Ortho rehabilitation and pain management

Free Consultancy 👉 𝟐𝟎% 𝐎𝐟𝐟 𝐎𝐧 𝐅𝐢𝐫𝐬𝐭 𝐒𝐞𝐬𝐬𝐢𝐨𝐧 🌟 𝐇𝐨𝐦𝐞 𝐒𝐞𝐫𝐯𝐢𝐜𝐞𝐬 𝐀𝐯𝐚𝐢𝐥𝐚𝐛𝐥𝐞
Relieve Pain Today! Our experienced physiotherapists offer sustainable solutions for all kinds of joint pains.

👉 Treatment for Lower Back Pain
👉 Shoulder Pain Relief
👉 Knee Pain Therapy
👉 Sciatica Treatment
👉 Neck Pain Solutions

Our physiotherapy services have transformed the lives of thousands, promoting health and vitality.

📞 Contact Number: 0302 4529060



𝐆𝐞𝐭 𝐑𝐞𝐥𝐢𝐞𝐟 𝐅𝐫𝐨𝐦 𝐏𝐚𝐢𝐧 𝐖𝐢𝐭𝐡𝐨𝐮𝐭 𝐀𝐧𝐲 𝐌𝐞𝐝𝐢𝐜𝐢𝐧𝐞 𝐀𝐧𝐝 𝐒𝐮𝐫𝐠𝐞𝐫𝐲.
درد سے مکمل نجات پائیں بغیر ادویات اور سرجری کے ۔
𝐁𝐨𝐨𝐤 𝐘𝐨𝐮𝐫 𝐀𝐩𝐩𝐨𝐢𝐧𝐭𝐦𝐞𝐧𝐭 𝐑𝐢𝐠𝐡𝐭 𝐍𝐨𝐰 𝐓𝐨 𝐥𝐢𝐯𝐞 𝐀𝐜𝐭𝐢𝐯𝐞 𝐋𝐢𝐟𝐞 ☆
بہترین اور پرسکون زندگی کے لیے ابھی اپنے ڈاکٹر سے رابطہ کریں۔

𝐎𝐔𝐑 𝐒𝐄𝐑𝐕𝐈𝐂𝐄𝐒

》𝐍𝐞𝐜𝐤 𝐏𝐚𝐢𝐧
》𝐒𝐡𝐨𝐮𝐥𝐝𝐞𝐫 𝐏𝐚𝐢𝐧
》𝐋𝐨𝐰 𝐁𝐚𝐜𝐤 𝐏𝐚𝐢𝐧
》𝐊𝐧𝐞𝐞 𝐏𝐚𝐢𝐧
》𝐒𝐭𝐫𝐨𝐤𝐞

𝐂𝐨𝐧𝐭𝐚𝐜𝐭 𝐔𝐬 0302 4529060
ابھی رابطہ کریں

𝐁𝐨𝐨𝐤 𝐘𝐨𝐮𝐫 𝐀𝐩𝐩𝐨𝐢𝐧𝐭𝐦𝐞𝐧𝐭

0302 4529060

𝐆𝐞𝐭 𝐑𝐞𝐥𝐢𝐞𝐟 𝐅𝐫𝐨𝐦 𝐲𝐨𝐮𝐫 𝐏𝐚𝐢𝐧 𝐖𝐢𝐭𝐡𝐨𝐮𝐭 𝐌𝐞𝐝𝐢𝐜𝐢𝐧𝐞𝐬 𝐚𝐧𝐝 𝐒𝐮𝐫𝐠𝐞𝐫𝐲

𝐁𝐨𝐨𝐤 𝐘𝐨𝐮𝐫 𝐀𝐩𝐩𝐨𝐢𝐧𝐭𝐦𝐞𝐧𝐭
Dr. Awais Habib

𝐆𝐞𝐭 𝐑𝐞𝐥𝐢𝐞𝐟 𝐅𝐫𝐨𝐦 𝐲𝐨𝐮𝐫 𝐏𝐚𝐢𝐧 𝐖𝐢𝐭𝐡𝐨𝐮𝐭 𝐌𝐞𝐝𝐢𝐜𝐢𝐧𝐞𝐬 𝐚𝐧𝐝 𝐒𝐮𝐫𝐠𝐞𝐫𝐲



Call us now

0302 4529060

50% for deserving people

𝐆𝐞𝐭 𝐑𝐞𝐥𝐢𝐞𝐟 𝐅𝐫𝐨𝐦 𝐲𝐨𝐮𝐫 𝐏𝐚𝐢𝐧 𝐖𝐢𝐭𝐡𝐨𝐮𝐭 𝐌𝐞𝐝𝐢𝐜𝐢𝐧𝐞𝐬 𝐚𝐧𝐝 𝐒𝐮𝐫𝐠𝐞𝐫𝐲

We are providing physiotherapy Services in Islamabad

#فالج
#لقوہ














فالج | لقوہ | پٹھوں کا درد |کمر درد| جوڑوں کا درد | پیدائشی معذوری | کندھے کا درد | عرق النساء| ہاتھ پاؤں کا سن ہو جانا |آپریشن کے بعد بحالی | پو لیو| معذور افراد کی بحالی | مہروں کے مسائل | ڈسک سلپ| ٹانگ یا بازو کا سن ہو جانا

