With novel coronavirus rocking the world I feel that our perspective on health has become more preventive than rehabilitative. As a pain clinician, the power of proper breathing has always fascinated me. Using breath as a natural painkiller and immunity booster has been the core of my prescriptive treatment. This blog is for those of you who want to take charge of your health and immunity. 

What are our breathing parts?

Rib cage and lungs-Lungs are enclosed in a mobile structure called the rib cage. It is moved by muscles called the Intercostals ( between the ribs), muscles of the spine, muscles of the neck and shoulders.

Diaphragm– Dome-shaped muscle separating the chest and abdominal cavity. Its flattening helps us to fill the air in the lungs and doming up pushes the air gently out. It is the main breathing muscle.

Abdominals– The outward movement of the abdominals help in the downward descent of the diaphragm. They set the rhythm of the diaphragm and the overall rate and quality of breathing.

Stress breathing

 Repetitive postures like prolonged chair sitting and tight clothing causes rounded shoulders and sucked in belly. This does not the free outward movement of the abs leading to reduced movement of the diaphragm. Due to this we unknowingly start overusing the muscles in the neck and shoulders causing further stooping. This causes shallow breathing from the upper chest, increasing the breath rate and reducing the quality. In short faulty breath, pattern puts our sympathetic system into overdrive and causing immune hyperactivity to fight an unknown antigen. Years into this pattern overuses the immune system and causes metabolic fatigue. This is a point where the immune system is unable to fight the real antigen as it is tired of fighting an imaginary one.


 1.While chair sitting try to sit away from the back of the chair. This helps to train a neutral spine

2.Untuck your tailbone ie unround your lower back.

3. Sit on your sit bones.

4. Can try a different sitting position like floor sitting, low cushion sitting.

5. While standing back your pelvis and hips back. 

6.Always hinge from the hips to bend and not from the waist. 

7.Keep the shoulders down and back and keep the lower ribs down.


Kneeling chest opener– Kneel on all fours with the hands right under the shoulders. Keep the shoulders and spine relaxed. Breathe in and pinch the shoulder blades together without lifting the hands … breathe out and come back to starting position. Breathe in 4 counts and out 4 .. slowly aim at making the exhale double of inhale. Repeat 2-3 times every 90 min.

 Belly breathe in kneeling-  Starting position same as above. Breathe in and allow the belly to loosen towards the floor. Breathe out and gently pull the navel to the spine without arching or rounding the back.. Breath count and rep same as above.

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. Mindful practice keeps stress breathing low. Choose any comfortable position . Keep the spine in 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. 

Hope the above read helps you to breathe well and remain healthy…. Take care



Hi, this blog is for those of you suffering from neck pain which simply doesn’t leave you and wondering what to do.

What is it?

SPONDYLOSIS in simple terms is a degenerative condition of the spinal discs. It is age-related wear and tears. Studies suggest that already 1 in 4 of us have it.

What does it feel like?

Painful muscle spasm in the Beck, upper back, shoulder, and arm.

Numbness and tingling in the fingertips in case of nerve compression.

Frequent headaches aggravated by any turning of the head.

Trouble keeping your body balance.

Sleep disturbances due to pain or discomfort are common.

Though by textbook it’s a degenerative and age-related condition I now see more younger and middle-aged adults suffering from this. 

Posture and pain

Work from home, online classes, and virtual meetups mean more screen time for work and leisure.

More sustained stooped posture with rounded shoulders, forward head, and poking chin.

This abnormal and stressful position of the head weakens the upper back muscles. Now with little or no support from the strong upper back musculature, the small muscles of the head and neck have to work extra hard to position the head in neutral. This leads to a fatigue-pain cycle, causing continual or relapsing neck pain and headaches.

What to do?

Shoulder blade squeeze- Be seated with the neck and shoulders relaxed. Breathe in and gently pinch the shoulder blades together without pushing the ribs in the front. Hold for 2-3 counts breathe out and relax. Repeat 2-3 times every hour.

