Patient Education

Lipid Disorder (High blood cholesterol)

Cholesterol is a waxy substance that’s found in the fats (lipids) in your blood. While your body needs cholesterol to continue building healthy cells, having high cholesterol can increase your risk of heart disease.
When you have high cholesterol, you may develop fatty deposits in your blood vessels. Eventually, these deposits make it difficult for enough blood to flow through your arteries. Your heart may not get as much oxygen-rich blood as it needs, which increases the risk of a heart attack. Decreased blood flow to your brain can cause a stroke.
High cholesterol can be inherited, but it’s often the result of unhealthy lifestyle choices, and thus preventable and treatable. A healthy diet, regular exercise and sometimes medication can go a long way toward reducing high cholesterol.

High cholesterol has no symptoms. A blood test is the only way to detect high cholesterol.

Cholesterol is carried through your blood, attached to proteins. This combination of proteins and cholesterol is called a lipoprotein. You may have heard of different types of cholesterol, based on what type of cholesterol the lipoprotein carries. They are:
1. Low-density lipoprotein (LDL). LDL, or “bad,” cholesterol transports cholesterol particles throughout your body. LDL cholesterol builds up in the walls of your arteries, making them hard and narrow.
2. High-density lipoprotein (HDL). HDL, or “good,” cholesterol picks up excess cholesterol and takes it back to your liver.

Factors within your control such as inactivity, obesity and an unhealthy diet contribute to high LDL cholesterol and low HDL cholesterol.

Factors beyond your control may play a role, too. For example, your genetic makeup may keep cells from removing LDL cholesterol from your blood efficiently or cause your liver to produce too much cholesterol.
Risk factors
Factors that may increase your risk of high cholesterol include:
1. Poor diet. Eating saturated fat, found in animal products, and trans fats, found in some commercially baked cookies and crackers, can raise your cholesterol level. Foods that are high in cholesterol, such as red meat and full-fat dairy products, will also increase your total cholesterol.
2. Obesity. Having a body mass index (BMI) of 30 or greater puts you at risk of high cholesterol.
3. Large waist circumference. Your risk increases if you are a man with a waist circumference of at least 40 inches (102 centimeters) or a woman with a waist circumference of at least 35 inches (89 centimeters).
4. Lack of exercise. Exercise helps boost your body’s HDL, or “good,” cholesterol while increasing the size of the particles that make up your LDL, or “bad,” cholesterol, which makes it less harmful.
5. Smoking. Cigarette smoking damages the walls of your blood vessels, making them likely to accumulate fatty deposits. Smoking may also lower your level of HDL, or “good,” cholesterol.
6. Diabetes. High blood sugar contributes to higher LDL cholesterol and lower HDL cholesterol. High blood sugar also damages the lining of your arteries.

High cholesterol can cause atherosclerosis, a dangerous accumulation of cholesterol and other deposits on the walls of your arteries. These deposits (plaques) can reduce blood flow through your arteries, which can cause complications, such as:
1. Chest pain. If the arteries that supply your heart with blood (coronary arteries) are affected, you may have chest pain (angina) and other symptoms of coronary artery disease.
2. Heart attack. If plaques tear or rupture, a blood clot may form at the plaque-rupture site — blocking the flow of blood or breaking free and plugging an artery downstream. If blood flow to part of your heart stops, you’ll have a heart attack.
3. Stroke. Similar to a heart attack, if blood flow to part of your brain is blocked by a blood clot, a stroke occurs.

Heart-healthy lifestyle changes that can lower your cholesterol can help prevent you from having high cholesterol in the first place as well. To help prevent high cholesterol, you can:
1. Eat a low-salt diet that includes many fruits, vegetables and whole grains
2. Limit the amount of animal fats and use good fats in moderation.
3. Lose extra pounds and maintain a healthy weight
4. Quit smoking
5. Exercise on most days of the week for at least 30 minutes
6. Drink alcohol in moderation, if at all.