𝐁𝐨𝐨𝐤 𝐘𝐨𝐮𝐫 𝐀𝐩𝐩𝐨𝐢𝐧𝐭𝐦𝐞𝐧𝐭 𝐑𝐢𝐠𝐡𝐭 𝐍𝐨𝐰 𝐓𝐨 𝐋𝐢𝐯𝐞 𝐀𝐜𝐭𝐢𝐯𝐞 𝐋𝐢𝐟𝐞𝐬𝐭𝐲𝐥𝐞.

OUR SERVICES:

》SCIATICA
》FROZEN SHOULDER
》STROKE REHAB
》CHRONIC BACK PAIN
》MUSCLE SPASM
》KNEE TRANSPLANT REHAB
》JOINTS PAIN /STIFFNESS
》SPORTS INJURIES

𝐂𝐨𝐧𝐭𝐚𝐜𝐭 𝐔𝐬 𝐍𝐨𝐰 :
ابھی رابطہ کریں۔
Dr. Awais Habib

0302 4529060

We are providing physiotherapy Services in Islamabad Dr. Awais Habib

#فالج
#لقوہ














فالج | لقوہ | پٹھوں کا درد |کمر درد| جوڑوں کا درد | پیدائشی معذوری | کندھے کا درد | عرق النساء| ہاتھ پاؤں کا سن ہو جانا |آپریشن کے بعد بحالی | پو لیو| معذور افراد کی بحالی | مہروں کے مسائل | ڈسک سلپ| ٹانگ یا بازو کا سن ہو جانا

𝐁𝐨𝐨𝐤 𝐘𝐨𝐮𝐫 𝐀𝐩𝐩𝐨𝐢𝐧𝐭𝐦𝐞𝐧𝐭 𝐑𝐢𝐠𝐡𝐭 𝐍𝐨𝐰 𝐓𝐨 𝐋𝐢𝐯𝐞 𝐀𝐜𝐭𝐢𝐯𝐞 𝐋𝐢𝐟𝐞𝐬𝐭𝐲𝐥𝐞.

OUR SERVICES:

》SCIATICA
》FROZEN SHOULDER
》STROKE REHAB
》CHRONIC BACK PAIN
》MUSCLE SPASM
》KNEE TRANSPLANT REHAB
》JOINTS PAIN /STIFFNESS
》SPORTS INJURIES

𝐂𝐨𝐧𝐭𝐚𝐜𝐭 𝐔𝐬 𝐍𝐨𝐰 :
ابھی رابطہ کریں۔

0302 4529060

Get Rid of Toxic Blood Before “RAMAZAN” Because “HIJAMA” is sunnah!

Grab this offer now!

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0302 4529060



Everyone Ortho rehabilitation and pain management

Pain relief from lower back without medicines

Free Consultation 24/7

Call us now
0302 4529060

Ortho rehabilitation and pain management
Everyone

𝐆𝐞𝐭 𝐑𝐞𝐥𝐢𝐞𝐟 𝐅𝐫𝐨𝐦 𝐏𝐚𝐢𝐧 𝐖𝐢𝐭𝐡𝐨𝐮𝐭 𝐀𝐧𝐲 𝐌𝐞𝐝𝐢𝐜𝐢𝐧𝐞 𝐀𝐧𝐝 𝐒𝐮𝐫𝐠𝐞𝐫𝐲.
درد سے مکمل نجات پائیں بغیر ادویات اور سرجری کے ۔

OUR SERVICES

》Neck pain
》Shoulder pain
》Low back pain
》 Knee pain
》 Stroke

𝐁𝐨𝐨𝐤 𝐘𝐨𝐮𝐫 𝐀𝐩𝐩𝐨𝐢𝐧𝐭𝐦𝐞𝐧𝐭 𝐑𝐢𝐠𝐡𝐭 𝐍𝐨𝐰 𝐓𝐨 𝐥𝐢𝐯𝐞 𝐀𝐜𝐭𝐢𝐯𝐞 𝐋𝐢𝐟𝐞 Style
بہترین اور پرسکون زندگی کے لیے ابھی اپنے ڈاکٹر سے رابطہ کریں۔

