoors for 60 min everyday.

To sum it all I’m quoting one of the foremost pain clinicians Dr Greg Lehman BKin ,Msc,DC,MscPT

The body is more of an Ecosystem and less of a car that needs aligning. Our treatment should reflect this

References

smartphone usage and cervical pain and fatigue

file:///Users/Anju/Downloads/THE%20EFFECT%20OF%20ADDING%20FORWARD%20HEAD%20POSTURE%20CORRECTIVE%20EXERCISES%20I

Sitting posture of subjects with postural backache

https://www.sciencedirect.com/science/article/abs/pii/S0161475406000261

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STRETCHHHHHHH….

Hi, welcome to part 1 of my 2 part series where I talk all about stretching. Stretching has been a hot topic of discussion in fitness circles for some time now with researchers giving varied conclusions about the efficacy, type, duration of hold, when to do them, and what to do..

This blog is dedicated to these FAQ’s and part 2 will have selected few movements which have helped me and my patients over years.

Stretching simply

Most muscles are attached at both ends to bones and movement of the muscle moves the bones. In simple terms, it is the activity of moving one end away from the other keeping one end fixed.

How should I feel

You should feel a gentle, sustained pull or tension through the length of the muscle. At no point should you feel pain. Keep breathing gently and regularly throughout the movement.

How much is too much

2-4 times with a hold time of 10 counts every 90 minutes is a good starting point… You can slowly increase the duration of hold as you ease into the positions.

When to do

If you are looking at performance its good to do the stretches as a cool-down routine

If you are looking to improve your overall flexibility good to do it in small doses at regular intervals throughout the day.

If you are looking to destress and unwind you can do a twenty-minute routine just before bedtime.

Stretch menu

Like a menu card stretching also has a variety to choose from…

With props

A block. yoga belt, bolster, low stool, window sill, wall, or even your kitchen counter can help you get into a stretch. So look around you and be creative.

With breath

Breathe into the chest and the belly while getting into a stretch and out and relax…

Partner stretch

Certain lower body stretches can be done with a partner.. It adds a social component to our otherwise socially distant routine.

Active muscle contraction

Tighten the muscle opposite to the one you want to stretch. Hold the contraction for 5-8 sec and relax. Now gently lengthen the muscle you want to stretch till you feel tension. To stretch your tight biceps tighten the triceps and repeat as above.

These are my 2 cents on this.. please feel free to put in your valuable comments and suggestions … Take care and stretch well

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Breath of life

As I lay down all tucked in

Grateful for the breath of life which fills me in

I bend my knees and relax my toes

Lengthen my head into the pillows

With back rested and feet on the bed

I let go of myself from toes to head

I breathe in through the nose

Allowing my belly to fill like bellows

Now I let the air out gently through my pursed lips

My belly now sinks towards my rested hips

This gentle bobbing is a lot of fun

It’s called Breathing into the Abdomen

Do it in the morning or at night

This breathwork is sure to make you light.

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Boosting immunity the movement way

Post author By Anjanaa Nishath
Post date April 29, 2021
No Comments on Boosting immunity the movement way

With a curb on outdoor movements, closure of fitness spaces we are now looking differently to fulfill our much-needed exercise quota indoors. Anyone who had been reasonably active and consistent with exercise would know how it feels to not do it for some time. Apart from mood-boosting and better work output I want to talk about one of the most underrated uses of movement Immunity-boosting in this blog… so let’s get moving

Lymphatic system

An intricate system of tubes that remove metabolic wastes, transport fatty acid, and most importantly produce immune cells (such as lymphocytes, monocytes, and antibody-producing cells called plasma cells) aka our natural immunity system primer.

It’s all about the forces

The lymphatic vessels are very delicate and solely depend on gravity and forces around them to push the lymph around. The forces are muscular shortening and lengthening… you guessed it right movements use muscles and working muscles move the lymph.. better lymphatic movements better WBC circulation and better immunity. In short more movement more immunity.

Let’s see how to

A simple barefoot stroll in the house for 5 min every 60 min is a great kick starter.

For the desk junkies out there, invest in a good standing desk.

While standing vary the foot position..stand with the feet shoulder-width distance and the outer border parallel to each other to use those gluts more. You can stand one foot ahead of the other as in a short step. You can change sides every 30 minutes.

Try low sitting as much pain-free- you can sit on 2 cushions then move to 1 and try floor sitting.