Hypothyroidism (underactive thyroid)

Hypothyroidism is a condition in which your thyroid gland doesn’t produce enough of certain crucial hormones.

Hypothyroidism may not cause noticeable symptoms in the early stages. Over time, untreated hypothyroidism can cause a number of health problems, such as obesity, joint pain, infertility and heart disease.

Accurate thyroid function tests are available to diagnose hypothyroidism. Treatment with synthetic thyroid hormone is usually simple, safe and effective once you and your doctor find the right dose for you.

The signs and symptoms of hypothyroidism vary, depending on the severity of the hormone deficiency. Problems tend to develop slowly, often over a number of years.

At first, you may barely notice the symptoms of hypothyroidism, such as fatigue and weight gain. Or you may simply attribute them to getting older. But as your metabolism continues to slow, you may develop more-obvious problems.
Hypothyroidism signs and symptoms may include:
1. Fatigue
2. Increased sensitivity to cold
3. Constipation
4. Dry skin
5. Weight gain
6. Puffy face
7. Hoarseness
8. Muscle weakness
9. Elevated blood cholesterol level
10. Muscle aches, tenderness and stiffness
11. Pain, stiffness or swelling in your joints
12. Heavier than normal or irregular menstrual periods
13. Thinning hair
14. Slowed heart rate
15. Depression
16. Impaired memory
17. Enlarged thyroid gland (goiter)

Risk factors
Although anyone can develop hypothyroidism, you’re at an increased risk if you:
1. Are a woman
2. Are older than 60
3. Have a family history of thyroid disease
4. Have an autoimmune disease, such as type1 diabetes or celiac disease
5. Have been treated with radioactive iodine or anti-thyroid medications
6. Received radiation to your neck or upper chest
7. Have had thyroid surgery (partial thyroidectomy)
8. Have been pregnant or delivered a baby within the past six months

Untreated hypothyroidism can lead to a number of health problems:
1. Goiter. Constant stimulation of your thyroid to release more hormones may cause the gland to become larger — a condition known as a goiter. Although generally not uncomfortable, a large goiter can affect your appearance and may interfere with swallowing or breathing.
2. Heart problems. Hypothyroidism may also be associated with an increased risk of heart disease and heart failure, primarily because high levels of low-density lipoprotein (LDL) cholesterol — the “bad” cholesterol — can occur in people with an underactive thyroid.
3. Mental health issues. Depression may occur early in hypothyroidism and may become more severe over time. Hypothyroidism can also cause slowed mental functioning.
4. Peripheral neuropathy. Long-term uncontrolled hypothyroidism can cause damage to your peripheral nerves. These are the nerves that carry information from your brain and spinal cord to the rest of your body — for example, your arms and legs. Peripheral neuropathy may cause pain, numbness and tingling in affected areas.
5. Myxedema. This rare, life-threatening condition is the result of long-term, undiagnosed hypothyroidism. Its signs and symptoms include intense cold intolerance and drowsiness followed by profound lethargy and unconsciousness.
6. Myxedema coma. A myxedema coma may be triggered by sedatives, infection or other stress on your body. If you have signs or symptoms of myxedema, you need immediate emergency medical treatment.
7. Infertility. Low levels of thyroid hormone can interfere with ovulation, which impairs fertility. In addition, some of the causes of hypothyroidism — such as autoimmune disorder — can also impair fertility.
8. Birth defects. Babies born to women with untreated thyroid disease may have a higher risk of birth defects compared to babies born to healthy mothers. These children are also more prone to serious intellectual and developmental problems.
9. Physical and Meental Development Problems: Infants with untreated hypothyroidism present at birth are at risk of serious problems with both physical and mental development. But if this condition is diagnosed within the first few months of life, the chances of normal development are excellent.

Hyperthyroidism (overactive thyroid)

Hyperthyroidism (overactive thyroid) occurs when your thyroid gland produces too much of the hormone thyroxin. Hyperthyroidism can accelerate your body’s metabolism, causing unintentional weight loss and a rapid or irregular heartbeat.

