Ortho

A 26-year-old banker visited the PT department with medical diagnosis of left ankle sprain. The
patient mentioned that she got injured while descending the stairs 4 weeks back. Her X-ray
confirmed ligamentous damage.

Her chief complaint was pain majorly on lateral and dorsal aspect of left ankle which was recorded
as 5/10 on visual analog scale. She complaint of aggravation in pain while prolonged standing, and
palpation on lateral or dorsal aspect of foot and ankle. She was also, having difficulty in moving in
and out of car or even walking at moderate pace, to avoid this discomfort, patient was wearing
crepe bandage to support ankle. While assessment, all vitals were found to be normal. Slight edema
was present on lateral aspect of dorsum of left foot with decreased ankle eversion and inversion
strength, which was noted 3+/5 on Manual Muscle Testing (Daniel’s and Worthingham). The patient
took 16 visits in time span of 4 weeks. The short goals were to decrease pain and swelling while long
term goals were to improve muscle strength and flexibility, enhance stability, proprioception and
facilitate return to activities of daily living. Her treatment was initiated with soft tissue mobilization,
cryotherapy for 10 minutes (Bleakly c et al., 2004) in raised position of ankle an IFT for edema
control and pain control. Distal Fibular Mobilization with movement in anterior and posterior
direction (Brian R Mulligan 1993) was done to improve movement.

Her treatment was designed according to the Kisner and Colby which included as isometrics and
then progressed to TheraBand exercises with resistance level adjusted as per the comfort and ability
of patient along with strengthening of hip abductors, extensors, knee flexors and extensors; a weight
bearing to weight shifting exercises, calf raises, step-up marchers on trampoline, clamps, wobble
board, lunges, calf and hamstring stretches.

As a result, the rating on Visual Analog Scale came down to zero in 8 visits and 90% of movement
was regained in 10 visits. But patient continued physiotherapy sessions on my advice for strength
training to avoid recurrence of injury to the ankle which resulted into improved muscle strength and
endurance at the end of the treatment.
 Cardio

A 60 year old police officer came to the department by the reference of his cardiologist with the case
of coronary heart disease .He was reffered for the complaint of shortness of breath ,chest pain and
excessive fatigue on exertion.He was having difficulty in walking because of fatigue and shortness of
breath.He was having an active lifestyle before coronary heart disease and was depressed because
of inability to perform his activities of daily living because of illness.

During assessment I found that his heart rate was 80 beats per minute,his blood pressure was
140/90 mmHg and oxygen saturation at 95% on room air.His lung sounds were clear.He had
decreased exercise tolerance ,with a six-minute walk distance of only 200 meters (American heart
association,2008).

I designed an exercise programme for him in such a manner that targets to improve his exercise
tolerance and reduce his symptoms.I made him do stationary bike cycling for 20-30 minutes and
monitored walk on treadmill .I also started resistance training using weights and resistance bands to
strengthen his upper and lower extremities.I also did stretching for all major muscles to imprve
flexibility.

I also counselled patient to motivate him for better lifestyle and cease smoking and do regular
physical activity with healthy diet.

Eventually, after 6 weeks of physiotherapy patient exhibited significant improvement in his

A 31 years female presented with a case if bell’s palsy on her left side of face . She had dropping of
left eyelid and mouth and was unable to close her eyes completely and she was also had difficulty in
speaking , drinking water , eating and she also head pain behind her left year . She had no relevant
medical history with no hearing loss .

First and formost I performed facial muscle examination in which I assessed the strength and tone
of the facial muscle on the effected side in which I found out the significant weakness in left side
facial muscle including orbicularis oris, oculi and zygomaticus muscles . After this I checked sensory
examination of left side of face in which patient reported some degree of numbness and tingling and
I did range of motion examination in which patient showed limitation in range of motion of smiling ,
raising eyebrow and puckring lips and I also assessed the patient on the basis of activities of daily
living viz. speaking , eating, drinking in which patient reported difficulties in all these activities .

After a throw examination I planned a customized treatment plan for her which included facial
exercise ( Coulson and O’ Tode, 2018) in which patient was instructed to smile widely , puckering
lips and raising the eyebrow biofeedback , She was advice to repeat these exercises with set of 10
repetitions thrice a day

I also did massage ( Nitchai et al. , 2018) and electrical stimulation on the effected site for 20
minutes thrice a week ( Deol , G.S. , & Bhatia, M, 2017) . I also made sure that patient perform all the
exercises at home given as home program to her. Additionally I also educated the patient about
avoiding exposure to extreme temperature , and also advised to protect his eye by using artificial
tears and wearing and eye patch during sleep .

After 4 weeks of physiotherapy treatment, the patient recovered significantly . She was able to eat
and drink without drooling and she had no pain behind the ear and her eyelids were blinking without
drooping.
 Knee Replacement

A 55 years male presented with knee replacement surgery of bilateral knee (4 weeks ago) , after
severe osteoarthritis . He was having pain and swelling in both knees with limited range of motion .
His lower limb muscles especially quadriceps and hamstring . He was having difficulty in activities of
daily living including standing up from chair , walking and climbing stairs . According to the position
of patient I developed a treatment plan in which short term goals were to decrease pain and
swelling and increase range of motion and long term goals were to improve muscle strength and gait
pattern and meet the normal activities of daily living, for that I included range of motion exercise to
improve range of motion of joint by doing flexion and extension exercises and passive range of
motion exercises. I also emphasized on strengthening exercises isometric exercise for knee and hip ,
lunges , step-ups , straight leg raise ( Liao CD,Tsauo JY, Huang, SW, Ku JW, Hsiao DJ, Liou TH Journal,
Archives of Physical Medicine and Rehabilitation, 2013) .

I also did manual therapy techniques such as massage . mobilization and stretching to reduce pain
and swelling, along with this I also gave him gait training to improve his walking pattern (Jons D ,
Westby MD, Journal of Orthopedic & Sports physical therapy)

I also counselled patient for importance of home exercise program, good posture and management
of pain & swelling .

After 6 weeks patient improved significantly. Hi pain and swelling were diminished , he had
improved range of motion with good muscle strength . He was able to perform activities of daily
living with ease & with a home exercise plan focusing on strength and endurance training patient
was discharge.