On the floor try long sitting ( sit without or minimal back support and stretch the knees in front of you. Toes will point to the ceiling.)

Cross legged sitting ( sukhasasana, Padmasana)

Side-swept sitting

Microbreaks to strength train-Take small regular breaks 2 minutes every 60 min. You can do your own bodyweight moves like ( Wall or incline pushups, Squats, lunges Or even jumping jacks. Start with 5 reps of 2 movements and can add more reps or more movements)

Balance trainer- A balance pad is a great way to add whole body balance work which uses more of us in a fun way. ( Try standing on it with both feet shoulder-width, feet close, and 1 legged stand. Try to hold the for 1 min each side and can repeat 2-3 times )

Focus on how and what you eat– We are what we eat… Eat wholesome unrefined locally grown foods. Add more whole grains and nuts to your plate. This will make you chew the food more and add more movement to the jaw muscles and strengthen them.

Try to have a meal or a snack sitting on the floor.

Breathe better and mindfully- Cant emphasize its importance enough. For actionable please refer to my previous and dedicated blog -Breath as an immunity booster….

This blog is a collection of those small changes which have helped me personally .. If you have any great ideas please feel free to reach out and we can add on to this list…. Take care and stay safe

Physiotherapy Post Operative Care

Management of postoperative pain at home – Part 2

Post author By Anjanaa Nishath
Post date April 16, 2021
No Comments on Management of postoperative pain at home – Part 2

Hi, this is part 2 of the post-operative pain series. This is all about what to do, what, and how to eat and sleep. In short, manage the pain and fatigue effectively such that it abates fully and not liners on making it chronic. Listing the actionable which have helped my patients and me during this phase… so let’s roll

Move frequently

Can’t stress the importance of these 2 words enough. Just be open to moving yourself at regular timed intervals. It can be strolling indoors for 2min every 90 min. Sitting without back support for some time these are just a few. Regular movement releases endorphins our natural painkillers.

Balance work

As I have written in my previous blogs balance movements are natural and whole-body activities. These will help to recruit more muscles and build up confidence and coordination. These make movements efficient and pain-free. A simple 10 min routine is a good starting point. For specific work please refer to my blog on Ankle pain and you

Focus on your breathing

When we are in pain or any discomfort the first response is to hold the breath in shortstop breathing for some time and then take a big gulp of air. This adversely the rate of breathing. Apart from this the quality of breathing also lessens. We breathe rapidly, shallow, and irregularly. Both these increase our sensitivity to pain and increases fatigue. For further reading on this topic and some breathing exercises please refer to my blog on Breath our natural immunity booster.

You are what you eat

Any surgery or procedure affects gut health and mobility. To make sure that you are absorbing the maximum from your food keep the food rich in whole and unpolished grains. Native grains like millets, sorghum, or maize are recommended.

Eat small meals at regular 2 to 3-hour intervals. Choose fiber-rich and easily digestible vegetables like ridge gourd, bottle gourd, and pumpkin.

Start with a set of 3 vegetables and add 1 vegetable to your plate every week.

Sleep hygiene

Can’t talk enough about it. Sleep in a calm and cool place. Try to sleep at the same time every day to set your circadian rhythm. Avoid screen time at least half an hour before bed. Instead, you can try writing a gratitude journal. If you wake up in the middle of the night try not to see the screen. Instead, you can try belly breathing. This technique has been described in detail in my previous blog- Breath the immunity booster. You can do twisting movements in the bed. These will loosen you up and feel relaxed. Try to get good sleep between 10 pm to 2 am. This is the money time for sleep.

Get the sunshine vitamin

Go out basking in the sunshine every day for at least 15 to 20 min. A preferable time works are 7.30 am to 9.30 am . Sunlight stimulates the production of melatonin which sets our circadian rhythm.

Postoperative recuperating can be hard so I hope these evidence-backed lifestyle tips help you to Recover well and Live pain-free… take care

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POSTOPERATIVE PAIN AND YOU – Part 1

Post author By Anjanaa Nishath
Post date April 9, 2021
No Comments on POSTOPERATIVE PAIN AND YOU – Part 1

Hi, welcome to my 2 part series on postoperative pain and its management with movements, food, breath, and sleep. If this interests you read on

In part one will be sharing my thoughts on moving more and reducing dependence on pain meds while being in the hospital.

Part 2 will focus on how to live pain-free after surgery and not carry on with the pain to make it chronic aka A part of your life.