Standing belly breathing

Stand comfortably with feet hip-width distance against a wall such that the upper back and the hips are in contact with the wall. Breathe into the belly keeping the shoulders, jaw, and neck relaxed. Breathe out through the nose gently keeping the torso and upper body relaxed. Keep the lower ribs down throughout the movement. You can start with inhaling of 3 counts and exhale to 3. Once this is comfortable focus on making the exhale double of inhaling. Repeat 2 times every hour.

Chin tucks- Be seated in a comfortable position and just move the chin to the back of your head keeping the head in line with the neck. You will feel some work at the back of the neck. Repeat 2-3 times every hour. Can do it lying on the back or on the chest too if comfortable.

Mindfulness at work– Every hour take a 10-sec break, just scan for any tension in the face, jaw, neck, shoulder, and temples.  If you find any tension just gently Close your eyes and breathe as gently as possible focusing more on your exhale. Repeat 2 to 3 times.

Hope these strategies help you to manage your pain and be pain-free… Wishing you a movement-rich life.



Covid 19 has put us all into a mandatory captivity and a new normal. Here are my two cents on this.

New normal

Work from home, online classes, and virtual meetups mean more screen time for work and leisure.

More sustained postures with rounded shoulders, forward head, and poking chin.

Increased chair sitting reduces hip and knee flexibility.

Less weight-bearing activities lead to reduced bone mineral density.

More screen time disrupts melatonin production and hence reduces the quality and quantity of sleep.

All of these cause chronic fatigue, irritability, painful muscle knots, or myofascial triggers.

As a pain clinician, this is where I find my patients in a classic Pain -Weakness cycle.

How can yoga help?

Yoga is a way of life and an experiential science. For this blog, I am going to focus on the movement component of yoga ie Asanas.

The practice of asanas makes us move the body in the range we don’t usually move. This improves flexibility and overall coordination.

Frees up the tight hips and groin muscles

Breathing while holding the asanas makes us mindful of the pattern of breathing and helps to improve the quality rate and depth of breathing.

Increases the secretion of our feel-good chemicals like dopamine, serotonin,  endorphins and reduces the level of cortisol which greatly decreases stress.

Improves the Samatvam or balance of the body and mind.

Dos and don’ts

This is to give you tools for safe practice and not intended to replace a qualified practitioner. It is ideal to consult a practitioner to make a program tailor-made for you.

If you are a beginner or restarting after a long gap, start with a 15 to 20 min routine to be done preferably on an empty stomach.

Choose a manageable time and be consistent.

Give a day’s rest in between sessions.

Focus on the form and not the number of poses done.

Get in and out of the pose gently.

Attempt a pose how much ever comfortable. Breathe mindfully focussing more on the exhale in that position.

Always end the routine with belly breathing, keeping exhale twice of inhale. Start with 3 rounds and proceed up to 20 rounds at one time. Once comfortable with this, you can try both nostril pranayama like ujjayi or sheethali and then go to cleansing kriyas like kapalbhati and Nadi shodhana pranayama.

Sample routine

Setubandhasana- 5 rounds hold for 15 sec each time.Follow the same for all the poses 


Spinal twist with knees bent and then 1 knee straight






End the routine with Savasana for 1 min and belly breathing 3-5 rounds with exhale twice of inhale.

Hope this blog motivates you to move gently, mindfully, and with control…Want to sign off by wishing all of you a movement-rich month..

Pain Management Physiotherapy


We are designed to move for survival and our wellbeing. Recent researchers have shown that regular movements act as a natural painkiller by releasing serotonin, dopamine, GABA, and endorphins. So if you or your loved one is in pain and looking for more substantial ways of managing it then read on.

What happens when we move?


Better general circulation

Easier lymphatic drainage so fewer chances of swelling of hands and feet.

Better muscular control and coordination.

Improved bone health.

Improved gut mobility so good appetite and easier bowel emptying.