𝐂𝐨𝐧𝐭𝐚𝐜𝐭 𝐔𝐬 𝐍𝐨𝐰: 0302 4529060
ابھی رابطہ کریں۔
𝐕𝐢𝐬𝐢𝐭 𝐔𝐩𝐬𝐰𝐢𝐧𝐠 𝐑𝐞𝐡𝐚𝐛 𝐂𝐞𝐧𝐭𝐞𝐫 𝐋𝐚𝐡𝐨𝐫𝐞 𝐅𝐨𝐫 𝐂𝐨𝐧𝐬𝐭𝐢𝐭𝐮𝐭𝐢𝐨𝐧 𝐚𝐧𝐝 𝐓𝐫𝐞𝐚𝐭𝐦𝐞𝐧𝐭.
ایڈریس:

117 جی 4 بلاک جوہر ٹاون لاہور

𝐆𝐞𝐭 𝐑𝐞𝐥𝐢𝐞𝐟 𝐅𝐫𝐨𝐦 𝐏𝐚𝐢𝐧 𝐖𝐢𝐭𝐡𝐨𝐮𝐭 𝐀𝐧𝐲 𝐌𝐞𝐝𝐢𝐜𝐢𝐧𝐞 𝐀𝐧𝐝 𝐒𝐮𝐫𝐠𝐞𝐫𝐲.
درد سے مکمل نجات پائیں بغیر ادویات اور سرجری کے ۔
𝐎𝐮𝐫 𝐒𝐞𝐫𝐯𝐢𝐜𝐞𝐬

》𝐍𝐞𝐜𝐤 𝐏𝐚𝐢𝐧
》𝐒𝐡𝐨𝐮𝐥𝐝𝐞𝐫 𝐏𝐚𝐢𝐧
》𝐋𝐨𝐰 𝐁𝐚𝐜𝐤 𝐏𝐚𝐢𝐧
》 𝐊𝐧𝐞𝐞 𝐏𝐚𝐢𝐧
》 𝐒𝐭𝐫𝐨𝐤𝐞

𝐁𝐨𝐨𝐤 𝐘𝐨𝐮𝐫 𝐀𝐩𝐩𝐨𝐢𝐧𝐭𝐦𝐞𝐧𝐭 𝐑𝐢𝐠𝐡𝐭 𝐍𝐨𝐰 𝐓𝐨 𝐋𝐢𝐯𝐞 𝐀𝐜𝐭𝐢𝐯𝐞 𝐋𝐢𝐟𝐞𝐬𝐭𝐲𝐥𝐞.
بہترین اور پرسکون زندگی کے لیے ابھی اپنے ڈاکٹر سے رابطہ کریں۔
𝐂𝐨𝐧𝐭𝐚𝐜𝐭 𝐔𝐬 𝐍𝐨𝐰 :
ابھی رابطہ کریں۔
0302 4529060

𝐕𝐢𝐬𝐢𝐭 𝐔𝐩𝐬𝐰𝐢𝐧𝐠 𝐑𝐞𝐡𝐚𝐛 𝐂𝐞𝐧𝐭𝐞𝐫 𝐋𝐚𝐡𝐨𝐫𝐞, 𝐅𝐨𝐫 𝐂𝐨𝐧𝐬𝐮𝐥𝐭𝐚𝐭𝐢𝐨𝐧 𝐀𝐧𝐝 𝐓𝐫𝐞𝐚𝐭𝐦𝐞𝐧𝐭.

ایڈریس:

117 جی 4 بلاک جوہر ٹاون لاہور





Vist us on YouTube for physiotherapy community awareness programe

https://www.youtube.com/watch?v=f9LTE5dKHkY

𝐆𝐞𝐭 𝐑𝐞𝐥𝐢𝐞𝐟 𝐅𝐫𝐨𝐦 𝐏𝐚𝐢𝐧 𝐖𝐢𝐭𝐡𝐨𝐮𝐭 𝐀𝐧𝐲 𝐌𝐞𝐝𝐢𝐜𝐢𝐧𝐞 𝐀𝐧𝐝 𝐒𝐮𝐫𝐠𝐞𝐫𝐲.
درد سے مکمل نجات پائیں بغیر ادویات اور سرجری کے ۔
𝐎𝐮𝐫 𝐒𝐞𝐫𝐯𝐢𝐜𝐞𝐬