So let’s get on with Part 1.

After the surgery

In this stage, you are still in the hospital under medical supervision. This is the time your physical therapist will visit you and encourage you to move the whole of you as in walking or stair climbing or parts of you as in turning in bed, rolling, or specific prescriptive exercises. The movement program is tailor-made to your needs. The idea is to help you move more and more of yourself and aid the body’s natural pain regulatory response.

Few of those for you

Windmill in the bed

Lie on to one side whichever comfortable. Bend the top knee and hip and place the knee on a pillow in front. Stretch both the arms in the front at shoulder level or whatever level comfortable. Breathe in into the belly counting to 2 and lift the top arm up such that you do not rotate your torso. Breathe out through the nose and return to starting counting the same count or even double of comfortable. You can repeat it every hour 2 to 3 times. This improves your lung function, the movement of the diaphragm which is the main respiratory muscle, and the abdominals which are important for a good pain-free posture

Bearhug

Sit cross-legged or in a chair, breathe in and lift the arms up and outward. Breathe out, curl the spine and hug yourself gently. Repeat and breath count as above.

Belly breathing – Can do this in any position like sitting, standing lying, or even moving. This helps in improving the diaphragmatic movement and the overall quality of breathing. The mindful practice of this activates parasympathetic and keeps stress breathing low. Choose any comfortable position. Keep the spine neutral and relax or drop the shoulders. Breathe in counting to 4 such that the abdominals move out. Keeping the same neutral breathe out gently counting to 8 pulling the navel gently to the spine. Repeat as comfortable.

Chin tucks in lying

Lie on your back and can bend both knees slightly by placing a pillow under them. Place the neck of the head and neck on a pillow too. Breathe out and gently try to bring the chin to the chest keeping the shoulders and the ribs relaxed. You will feel some work at the back of the neck and head. Repeat it 2 to 3 times every hour. This activity strengthens the postural neck and shoulder blade muscles.

Ball of power

This activity is a modification of Foundation training work. Lie on the back such that the head and the mid back are rested on 1 to 2 pillows. Slightly cup the fingers and press the fingertips together like holding an imaginary ball in the palms. Breathe in and lift the arms up with the elbows bent gently. Keep the lower part of your ribs on the pillows. Lift it up to a point where you can keep the ribs back down. Repeat 2 to 3 times each hour.

All of these movements work on building your stabilizer groups and with breathing being in relaxation, better lung function, immunity, and pain relief… Signing off, for now, will be back soon with part 2 of this series… Till then take care and live pain-free

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Indoor warriors

This blog is all about action items because as rightly said every life-changing journey starts with baby steps. So here are the baby steps

Open the windows and allow sunlight to stream in. It will allow UVB to come in which is a Vit D synthesis initiator. Bask in this anytime between 7.30 am to 9.30 am for maximum benefits.
Add more Vit b12 to your diet. Vit b12 increases D3 absorption. A bowl of curd, 2 glasses of buttermilk, 2 helpings of greens, a cup of lentil or sprouts should do the trick.
Go furniture-free as much as possible. You will be using more of yourself to hold the position.
Add natural functional squats by getting on the floor more often.

Move more indoors

For every 40 min of chair sitting or any stationary position walk for 5 min barefoot or with minimal footwear. Walking is one of the best weight-bearing activities which helps in bone mineral synthesis. All in a day’s walk isn’t it

Find your balance

These 3 simple words have had a profound impact physically and philosophically in my life. Let us talk about the physiological benefits for now.

Balancing activities are whole-body movements recruiting more muscles and the larger part of the skeletal system. Larger forces call for better bone density aka stronger bones to withstand them safely. Here are a few balance movements which have helped me greatly

Walk barefoot on as many surfaces as possible. You can try walking on a pebble way, sand, grass, or carpet.
Cushion walk– Put 3-5 cushions on a non-slip surface 5 cm apart. Stand on 1 cushion with feet hip-width distance. Take a step onto the cushion in the front without losing balance. Then you can move back to the starting cushion. Start with 2 cushions at a time and can move up to 3-5 cushions. You can repeat 2-3 times every hour.
Balance on 1 leg– Stand as above on a non-slip stable surface. Lift 1 leg up such that the hip and knee are bent to 90 degrees. Hold this position for 30 sec to 1 min each side and can repeat as above.
Side leg lift – Lift one leg sideways 5-6 cms from the midline of the body without tilting or leaning. Hold as above. Repeat as above.
Back leg raise-Stand as above and lift one leg to the back keeping the knee soft and straight. Lift the leg to about 5-8 cms and keep the toes pointed to the floor. Hold and repeat as above.
Vrikshasana
Chair pose in yoga ……… Signing off with FIND YOUR BALANCE. Cheers

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Bone health in captivity

We are as strong as our weakest link. This saying is aptly perfect in my practice as a pain clinician. Pain is our body’s way of telling us that it needs to be treated differently in short a lifestyle overhaul. In this perspective balanced living is vital to treat pain and remain pain-free.