Several treatments are available for hyperthyroidism. Doctors use anti-thyroid medications and radioactive iodine to slow the production of thyroid hormones. Sometimes, hyperthyroidism treatment involves surgery to remove all or part of your thyroid gland.

Although hyperthyroidism can be serious if you ignore it, most people respond well once hyperthyroidism is diagnosed and treated.

Hyperthyroidism can mimic other health problems, which can make it difficult for your doctor to diagnose. It can also cause a wide variety of signs and symptoms, including:
1. Unintentional weight loss, even when your appetite and food intake stay the same or increase
2. Rapid heartbeat (tachycardia) — commonly more than 100 beats a minute
3. Irregular heartbeat (arrhythmia)
4. Pounding of your heart (palpitations)
5. Increased appetite
6. Nervousness, anxiety and irritability
7. Tremor — usually a fine trembling in your hands and fingers
8. Sweating
9. Changes in menstrual patterns
10. Increased sensitivity to heat
11. Changes in bowel patterns, especially more frequent bowel movements
12. An enlarged thyroid gland (goiter), which may appear as a swelling at the base of your neck
13. Fatigue, muscle weakness
14. Difficulty sleeping
15. Skin thinning
16. Fine, brittle hair

Older adults are more likely to have either no signs or symptoms or subtle ones, such as an increased heart rate, heat intolerance and a tendency to become tired during ordinary activities.
Risk factors
Risk factors for hyperthyroidism, include:

1. A family history, particularly of Graves’ disease
2. Female sex
3. A personal history of certain chronic illnesses, such as type1 diabetes, pernicious anemia and primary adrenal insufficiency

Hyperthyroidism can lead to a number of complications:
1. Heart problems.
Some of the most serious complications of hyperthyroidism involve the heart. These include a rapid heart rate, a heart rhythm disorder called atrial fibrillation that increases your risk of stroke, and congestive heart failure — a condition in which your heart can’t circulate enough blood to meet your body’s needs.
2. Brittle bones.
Untreated hyperthyroidism can also lead to weak, brittle bones (osteoporosis). The strength of your bones depends, in part, on the amount of calcium and other minerals they contain. Too much thyroid hormone interferes with your body’s ability to incorporate calcium into your bones.
3. Eye problems.
People with Graves’ ophthalmopathy develop eye problems, including bulging, red or swollen eyes, sensitivity to light, and blurring or double vision. Untreated, severe eye problems can lead to vision loss.
4. Red, swollen skin.
In rare cases, people with Graves’ disease develop Graves’ dermopathy. This affects the skin, causing redness and swelling, often on the shins and feet.
5. Thyrotoxic crisis.
Hyperthyroidism also places you at risk of thyrotoxic crisis — a sudden intensification of your symptoms, leading to a fever, a rapid pulse and even delirium. If this occurs, seek immediate medical care.

High blood pressure (hypertension)

Hypertension, or high blood pressure, is the constant pumping of blood through blood vessels with excessive force and is one of the most important causes of premature death worldwide.

High blood pressure is a common condition in which the long-term force of the blood against your artery walls is high enough that it may eventually cause health problems, such as heart disease.

In 2025, an estimated 1.56 billion adults will be living with hypertension. Hypertension kills nearly 8 million people every year, worldwide and nearly 1.5 million people each year in the South-East Asia (SEA) Region.
You can have high blood pressure (hypertension) for years without any symptoms. Even without symptoms, damage to blood vessels and your heart continues and can be detected. Uncontrolled high blood pressure increases your risk of serious health problems, including heart attack and stroke.
High blood pressure generally develops over many years, and it affects nearly everyone eventually. Fortunately, high blood pressure can be easily detected. And once you know you have high blood pressure, you can work with your doctor to control it.

Most people with high blood pressure have no signs or symptoms, even if blood pressure readings reach dangerously high levels.

A few people with high blood pressure may have headaches, shortness of breath or nosebleeds, but these signs and symptoms aren’t specific and usually don’t occur until high blood pressure has reached a severe or life-threatening stage.