》𝐍𝐞𝐜𝐤 𝐏𝐚𝐢𝐧
》𝐒𝐡𝐨𝐮𝐥𝐝𝐞𝐫 𝐏𝐚𝐢𝐧
》𝐋𝐨𝐰 𝐁𝐚𝐜𝐤 𝐏𝐚𝐢𝐧
》 𝐊𝐧𝐞𝐞 𝐏𝐚𝐢𝐧
》 𝐒𝐭𝐫𝐨𝐤𝐞

𝐁𝐨𝐨𝐤 𝐘𝐨𝐮𝐫 𝐀𝐩𝐩𝐨𝐢𝐧𝐭𝐦𝐞𝐧𝐭 𝐑𝐢𝐠𝐡𝐭 𝐍𝐨𝐰 𝐓𝐨 𝐋𝐢𝐯𝐞 𝐀𝐜𝐭𝐢𝐯𝐞 𝐋𝐢𝐟𝐞𝐬𝐭𝐲𝐥𝐞.
بہترین اور پرسکون زندگی کے لیے ابھی اپنے ڈاکٹر سے رابطہ کریں۔
𝐂𝐨𝐧𝐭𝐚𝐜𝐭 𝐔𝐬 𝐍𝐨𝐰 :
ابھی رابطہ کریں۔

0302 4529060

𝐕𝐢𝐬𝐢𝐭 𝐔𝐩𝐬𝐰𝐢𝐧𝐠 𝐑𝐞𝐡𝐚𝐛 𝐂𝐞𝐧𝐭𝐞𝐫 𝐋𝐚𝐡𝐨𝐫𝐞, 𝐅𝐨𝐫 𝐂𝐨𝐧𝐬𝐮𝐥𝐭𝐚𝐭𝐢𝐨𝐧 𝐀𝐧𝐝 𝐓𝐫𝐞𝐚𝐭𝐦𝐞𝐧𝐭.

ایڈریس:

117 جی 4 بلاک جوہر ٹاون لاہور

We are providing physiotherapy services in lahore.
Our services;
Neck Pain
Back Pain
Sciatica
Stroke rehabilitation
Cp child
Frozen shoulder
Shoulder pain
Disc slip
Home physiotherapy services also available…
We have 6 years of experience in physical therapy department..
Please visit our Clinic in lahore johar town


.

Contact us :

0302-4529060

🟥 𝗟𝗢𝗪𝗘𝗥 𝗕𝗔𝗖𝗞 𝗣𝗔𝗜𝗡 & 𝗖𝗢𝗖𝗖𝗬𝗗𝗬𝗡𝗜𝗔 🟥

میڈیسن اور سرجری کے بغیر علاج

Dr. Awais Habib - Physiotherapist
(Clinical physiotherapist
Sports Physiotherapist
Chiropractor/Pain Specialist/PT)

0302-4529060






Home physiotherapist in Lahore

Book your appointment with best Physiotherapist in lahore johar Town for your health issues

pain
pain

Overcome your sports injury with our physiotherapy treatment !
Sports and Physical Activity Physiotherapists are involved in the prevention and management of injuries caused by engagement in sports and exercise at all ages and levels of skill. These professional physiotherapists offer evidence-based guidance on safe sport and exercise participation