For any chronic pain, fatigue, or weakness I run a blood profile specially VitD3, and have seen enough results now to say that nearly 75% of us are deficient in this naturally producing vitamin. So what has changed in the urban us?

Evolution and bone health

From the time of our evolution as homo sapiens ie present us our gene pool roughly remains the same. For our hunter-gatherers or even the farming ancestors, strong bones were essential for survival. Activities of survival like long-distance walking, occasional running, hunting, foraging for food, working for long hours in the fields, bearing and rearing children carrying heavy loads, and children placed great stresses on the skeletal system. Hence the requirement for robust bones.

So what has changed now if not the genes?

Our movement offloading. In the urban world, we have learned to outsource the so-called repetitive and boring movements. Driving for walking, robots for cleaning, washers for washing, elevator for stairs, and a supermarket jaunt for food. Even the food we get is pre-processed often not requiring the complete cooking process.

All of these allow us to move less or not at all. When there is no stimulus to move and weight bear why should the body keep the bones robust? What you don’t use you lose…

Bone health and captivity

With the new normal our outdoor movements are reduced to non-existent. This makes us sunlight deficient.

When your skin is exposed to sunlight, it makes vitamin D from cholesterol. The sun’s ultraviolet B (UVB) rays hit cholesterol in the skin cells, providing the energy for vitamin D synthesis to occur. That’s why vit d is the sunshine vitamin.

How does being low on Vitamin d feel like

Getting sick often
Fatigue
Widespread muscle pain
Mood swings and feeling low
Weight gain
Reduced appetite
Low sleep quality.

If all of this is making you think about the action items please follow my next blog the Sunshine warriors. Will delve into the how to and what to … Till then open the glass windows and allow the sunshine to come in. Lounge in it and enjoy the warmth for 15 to 20 min… cheers

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LET GO

Taking my thoughts on the elusive and inefficient but defined 6 packs this blog is about how to create a strong and functionally efficient core. ( Not just abs). Cosmetically it will make you look taller, leaner, and smarter. Physiologically it will keep you well-aligned and injury-free.

So let go and breathe

Do the unthinkable relax your abdominals. Allow the flexible abs to stretch out during every breath and gently tuck in by itself with each breath out. Believe me, when you do it mindfully you touch the philosophical Let go… cool, isn’t it?

Align yourself

Overarchers

This is for those of you who breathe into the chest lifting it up and pull the shoulders back to straighten yourself up. You also have always felt that the low back is curved forwards more than others and at any given point you can easily move your hand across the low back curve.

Make sure to stack the lower ribs with the pelvis such that they are in the same line. If you feel that you are jutting your ribs forward just breathe in into the belly and breathe out gently tucking it back in. Repeat till comfortable.

Curlers

Oh, those rock-solid abs do not allow you to straighten out. You will see that you habitually sit on the back pockets and slouch chronically. So open up. Lift the rib cage up with every breath in. Be mindful to not poke the chin.

Movement nuggets

I come to my favorite part of movement prescription. So sharing a few movements have helped me to be aligned and pain-free.

Superman on the pillow

Lie on the chest with 2 pillows approximately 10-15 cms in height under the front of hips such that they are in the same line. Drop the head forward down and keep the arms by the side of the body palms facing you. Keeping the toes pointing forwards and the knee soft and straight lift 1 leg up such that the leg is in the same line as the pillow. Go up and down keeping the upper body and hips relaxed. While lifting up be mindful to not overarch the low back. Repeat 10-15 times.

Flying superman

Same starting position. Lift the 1 arm up keeping the above correctives in mind. Can keep the palm facing down and if you want to add some rotation keep it facing towards you. Repeat as above.

Want to sign off for now wishing you a Trainable, Efficient, and Pain-free body and mind… Cheers