Causes depend on the type of Hypertension; there are two types of high blood pressure:
1. Primary (essential) hypertension
For most adults, there’s no identifiable cause of high blood pressure. This type of high blood pressure, called primary (essential) hypertension, tends to develop gradually over many years.
2. Secondary hypertension
Some people have high blood pressure caused by an underlying condition. This type of high blood pressure, called secondary hypertension, tends to appear suddenly and cause higher blood pressure than does primary hypertension. Various conditions and medications can lead to secondary hypertension, including:
• Obstructive sleep apnea
• Kidney problems
• Adrenal gland tumors
• Thyroid problems
• Certain defects you’re born with (congenital) in blood vessels
• Certain medications, such as birth control pills, cold remedies, decongestants, over-the-counter pain relievers and some prescription drugs
• Illegal drugs, such as cocaine and amphetamines

Risk factors
High blood pressure has many risk factors, including:
• Age. The risk of high blood pressure increases as you age. Until about age 64, high blood pressure is more common in men. Women are more likely to develop high blood pressure after age 65.
• Race. High blood pressure is particularly common among people of African heritage, often developing at an earlier age than it does in whites. Serious complications, such as stroke, heart attack and kidney failure, also are more common in people of African heritage.
• Family history. High blood pressure tends to run in families.
• Being overweight or obese. The more you weigh the more blood you need to supply oxygen and nutrients to your tissues. As the volume of blood circulated through your blood vessels increases, so does the pressure on your artery walls.
• Not being physically active. People who are inactive tend to have higher heart rates. The higher your heart rate, the harder your heart must work with each contraction and the stronger the force on your arteries. Lack of physical activity also increases the risk of being overweight.
• Using tobacco. Not only does smoking or chewing tobacco immediately raise your blood pressure temporarily, but the chemicals in tobacco can damage the lining of your artery walls. This can cause your arteries to narrow and increase your risk of heart disease. Secondhand smoke also can increase your heart disease risk.
• Too much salt (sodium) in your diet. Too much sodium in your diet can cause your body to retain fluid, which increases blood pressure.
• Too little potassium in your diet. Potassium helps balance the amount of sodium in your cells. If you don’t get enough potassium in your diet or retain enough potassium, you may accumulate too much sodium in your blood.
• Drinking too much alcohol. Over time, heavy drinking can damage your heart. Having more than one drink a day for women and more than two drinks a day for men may affect your blood pressure.
If you drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women and two drinks a day for men. One drink equals 12 ounces of beer, 5 ounces of wine or 1.5 ounces of 80-proof liquor.
• Stress. High levels of stress can lead to a temporary increase in blood pressure. If you try to relax by eating more, using tobacco or drinking alcohol, you may only increase problems with high blood pressure.
• Certain chronic conditions. Certain chronic conditions also may increase your risk of high blood pressure, such as kidney disease, diabetes and sleep apnea.
Sometimes pregnancy contributes to high blood pressure, as well.
Although high blood pressure is most common in adults, children may be at risk, too. For some children, high blood pressure is caused by problems with the kidneys or heart. But for a growing number of kids, poor lifestyle habits, such as an unhealthy diet, obesity and lack of exercise, contribute to high blood pressure.