Consult with us for more details
📞923024529060

گوشت کھانے میں اعتدال برتیں

Ortho rehabilitation and pain management
Book your appointment now
03024529060

Sleep disorders in the elderly
Compared with younger people, elderly people show age-related sleep changes, including an advanced sleep phase and decreased slow-wave sleep, which result in fragmented sleep and early awakening. People with chronic insomnia may have trouble falling asleep. Others wake up several times during the night, or wake up too early and are unable to fall back asleep. During the day, they often feel fatigued, are irritable, and have poor concentration and energy. Chronic insomnia also increases the risk of accidents such as falls and other health conditions, like depression, diabetes, heart disease, and cognitive impairment.
Understanding the causes of insomnia in your elderly parent and changing certain habits can help improve sleep.
1) Primary sleep disorders
Sleep apnea syndrome
Restless legs syndrome, periodic limb movement disorder
Rapid eye movement sleep behavior disorder
Circadian rhythm sleep‐wake disorders (advanced and delayed sleep‐wake phase disorder)
(2) Acute and chronic medical illness
Allergy (allergic rhinitis, hay fever); Pain (arthritis, musculoskeletal pain); Cardiovascular (heart failure, acute coronary syndrome); Pulmonary (pneumonia, chronic obstructive pulmonary disease); Metabolic (diabetes, thyroid disorders), Gastrointestinal (gastroesophageal reflux disease, constipation/diarrhea, acute colitis, gastric ulcer); Urinary (nocturia, incontinence, overactive bladder, benign prostate hypertrophy for men); Psychiatric diseases (depression, anxiety, psychosis, delirium, alcoholism); Neurological disorders (Alzheimer's disease, Parkinson's disease, cerebrovascular disease, epilepsy); Pruritus; Menopause
(3) Behavioral causes and psychological/physical stressors
Daytime napping; go to bed too early; use the bed for other activities (watching TV, reading); lack of exercise during daytime; death of a partner/spouse; loneliness; hospitalization
(4) Environmental causes
Noise, light, cold/hot temperature, humidity, uncomfortable bedding, lack of light exposure during daytime
(5) Medications
Psychostimulants; antidepressants (selective serotonin reuptake inhibitors); antihypertensives (beta‐blocker, alpha‐blocker); antiparkinsonian drugs (levodopa); bronchodilators (theophylline); steroids; antihistamines (H1 and H2 blockers); anticholinergics; alcohol; interferons
Chronic insomnia disorder
Criteria A‐F must be met
A. The patient reports, or the patient's parent or caregiver observes, one or more of the following:
1. Difficulty initiating sleep.
2. Difficulty maintaining sleep.
3. Waking up earlier than desired.
4. Resistance to going to bed on appropriate schedule.
5. Difficulty sleeping without parent or caregiver intervention.
B. The patient reports, or the patient's parent or caregiver observes, one or more of the following related to the nighttime sleep difficulty:
1. Fatigue/malaise.
2. Attention, concentration, or memory impairment.
3. Impaired social, family, occupational, or academic performance.
4. Mood disturbance/irritability.
5. Daytime sleepiness.
6. Behavioral problems (eg, hyperactivity, impulsivity, aggression).
7. Reduced motivation/energy/initiative.
8. Proneness for errors/accidents.
9. Concerns about or dissatisfaction with sleep.
C. The reported sleep/wake complaints cannot be explained purely by inadequate opportunity (ie, enough time is allotted for sleep) or inadequate circumstances (ie, the environment is safe, dark, quiet, and comfortable) for sleep.
D. The sleep disturbance and associated daytime symptoms occur at least three times per week.
E. The sleep disturbance and associated daytime symptoms have been present for at least 3 mo
F. The sleep/wake difficulty is not better explained by another sleep disorder.
Sleep hygiene
(1) Regular exercise
Take regular exercise. Adequate aerobic exercise improves the ability to fall asleep. Exercise in the early morning and early evening promotes deep sleep and improves sleep quality; however, exercise just before bedtime should be avoided.
(2) Bedroom environment
Keep bedroom dark and quiet. Noises and dim light can interrupt sleep. Maintain a comfortable bedroom temperature (below 24 degrees Celsius [75 degrees Fahrenheit]). During the summer season, consider using an air conditioner.
(3) Regular meals
Keep regular eating patterns, 3 times/day. When you feel hungry, eat a light snack (cheese, milk, nuts, or carbohydrates) but avoid heavy meals before bedtime.
(4) Limit fluid intake before bedtime
Limit fluid intake before bedtime to reduce the frequency of urination during sleep. In cases of cerebral infarction or angina pectoris, follow the instructions of your primary physician.
(5) Avoid caffeine
Caffeine intake before bedtime may result in sleep‐initiation and maintenance problems. Limit caffeinated foods and beverages (Green tea, tea, coffee, cola, and chocolate) to the equivalent of three cups of coffee and ingest them no later than 4 h before bedtime.
(6) Avoid alcohol
Limit alcoholic beverages, which may promote sleep initiation but cause fragmented and unrefreshing sleep.
(7) Avoid smoking
Avoid smoking in the evening. Ni****ne acts as a stimulant, interfering with sleep

Transcutaneous Electrical Nerve Stimulation (TENS).....

Introduction.

TENS is a method of electrical stimulation which primarily aims to provide a degree of symptomatic pain relief by exciting sensory nerves and thereby stimulating either the pain gate mechanism and/or the opioid system. The different methods of applying TENS relate to these different physiological mechanisms. The effectiveness of TENS varies with the clinical pain being treated, but research would suggest that when used ‘well’ it provides significantly greater pain relief than a placebo intervention. There is an extensive research base for TENS in both the clinical and laboratory settings and whilst this summary does not provide a full review of the literature, the key papers are referenced. It is worth noting that the term TENS could represent the use of ANY electrical stimulation using skin surface electrodes which has the intention of stimulating nerves. In the clinical context, it is most commonly assumed to refer to the use of electrical stimulation with the specific intention of providing symptomatic pain relief. If you do a literature search on the term TENS, do not be surprised if you come across a whole lot of ‘other’ types of stimulation which technically fall into this grouping.

The illustrations shows a 2 channel TENS unit as it has 4 lead wires (Each channel has two lead wires) with electrode pads attached.

Mechanism of Action
The type of stimulation delivered by the TENS unit aims to excite (stimulate) the sensory nerves, and by so doing, activate specific natural pain relief mechanisms. For convenience, if one considers that there are two primary pain relief mechanisms which can be activated : the Pain Gate Mechanism and the Endogenous Opioid System, the variation in stimulation parameters used to activate these two systems will be briefly considered.