Metabolic rate is improved so easier body weight control.


Release of endorphins, dopamine, serotonin, and reduced secretion of cortisol ( stress hormone).

Reduction of free radicals and p substance so reduced pain and inflammation.


Better diaphragmatic movement

Relaxed and even breathing

Parasympathetic activation

Lowers stress

Sample movement routine

In bed

Spinal twist– Lie on the back, arms by the side. Bend both the knees, drop them to one side and then another keeping the shoulders relaxed and on the bed. Repeat 3-5 times on each side.

 Belly breathing with arm raise-Lie on the back with the knees bent as much as possible. Breathe in through the nose and allow the belly to come out. Simultaneously interlace the fingers and take the arms upwards as much pain-free. Repeat 3 to 5 times.

 Pelvic Bridge

In-chair sitting

Seated figure of 4-Sit without back support and bend 1 knee such that that ankle is on the opposite knee in a figure of 4. Keep the chest up and hinge forward from the hip to a point where you feel the sensitivity in your butt region or the lower back. Stop at that point and breathe into that position for 3 to 5 breaths. Repeat it 3-5 times.

Seated cross leg stretch-Sit cross-legged as before. Gently pull one knee to the opposite shoulder, keeping both the sit bones in contact with the chair. Repeat as above.

In standing

Hip hinging -Stand with feet shoulder-width parallel. Keep the outer border of your feet parallel, keeping the heels out. Drop the knee caps. You will feel your glutes engaged. Keep the chest up and bend from the hips. Go to a where you feel a mild pull or stretch in the back of your thigh or even the low back. Stop, ease into it, and breathe. Repeat as above.

Hip hinging with knee bent-Repeat the same activity with your knees bent to 5 cms keeping the knee caps facing forward and parallel. Your weight must be on the heels. Repeat as above.

Hope these hacks help you to manage your pain and live pain free… Take care move more and better.

Pain Management


Covid 19 has put us all into mandatory captivity and a new normal. Here are my two cents on this.

New normal

Work from home, online classes, and virtual meetups mean more screen time for work and leisure.

More stooped posture with rounded shoulders, forward head, and poking chin.

More screen time disrupts melatonin production and hence reduces the quality and quantity of sleep.

Chronic fatigue and irritability lead to painful muscle knots or myofascial triggers and tension headaches.

Sustained posture and headaches

The weak upper back affects the neck position. Now the muscles of the head and neck have to work extra hard to keep the head in position ie neutral. This forms myofascial triggers and refers pain and sensitivity to the face particularly temples, behind the eyes, and the neck region. This is a tension band headache that feels like a tight band around the head.

Eyes and headaches

Eyes are constantly in a fixed gaze to the screen. This causes weakness of the eye muscles causing eye strain, myopia, and headaches.

What to do to


After every 45 min of screen time stand near the window and look out as far as you can. Keeping the head in the same position look as close as possible. If you wear glasses do with them. Repeat 3 to 6 times every 45 min.

Eye squeeze-Squeeze shut the eyes and count till 10. Relax and open.

Mindfulness at work– Every hour take a 10-sec break, just scan for any tension in the face, jaw, neck, shoulder, and temples.  If you find any tension just gently close your eyes and breathe as gently as possible focusing more on your exhale. Repeat 2 to 3 times.

Upper back functional

Shoulder blade squeeze– Be seated with the neck and shoulders relaxed. Breathe in and gently pinch the shoulder blades together without pushing the ribs in the front. Hold for 2-3 counts breathe out and relax. Repeat 2-3 times every hour.

Standing against the wall and leaning to 1 side with the ribs

Stand against the wall with the lower ribs against it. Drop and relax the shoulders, jaw and even your belly. Lift the arm up to shoulder level sideways such that the little finger is against the wall and lean towards the same side without moving the hips and the feet. Repeat at above. Stop and ease into the position where you feel a pull in the lower back. Repeat as above.