The excessive pressure on your artery walls caused by high blood pressure can damage your blood vessels, as well as organs in your body. The higher your blood pressure and the longer it goes uncontrolled, the greater the damage.
Uncontrolled high blood pressure can lead to complications including:
• Heart attack or stroke. High blood pressure can cause hardening and thickening of the arteries (atherosclerosis), which can lead to a heart attack, stroke or other complications.
• Aneurysm. Increased blood pressure can cause your blood vessels to weaken and bulge, forming an aneurysm. If an aneurysm ruptures, it can be life-threatening.
• Heart failure. To pump blood against the higher pressure in your vessels, the heart has to work harder. This causes the walls of the heart’s pumping chamber to thicken (left ventricular hypertrophy). Eventually, the thickened muscle may have a hard time pumping enough blood to meet your body’s needs, which can lead to heart failure.
• Weakened and narrowed blood vessels in your kidneys. This can prevent these organs from functioning normally.
• Thickened, narrowed or torn blood vessels in the eyes. This can result in vision loss.
• Metabolic syndrome. This syndrome is a cluster of disorders of your body’s metabolism, including increased waist circumference; high triglycerides; low high-density lipoprotein (HDL) cholesterol, the “good” cholesterol; high blood pressure and high insulin levels. These conditions make you more likely to develop diabetes, heart disease and stroke.
• Trouble with memory or understanding. Uncontrolled high blood pressure may also affect your ability to think, remember and learn. Trouble with memory or understanding concepts is more common in people with high blood pressure.
• Dementia. Narrowed or blocked arteries can limit blood flow to the brain, leading to a certain type of dementia (vascular dementia). A stroke that interrupts blood flow to the brain also can cause vascular dementia.

What is Diabetes Mellitus?

Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar. Hyperglycemia, or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body’s systems, especially the nerves and blood vessels. In 2014, 8.5% of adults aged 18 years and older had diabetes. In 2016, diabetes was the direct cause of 1.6 million deaths and in 2012 high blood glucose was the cause of another 2.2 million deaths. In general Diabetes can be categorized into:
1. Chronic diabetes conditions include:
a) Type 1 diabetes
b) Type 2 diabetes.
2. Potentially reversible diabetes conditions include:
a) Pre-diabetes: when your blood sugar levels are higher than normal, but not high enough to be classified as diabetes
b) Gestational diabetes: which occurs during pregnancy but may resolve after the baby is delivered

Type 1 diabetes
Type 1 diabetes (previously known as insulin-dependent, juvenile or childhood-onset) is characterized by deficient insulin production and requires daily administration of insulin. type1 diabetes is not preventable with current knowledge.
Symptoms include excessive excretion of urine (polyuria), thirst (polydipsia), constant hunger, weight loss, vision changes, and fatigue. These symptoms may occur suddenly.
Causes of type 1 diabetes
The exact cause of type1 diabetes is unknown. What is known is that your immune system — which normally fights harmful bacteria or viruses — attacks and destroys your insulin-producing cells in the pancreas. This leaves you with little or no insulin. Instead of being transported into your cells, sugar builds up in your bloodstream.
Type1 is thought to be caused by a combination of genetic susceptibility and environmental factors, though exactly what those factors are is still unclear. Weight is not believed to be a factor in type 1 diabetes.

Type2 diabetes
Type2 diabetes (formerly called non-insulin-dependent, or adult-onset) results from the body’s ineffective use of insulin. Type2 diabetes comprises the majority of people with diabetes around the world, and is largely the result of excess body weight and physical inactivity.
Symptoms may be similar to those of type1 diabetes, but are often less marked. As a result, the disease may be diagnosed several years after onset, once complications have already arisen.
Until recently, this type of diabetes was seen only in adults but it is now also occurring increasingly frequently in children.

Causes of Type2 diabetes
Type 2 diabetes develops when the body becomes resistant to insulin or when the pancreas is unable to produce enough insulin. Exactly why this happens is unknown, although genetics and environmental factors, such as being overweight and inactive, seem to be contributing factors.

(Pre-diabetes ) Impaired glucose tolerance and impaired fasting glycaemia
Impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG) are intermediate conditions in the transition between normality and diabetes. People with IGT or IFG are at high risk of progressing to type2 diabetes, although this is not inevitable.

Causes of pre-diabetes and type2 diabetes
In pre-diabetes (which can lead to type 2 diabetes) and in type2 diabetes, your cells become resistant to the action of insulin, and your pancreas is unable to make enough insulin to overcome this resistance. Instead of moving into your cells where it’s needed for energy, sugar builds up in your bloodstream.
Exactly why this happens is uncertain, although it’s believed that genetic and environmental factors play a role in the development of type2 diabetes too. Being overweight is strongly linked to the development of type2 diabetes, but not everyone with type2 is overweight.