Pain relief by means of the pain gate mechanism involves activation (excitation) of the A beta (Aβ) sensory fibres, and by doing so, reduces the transmission of the noxious stimulus from the ‘c’ fibres, through the spinal cord and hence on to the higher centres. The Aβ fibres appear to appreciate being stimulated at a relatively high frequency HF (in the order of 90 - 130 Hz or pps). It is difficult to find support for the concept that there is a single frequency that works best for every patient, but this range appears to cover the majority of individuals. Clinically it is important to enable the patient to find their optimal treatment frequency – which will almost certainly vary between individuals. Setting the machine and telling the patient that this is the ‘right’ setting is almost certainly not going to be the maximally effective treatment, though of course, some pain relief may well be achieved.

An alternative approach is to stimulate the A delta (Aδ) fibres which respond preferentially to a much low frequency LF (in the order of 2 - 5 Hz), which will activate the opioid mechanisms, and provide pain relief by causing the release of an endogenous op**te (encephalin) in the spinal cord which will reduce the activation of the noxious sensory pathways. In a similar way to the pain gate physiology, it is unlikely that there is a single (magic) frequency in this range that works best for everybody – patients should be encouraged to explore the options where possible.[1]

A third possibility is to stimulate both nerve types at the same time by employing a burst mode stimulation. In this instance, the higher frequency stimulation output (typically at about 100Hz) is interrupted (or burst) at the rate of about 2 - 3 bursts per second. When the machine is ‘on’, it will deliver pulses at the 100Hz rate, thereby activating the Aβ fibres and the pain gate mechanism, but by virtue of the rate of the burst, each burst will produce excitation in the Aδ fibres, therefore stimulating the opioid mechanisms. For some patients this is by far the most effective approach to pain relief, though as a sensation, numerous patients find it less acceptable than some other forms of TENS as there is more of a ‘grabbing’, ‘clawing’ type sensation and usually more by way of muscle twitching than with the high or low frequency modes.

TENS as a treatment technique is non invasive and has few side effects when compared with drug therapy. The most common complaint is an allergic type skin reaction (about 2-3% of patients) and this is almost always due to the material of the electrodes, the conductive gel or the tape employed to hold the electrodes in place. Most TENS applications are now made using self adhesive, pre gelled electrodes which have several advantages including reduced cross infection risk, ease of application, lower allergy incidence rates and lower overall cost. Digital TENS machines are becoming more widely available and extra features (like automated frequency sweeps and more complex stimulation patterns) are emerging, though there remains little clinical evidence for enhanced efficacy at the present time. Some of these devices do offer pre-programmed and/or automated treatment settings.

Impedence of Current Flow
The quantity of current that flow in the tissues depend on impedance of that pathway.The impedance include oh-mic resistance and inductive resistance. The inductive resistance negligible in the tissues . Generally,watery tissue as blood,muscle and nerve has low ohmic resistance :bone and fat has higher and epidermis has the highest of all.

Types of TENS
Conventtional TENS(High) Acupuncture-like TENS(Low) Brief Intense TENS
Physiological Intervention To activate large diameter non-notious afferent to elicit segmental analgesia. To produce muscle twitch to activate small diameter motor affrent to elicit extra segmental analgesia. To activate small diameter noxious affrents to elicit peripheral nerve blockade and extrasegmental analgesia.
Clinical Teqnique Low intensity \High Frequency at site of pain to produce strong but comfrtable sensation. High intensity\Low frequency over muscle or Acupuncture points to produce strong but comfortable contraction. High intensity \High frequency to produce maximum parathesia
Duration of stimulation 30 min No more than 20 min no more than 5 min.

Electrode Placement Technique
this is determined by the target muscle or muscle group either single or in relation to other muscles

Unilateral : Unilateral placement causes inflammation of one limb or half of muscle pair.
Bilateral : It allow the stimulation of both limbs or both halves of a muscle Pair
Uni-polar : Only one of two essential leads and the electrode connected to it are placed over the target area affected by the stimulation This electrode is called treatment electrode.
Quadripolar : Involve the use of two sets of electrode each originating from its own channel. It may be considered the concurrent application of two bipolar circuit. This technique could be used with stimulation of agonist and antagonist. Also could be used in crossed pattern or for large flat area as back.

Contraindications..........

Patients who do not comprehend the physiotherapist’s instructions or who are unable to co-operate
It has been widely cited that application of the electrodes over the trunk, abdomen or pelvis during pregnancy is contraindicated BUT a recent review suggests that although not an ideal (first line) treatment option, application of TENS around the trunk during pregnancy can be safely applied, and no detrimental effects have been reported in the literature (see www.electrotherapy,org for publication details).TENS during labour for pain relief is both safe and effective.
Patients with a Pacemaker should not be routinely treated with TENS though under carefully controlled conditions it can be safely applied. It is suggested that routine application of TENS for a patient with a pacemaker or any other implanted electronic device should be considered a contraindication.
Patients who have an allergic response to the electrodes, gel or tape
Electrode placement over dermatological lesions e.g. dermatitis, eczema
Application over the anterior aspect of the neck or carotid sinus[4]

Precautions.........