Hope all of these help you to be pain-free.. Move more….Take care

Pain Management Physiotherapy


Covid 19 has been difficult for all of us. With the healthcare system already overworked this blog is to help you manage one of the most commonly faced problems at home and also identify when to seek professional help.

How does it feel?

It’s a painful stiffness in the back of the leg below the knee commonly called the calf muscle. You can feel a twitching in the calf or the knee. In severe cases, you will feel that the whole leg is frozen and you are unable to bear weight on that leg. Any position change like sitting to standing, walking, or even turning in the bed can aggravate the pain.

When should you see a Dr?

Pain is unchanged and moderate to severe for more than 3weeks.

Burning sensation in the sole or the leg.

Numbness or tingling in the foot or calf.

Worsening of the pain and reduced mobility due to it.

Visible swelling in one or both feet.

DIY relief techniques

Tennis ball roll-Roll lengthwise with gentle pressure along with the calf bulk for 1-2 min every 90 min.

Hot or cold application -Can do it for 2-3min every 2 hours.

Ankle pumps and circle-Can be done in sitting or lying down. Push the feet down with the heels lifting up, then push the heels down with the toes pointed up. Repeat it 5-8 times every hour. Roll the ankle clockwise and then counterclockwise direction keeping the knee relaxed. Repeat 5 to 8 times every hour.

Toe scrunching and splaying– Curl the toes gently to feel the calf tense be there for 1 or 2 breaths. Now release the toes and spread them out fully as much as possible keeping the heel on the ground and the knee relaxed. Repeat as above.

Stroll with heel-toe pattern -Stand with the feet hip-width distance. Press the heel into the ground. Keep the knee soft. Gently push off with the toes. Walk slowly indoors with this pattern for 2 min every hour.

Hope these suggestions help you to heal faster and be pain-free. Take care

Pain Management Physiotherapy


Today’s blog is dedicated to one of the most commonly injured joints “The Ankle”. Research says that 1 in 4 people experience ankle injury or instability at some point in their lives. As a clinician can validate this as I see a similar presentation in my clinic.

Ankle though a small joint in size is biomechanically big in walking or any weight-bearing activity. The foot up and down activity at the ankle helps to clear the ground while walking and propel us forward by pushing the ground back. The tilting movements at the ankle or foot in and out helps to stabilize the foot and knee.

Being so functionally important it often gets overused and injured. Ankle injury presents compensation in standing and walking. A few compensations are as below

Limp and hop walk to avoid putting weight on the affected side.

Clawing and scrunching the toes.

Rolling the knee inwards causing a lot more push off from the inner border of the foot.

Reduced hip range of motion so the length of the step is shortened.

As with any compensation any of the above would make walking painful, inefficient, and injury-prone.Due to the pain, most patients start reducing or avoiding moving. Lack of movements reduces our balance system called Proprioception and makes the joint more unstable and injury-prone. A classic Pain – spasm – weakness cycle where I find most of my patients in. I am listing a few corrective movements which help us to get optimal balance and hence be pain-free.

  1. Walk barefoot on as many surfaces as possible. You can try walking on a pebble way, sand, grass, or carpet.
  2. 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.
  3. The 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. 
  4. You lift 1 leg to the side 5-6 coms from the midline of the body without tilting. Hold as above. Repeat as above.
  5. Vrikshasana
  6. Chair pose in yoga

The secret to a pain-free and strong ankle is good body balance. I hope all of these help you to improve the balance and be pain-free… Stay happy and healthy.

Pain Management Physiotherapy


Hi, as a pain clinician I see patients who want reliable information to understand their pain. This blog is to help you know your pain better and overcome it.

What is pain?

Pain is a protective and useful sensation. It tells the brain about actual or impending tissue damage. The immune system is mobilized to that region to heal the damage. In short, pain is vital for our survival and safety.

Is pain always equal to tissue damage?