Gestational diabetes
Gestational diabetes is hyperglycemia with blood glucose values above normal but below those diagnostic of diabetes, occurring during pregnancy.
Women with gestational diabetes are at an increased risk of complications during pregnancy and at delivery. They and their children are also at increased risk of type 2 diabetes in the future.
Gestational diabetes is diagnosed through prenatal screening, rather than through reported symptoms.

Causes of gestational diabetes
During pregnancy, the placenta produces hormones to sustain your pregnancy. These hormones make your cells more resistant to insulin.
Normally, your pancreas responds by producing enough extra insulin to overcome this resistance. But sometimes your pancreas can’t keep up. When this happens, too little glucose gets into your cells and too much stays in your blood, resulting in gestational diabetes.

What are common consequences of diabetes?
Over time, diabetes can damage the heart, blood vessels, eyes, kidneys, and nerves.
1. Adults with diabetes have a two- to three-fold increased risk of heart attacks and strokes.
2. Combined with reduced blood flow, neuropathy (nerve damage) in the feet increases the chance of foot ulcers, infection and eventual need for limb amputation.
3. Diabetic retinopathy is an important cause of blindness, and occurs as a result of long-term accumulated damage to the small blood vessels in the retina. 2.6% of global blindness can be attributed to diabetes.
4. Diabetes is among the leading causes of kidney failure.


What is asthma?
Asthma is a chronic disease characterized by recurrent attacks of breathlessness and wheezing, which vary in severity and frequency from person to person and occurs in people of all ages. It is the most common chronic disease among children.

It currently affects about 235 million people. Symptoms may occur several times in a day or week in affected individuals, and for some people become worse during physical activity or at night.

It isn’t clear why some people get asthma and others don’t, but it’s probably due to a combination of environmental and genetic (inherited) factors.

Asthma attack
During an asthma attack, the lining of the bronchial tubes swell and produce extra mucus causing the airways to narrow and reducing the flow of air into and out of the lungs. Recurrent asthma symptoms frequently cause sleeplessness, daytime fatigue, reduced activity levels and school and work absenteeism. Asthma has a relatively low fatality rate compared to other chronic diseases.
Asthma can’t be cured, but its symptoms can be controlled. Because asthma often changes over time, it’s important that you work with your doctor to track your signs and symptoms and adjust treatment as needed.

What triggers an asthma attack?
Although the fundamental causes of asthma are not completely understood, the strongest risk factors for developing asthma are inhaled asthma triggers. These include:

  1. Indoor allergens (for example house dust mites in bedding, carpets and stuffed furniture, pollution and pet dander).
  2. Outdoor allergens (such as pollens and moulds).
  3. Tobacco smoke.
  4. Chemical irritants in the workplace.
  5. Cold air,
  6. Extreme emotional arousal such as anger or fear, and physical exercise.
  7. Certain medications, such as aspirin and other non-steroid anti-inflammatory drugs, and beta-blockers (which are used to treat high blood pressure, heart conditions and migraine).
  8. Urbanization has also been associated with an increase in asthma, however the exact nature of this relationship is unclear.
  9. Sulfites and preservatives added to some types of foods and beverages, including shrimp, dried fruit, processed potatoes, beer and wine.
  10. Gastro-esophageal reflux disease (GERD), a condition in which stomach acids back up into your throat.
    Although asthma cannot be cured, appropriate management can control the disorder and enable people to enjoy good quality of life.