If there is abnormal skin sensation, the electrodes should preferably be positioned elsewhere to ensure effective stimulation
Electrodes should not be placed over the eyes
Patients who have epilepsy should be treated at the discretion of the therapist in consultation with the appropriate medical practitioner as there have been anecdotal reports of adverse outcomes, most especially (but not exclusively) associated with treatments to the neck and upper thoracic areas
Avoid active epiphyseal regions in children (though there is no direct evidence of adverse effect)
The use of abdominal electrodes during labour may interfere with foetal monitoring equipment and is therefore best avoided.

The Evidence for TENS for Pain Control
A 2020 review suggests that the use of TENS has positive outcomes in treatment of Primary Dysmenorrhea[5].

A 2014 study set out to provide a critical review of the latest basic science and clinical evidence for TENS. Key findings were:

Application of TENS at inadequate intensities is one of the primary factors attributed to conflicting reports of TENS efficacy. Using the strongest intensity that remains comfortable produces hypoalgesia in healthy subjects is imperative; lower intensities are ineffective. In addition to activation of greater numbers of sensory afferents, higher pulse amplitudes are proposed to activate deeper tissue afferents allowing for greater analgesia. High intensity TENS decreases post-operative opioid requirements and negative opioid-side effects.
Both High Frequency(HF) and Low Frequency(LF) TENS been shown to provide analgesia specifically when applied at a strong, non-painful intensity. HF TENS may be more effective for people taking opioids.
Effective analgesia for chronic pain conditions may be limited by the development of tolerance to TENS if repeated application of either HF or LF TENS at the same frequency, intensity and pulse duration is used daily.
Application of TENS electrodes at acupoint sites may increases analgesia and targeting the use of TENS during movement or required activity may provide the most benefit.
Systematic reviews suggest that TENS, when applied at adequate intensities, is effective for postoperative pain, osteoarthritis, painful diabetic neuropathy and some acute pain conditions.
Emerging evidence suggests TENs may be helpful for peoples with fibromyalgia and spinal cord injury.
TENS may be effective in restoration of central pain modulation, a measure of central inhibition.[1].

What is the labrum?
The labrum is a type of cartilage found in the shoulder joint. The shoulder is a ball-and-socket joint where the arm meets the body. The arm bone (humerus) forms a ball at the shoulder that meets the socket, which is part of the shoulder blade. These two bones are connected by ligaments — tough tissues forming tethers that hold the bones in relationship to each other.

There are two kinds of cartilage in the joint. The first type is the white cartilage on the ends of the bones (articular cartilage) which allows the bones to glide and move on each other. When this type of cartilage starts to wear out (a process called arthritis), the joint becomes painful and stiff.
The labrum is a second kind of cartilage in the shoulder, which is distinctly different from the articular cartilage. This cartilage is more fibrous or rigid than the cartilage on the ends of the ball and socket. Also, this cartilage is also found only around the socket where it is attached.

🔴What is the function of the labrum?
The labrum has two functions. The first is to deepen the socket so that the ball stays in place. Picture the shoulder joint as a beach ball on a dinner plate. The ball of the humerus (the “beach ball”) is much larger than the flat socket (the “dinner plate”). The ligaments are the tethers that go from bone to bone and hold them together to help keep the ball in the socket. The other way the ball is kept in the socket is the labrum.

The labrum is a thick tissue or type of cartilage that is attached to the rim of the socket and essentially forms a bumper that deepens the socket and helps keep the ball in place. In individuals where the labrum is too small or is torn due to an injury, the ball may slide part of the way out of the socket (subluxation) or all the way out of the socket (dislocation). The labrum goes all the way around the socket and in most areas is firmly attached to the bone of the socket.

The second function of the labrum is as an attachment of other structures or tissues around the joint. For example, the ligaments that help hold the joint together attach to the labrum in certain key locations. If there is an injury to the shoulder that tears the ligaments, sometimes the labrum is pulled off of the rim of the bone as well.

This injury usually involves a subluxation or dislocation of the shoulder and is usually due to trauma. The ball of the shoulder can dislocate toward the front of the shoulder (an anterior dislocation) or it can go out the back of the shoulder (called a posterior dislocation). In either case the labrum can be torn off of the bone. Usually when this happens the labrum does not heal back in the right location. Whether the joint continues to be unstable depends upon many factors.

The other structure that attaches to the labrum is the tendon of the biceps muscle. The biceps muscle is the muscle on the front of the arm which gets firm with bending the elbow. While this muscle is quite large, it turns into a small tendon about the size of a pencil that attaches inside the shoulder joint. At the other end of the muscle is a large tendon that attaches beyond the elbow in the forearm. The portion that attaches in the shoulder actually goes through a small hole in the rotator cuff tendons designed specifically for that tendon.