Not always.. when an injury happens for the first time there is actual tissue damage in that region. This is an acute injury. The immune system takes over and it’s healed in some time. Even after the healing is complete its memory is stored in the hippocampus (memory center). 

Next time when we move out repeat a similar movement pattern to the original injury the brain identifies it as a potential threat based on the past memory. To stop us from going further it releases pain substance and we feel the pain now even without any injury. This is an example of the brain being overprotective. When this happens multiple times inefficient compensatory movement patterns develop. This is the chronic pain-injury cycle. This is why we but just even when the injury has long healed.

Should I rest when in pain?

Not always. When the pain is more than 70% of your capacity,  it is good to protect and rest the part. The application of ice and heat helps in pain relief. Once the pain is down to 50 percent you can start moving slowly indoors making sure that you don’t do the aggravating movement. You can move the part in all pain-free zones. Belly breathing can help greatly to stabilize the core and decrease the pain. When the pain is stable at 50 percent for 24 to 48 hours or even less start with posture corrective exercises, core stability activity like simple tummy tuck in along with belly breathing. You can try bending from the hips instead of from the waist to bend forward.

A few things that help

While standing or sitting keep the outer borders of the feet parallel to each other and at hip-width distance.

Drop the knee caps while standing.

Wear comfortable clothing that allows the belly to move out with each breath.

Drop the shoulders down.

Belly breathe every 2 to 3 times every 60 min.

Pain though an uncomfortable feeling can be controlled and overcome. I want to leave this takeaway The biggest influencer of your pain is you… Stay happy and healthy.

Pain Management Physiotherapy

Trapezial Myalgia & You

Hi, and welcome to my latest blog. Today I’d like to talk about a topic close to my heart, because of my personal experience with it recently. 

Being naturally curious, I decided to make myself a subject and try different approaches to accelerate my healing. So this is all about my experience and the strategies which helped me to manage it.

What’s it all about?

In short, Trapezial Myalgia is the inflammation of the trapezius muscle on one or both sides. The trapezius is very important functionally as it connects and provides stability to the neck, shoulder, and upper back. 

What did it feel like?

Trapezial Myalgia started with mild stiffness at the base of my neck, which quickly became a sharp pricking pain spreading all over from my upper back, shoulders, neck, and even chest. In 30 minutes, I was in significant pain and developed a throbbing headache. I also felt exhausted and anxious, my sleep was disturbed, and the fatigue and pain continued over the next 3 days.

 How do you get it?

Typical causes of Trapezial Myalgia are injuries caused by accidents such as a fall on your side that suddenly twists your neck.

Lifting my chin up higher rather than moving my head causing a poking chin posture as in my case.

A constant state of dehydration is where your urine is more coloured than it should be.

Lack of adequate sunlight exposure ie less than 15 min every day.

The 3 stages of healing and Strategies that helped.

Freezing stage

(Immediate after the injury and can last up to 2 days)

In this, you feel a continuous throbbing and a headache on the same side of the injury. The neck feels stuck and any movement to it aggravates the headache. The goal is to reduce pain. You can try the following

Alternate hot and cold compress- Do it for 3min every hour. Start with Cold for 1 min – Hot pack for 1 min and end it with a cold pack for 1 min. This will bring the local inflammation down and give pain relief.

Adequate hydration- 3-4 liters of water every day. It will help to flush the pain substance out and improve circulation.

Walk- Stroll ideally in sunlight for 15 -20 min.

Belly breathe- Be in any comfortable position. Breathe in through your nose such that the belly should come out and out by gently tucking the belly back in. Keep the shoulders and neck relaxed throughout. Breathe in counting 4 and out to the same count. Repeat 2 times every hour.

Stiffness stage( Last up to 3 days after the freezing stage)

There is minimal pain but a generalized stiffness and soreness in the area. Neck movements are still restricted and shoulder movements are slowly getting free.

Continue with Cold compress for 2 min every 2 hours.