Asthma signs and symptoms include:

  1. Shortness of breath
  2. Chest tightness or pain
  3. Trouble sleeping caused by shortness of breath, coughing or wheezing
  4. A whistling or wheezing sound when exhaling (wheezing is a common sign of asthma in children)
  5. Coughing or wheezing attacks that are worsened by a respiratory virus, such as a cold or the flu

Signs that your asthma is probably worsening include:

  1. Asthma signs and symptoms that are more frequent and bothersome
  2. Increasing difficulty breathing (measurable with a peak flow meter, a device used to check how well your lungs are working)
  3. The need to use a quick-relief inhaler more often

Asthma signs and symptoms flare up in certain situations:

  1. Exercise induced asthma, which may be worse when the air is cold and dry
  2. Occupational asthma, triggered by workplace irritants such as chemical fumes, gases or dust
  3. Allergy-induced asthma, triggered by airborne substances, such as pollen, mold spores, cockroach waste or particles of skin and dried saliva shed by pets (pet dander)

When to Seek emergency treatment
Severe asthma attacks can be life-threatening. Work with your doctor to determine what to do when your signs and symptoms worsen — and when you need emergency treatment.
Signs of an asthma emergency include:

  1. Rapid worsening of shortness of breath or wheezing
  2. No improvement even after using a quick-relief inhaler, such as albuterol
  3. Shortness of breath when you are doing minimal physical activity.

Risk factors
A number of factors are thought to increase your chances of developing asthma. These include:

  1. Having a blood relative (such as a parent or sibling) with asthma
  2. Having another allergic condition, such as atopic dermatitis or allergic rhinitis (hay fever)
  3. Being overweight
  4. Being a smoker
  5. Exposure to secondhand smoke
  6. Exposure to exhaust fumes or other types of pollution
  7. Exposure to occupational triggers, such as chemicals used in farming, hairdressing and manufacturing

Asthma complications include:

  1. Signs and symptoms that interfere with sleep, work or recreational activities
  2. Sick days from work or school during asthma flare-ups
  3. Permanent narrowing of the bronchial tubes (airway remodeling) that affects how well you can breathe.
  4. Emergency room visits and hospitalizations for severe asthma attacks
  5. Side effects from long-term use of some medications used to stabilize severe asthma

Proper treatment makes a big difference in preventing both short-term and long-term complications caused by asthma.
While there’s no way to prevent asthma, but by working together, you and your doctor can design a step-by-step plan for living with your condition and preventing asthma attacks.

  • Follow your asthma action plan.
  • With your doctor and health care team, write a detailed plan for taking medications and managing an asthma attack.

Then be sure to follow your plan. Asthma is an ongoing condition that needs regular monitoring and treatment. Taking control of your treatment can make you feel more in control of your life in general.

  • Get vaccinated for influenza and pneumonia.
  • Staying current with vaccinations can prevent flu and pneumonia from triggering asthma flare-ups.
  • Identify and avoid asthma triggers.
  • A number of outdoor allergens and irritants — ranging from pollen and mold to cold air and air pollution —
    can trigger asthma attacks. Find out what causes or worsens your asthma, and take steps to avoid those triggers.
  • Monitor your breathing.
  • You may learn to recognize warning signs of an impending attack, such as slight coughing, wheezing or
    shortness of breath. But because your lung function may decrease before you notice any signs or symptoms, regularly measure and record your peak airflow with a home peak flow meter.
  • Identify and treat attacks early.
  • If you act quickly, you’re less likely to have a severe attack. You also won’t need as much medication to control your symptoms. When your peak flow measurements decrease and alert you to an oncoming attack, take your medication as instructed and immediately stop any activity that may have triggered the attack. If your symptoms don’t improve, get medical help as directed in your action plan.
  • Take your medication as prescribed.
  • Just because your asthma seems to be improving, don’t change anything without first talking to your doctor. It’s a good idea to bring your medications with you to each doctor visit, so your doctor can double-check that you’re using your medications correctly and taking the right dose.
  • Pay attention to increasing quick-relief inhaler use.
  • If you find yourself relying on your quick-relief inhaler, such as albuterol, your asthma isn’t under control. See your doctor about adjusting your treatment.


Anemia is a condition in which you don’t have enough healthy red blood cells to carry adequate oxygen to the body’s tissues. Having anemia may make you feel tired and weak.