Once inside the joint, the tendon is attached in part to the bone near the socket and in part to the labrum at the top of the joint. This tendon can get torn where it attaches to the bone, where it attaches to the labrum or at both locations.

🔴What is a labrum tear?

A labrum tear can take several forms, and it is very easy to confuse these types. As a result, it is important that you discuss with your physician exactly what type of tear you have.

ℹ️The first type of tear is one where the labrum is torn completely off of the bone. This is usually associated with an injury to the shoulder in which the shoulder has subluxated or dislocated. Sometimes this type of tear occurs and the individual does not realize that the shoulder has slid out of the socket.

ℹ️The second type of labrum tear is tearing within the substance of the labrum itself. The edge of the labrum over time may get frayed so that the edge is not smooth. This type of tearing is quite common and rarely causes symptoms. It is seen frequently in the shoulder as people get older (over 40 years of age). Sometimes the labrum may have a large tear where a portion of the labrum gets into the joint and causes clicking and catching as the ball moves around in the socket. This type of tear is very rare, and most labrum tears do not cause these symptoms.

ℹ️A third type of labrum tear is in the area where the biceps tendon attaches to the upper end of the socket. The socket can be divided into four regions: anterior (front), posterior (back), superior (the upper end near your head) or inferior (the lower end, which is toward the elbow).

The biceps tendon attaches at the superior end, where it blends in with the labrum. The labrum runs from there around the joint, both in an anterior and in a posterior direction. Due to injury in this area where the biceps tendon attaches, the labrum also can get injured. The injury in this area can be mild or it can be severe. Because the injury typically involves the biceps tendon and the labrum, because it is at the superior end of the socket and because it can affect the labrum attachments anterior and posterior to where the biceps attaches in this region, the acronym or abbreviation for this injury is a SLAP lesion. 🔑This stands for an injury that is superior labrum anterior and posterior.

There have been several grading systems or classification systems of this injury. In a lesser injury, the labrum is only partially detached in this area. In a more severe injury, the whole labrum is pulled off of the bone along with the biceps tendon. The most common classification divides SLAP lesions into four types.

🔴Exercises to Help a Shoulder Labral Tear

➡️Wall Stretches
Stand facing a wall, six inches away.
Lean forward with your hands above your head and rest your arms against the wall.
Gently lean your body forward, crawl your hands up the wall, and hold for 20 seconds.
Perform three times.

➡️Lateral Raises
Stand with your arms at your side.
If possible, use a lightweight (1 to 5 pounds), extend your arms up and away from your body to shoulder height, hold for five seconds, then release.
Perform three sets of 10 to 12 repetitions.

➡️Lying Down Shoulder Flex
Lie on your side — hurt shoulder toward the ceiling — with your hips and knees slightly bent.
If possible, use a lightweight (1 to 5 pounds), extend your arm straight and parallel with your body, and raise it toward the ceiling.
Raise your arm toward the ceiling and hold at a 45-degree angle for five seconds, then release.
Perform three sets of 10 to 12 repetitions.

➡️External Rotation Diagonal Up
Anchor a resistance band at knee level to a sturdy pole.
Stand to the side with your hurt shoulder opposite the side where the band is anchored.
Reach across the front of your body and pull the band up and above your shoulder, hold for five seconds, then release back down.
Perform three sets of 10 to 12 repetitions.

➡️External Rotation 90 Degrees
Anchor a resistance band at shoulder level to a sturdy pole.
Stand in front of where the band is anchored.
Pull the band up and over your shoulder, extending it forward away from your body, and hold for five seconds, then release.
Perform three sets of 10 to 12 repetitions.

➡️Cross-Body Stretch

Lie on your side ­— hurt shoulder toward the ground ­— with your hips and knees slightly bent.
Extend your lower arm out perpendicular to your body.
With your other hand, reach across your body and grab your opposite elbow.
Pull upward until you feel a slight stretch, hold for 30 seconds, then release.
Perform twice.

➡️Prone Row to External Rotation
Lie face down on a bed or couch where you can hang your arm down loosely.
If possible, use a lightweight (1 to 5 pounds) and bring your arm up to your side and hold for five seconds.
Raise your arm toward the ceiling as far as comfortably possible and hold for another five seconds, then release to the ground.
Perform three sets of 10 to 12 repetitions.

🔴Safety Considerations
These and other exercises are meant to relieve pain, not cause it. You should feel a mild to moderate stretch only. If any of the above exercises causes or increases pain, decrease your level of effort or number of repetitions until it stops hurting.If the pain continues, stop doing the exercises.