Chin tucks- Be seated in a comfortable position and just move the chin to the back of your head keeping the head in line with the neck. You will feel some work at the back of the neck. Repeat 2-3 times every hour. Can do it lying on the back or on the chest too if comfortable.

Expose to sunlight for 15 min every day

Belly breathing.

Prevention of relapse stage( From the time you feel 70-80 % better)

This is the most important stage of healing. Posture awareness, breath, adequate sleep, and good nutrition play an important role.

Basic Suryanamaskars with focus on the form- Pause at each step for 3-5 breaths and can do 8-10 rounds as a beginner and work up to 12-24 rounds over 4 weeks. Focus on keeping the breathing even and the shoulders relaxed throughout the practice. Can end it with 3-5 rounds of seated or lying belly breathing.

Walk with arm swing 15-30 min every alternate day.

Chin tucks as above while working.

Belly breathing – 3-5 times every 90 min.

Look away from the monitor every 60 min for 2 min.

Mindfully relax the jaw, shoulders, and belly.

I hope all of these techniques help you to be pain-free and remain so… Move more and live better

Pain Management Physiotherapy

Five Hacks to Living Pain Free

Hello and welcome to my new blog on living pain-free and moving with ease. As a pain clinician, I am asked this question frequently by patients on how to live pain-free and move with ease so this blog is all about it. Here are a few things which have helped me and my patients and I hope they help you too.

Move regularly

Research shows that moving regularly throughout the day has significantly more benefits than packing all your movement in an exercises session of an hour or more. This is because we have movement maps in the brain and these maps get activated and sharpened as we move regularly. These maps make our moments smooth coordinated and efficient. So whatever your goal is whether it is to lose weight or to be pain-free move regularly. An ideal would be to move for 2 to 5 minutes every 60 minutes throughout the day. Your movement could be quick push-ups or an on spot jog or even a walk around the block.

Move with the purpose

Purposeful movements like walking to and fro to get groceries has more benefit than just walking as an exercise or on a treadmill this is because our brain activates centres of memory on previous experiences of movement, so there is better neuromuscular coordination and efficiency. this creates a state of balance and generates feel-good hormones like Serotonin, Dopamine, and Endorphins which help us remain pain-free.


Belly breathing is the best natural painkiller as it stimulates the parasympathetic system. When we push the belly out while breathing-in, we allow the diaphragm which is the respiratory muscle to come down. This gives more space for the lungs to fill with air. When we breathe out gently talking the belly in we allow the diaphragm to go back to its resting position and make the exhalation full and better. This is a safe movement for a brain which is in a state of overdrive trying to fight pain.  It also makes breathing efficient and generates feel good hormones. To belly breathe; start in a comfortable position like lying or sitting. Keep your shoulders relaxed. Breathe in through the nose such that the belly moves forward and breathe out gently while talking your belly in. Make sure to have movement in your belly rathan than your chest. You can also add a count to your inhalation and exhalation of about 4 seconds.

Vary your Movements

Put in a variety of movements in your day. You can sit, stand or even walk differently to add variety for e.g. Cross-leg sitting, side-sitting or long-sitting can be variations to regular floor sitting. you can also try walking in a figure of eight or heel to toe touch pattern. Stand with the outer border of your feet parallel to each other. Make a note of the movements which you don’t typically do and try to add them slowly during the day. By adding movement variety we use different motor patterns and many more muscles to complete tasks. This makes the movement patterns efficient and helps us to be pain-free.

Balance work

Put in at least 10 minutes of balance work in the day these are whole-body movements and they greatly improve our movement quality and coordination.

 Some of them are  Stand on one leg  without support of the wall or furniture and without leaning to any side for at least 30 seconds to a minute switch sides and repeat three to five times

 In the same way you can raise 1 leg to the side  about 5 to 10 cms from the ground. Hold and repeat as above.

  You can raise one leg  to the back and repeat as above.

 Try to walk on your heels or toes for a change for 3 to 5 min.

I hope these hacks help you be pain-free and be what you have always wanted to be.