There are many forms of anemia, each with its own cause. Anemia can be temporary or long term, and it can range from mild to severe. You must see your doctor if you suspect you have anemia because it can be a warning sign of serious illness. Treatments for anemia range from taking supplements to undergoing medical procedures. You may be able to prevent some types of anemia by eating a healthy, varied diet.

Anemia signs and symptoms vary depending on the cause of your anemia. They may include:

  1. Fatigue
  2. Weakness
  3. Pale or yellowish skin
  4. Irregular heartbeats
  5. Shortness of breath
  6. Dizziness or lightheadedness
  7. Chest pain
  8. Cold hands and feet
  9. Headache

At first anemia can be so mild that it goes unnoticed. But symptoms worsen as anemia worsens.

Anemia occurs when your blood doesn’t have enough red blood cells. This can happen if:

  1. Your body doesn’t make enough red blood cells
  2. Bleeding causes you to lose red blood cells more quickly than they can be replaced
  3. Your body destroys red blood cells

What red blood cells do?
Your body makes three types of blood cells — white blood cells to fight infection, platelets to help your blood clot and red blood cells to carry oxygen throughout your body.

Red blood cells contain hemoglobin — an iron-rich protein that gives blood its red color. Hemoglobin enables red blood cells to carry oxygen from your lungs to all parts of your body and to carry carbon dioxide from other parts of the body to your lungs so that it can be exhaled.

To produce hemoglobin and red blood cells, your body needs iron, vitamin B-12, folate and other nutrients from the foods you eat.

Causes of anemia
Different types of anemia and their causes include:

  1. Iron deficiency anemia. This is the most common type of anemia worldwide. Iron deficiency anemia is caused by a shortage of iron in your body. Your bone marrow needs iron to make hemoglobin. Without adequate iron, your body can’t produce enough hemoglobin for red blood cells.
  2. Without iron supplementation, this type of anemia occurs in many pregnant women. It is also caused by blood loss, such as from heavy menstrual bleeding, an ulcer, cancer and regular use of some over-the-counter pain relievers, especially aspirin.
  3. Vitamin deficiency anemia. In addition to iron, your body needs folate and vitamin B-12 to produce enough healthy red blood cells. A diet lacking in these and other key nutrients can cause decreased red blood cell production.
  4. Additionally, some people may consume enough B-12, but their bodies aren’t able to process the vitamin. This can lead to vitamin deficiency anemia, also known as pernicious anemia.
  5. Anemia of chronic disease. Certain diseases such as cancer, HIV/AIDS, rheumatoid arthritis, kidney disease, Crohn’s disease and other chronic inflammatory diseases — can interfere with the production of red blood cells.
  6. Aplastic anemia. This rare, life-threatening anemia occurs when your body doesn’t produce enough red blood cells. Causes of aplastic anemia include infections, certain medicines, autoimmune diseases and exposure to toxic chemicals.
  7. Anemias associated with bone marrow disease. A variety of diseases, such as leukemia and myelofibrosis, can cause anemia by affecting blood production in your bone marrow. The effects of these types of cancer and cancer-like disorders vary from mild to life-threatening.
  8. Hemolytic anemias. This group of anemias develops when red blood cells are destroyed faster than bone marrow can replace them. Certain blood diseases increase red blood cell destruction. You can inherit a hemolytic anemia, or you can develop it later in life.
  9. Sickle cell anemia. This inherited and sometimes serious condition is an inherited hemolytic anemia. It’s caused by a defective form of hemoglobin that forces red blood cells to assume an abnormal crescent (sickle) shape. These irregular blood cells die prematurely, resulting in a chronic shortage of red blood cells.
  10. Other anemias. There are several other forms of anemia, such as thalassemia and malarial anemia.

Risk factors
These factors place you at increased risk of anemia:

  1. A diet lacking in certain vitamins. Having a diet that is consistently low in iron, vitamin B-12 and folate increases your risk of anemia.
  2. Intestinal disorders. Having an intestinal disorder that affects the absorption of nutrients in your small intestine such as Crohn’s disease and celiac disease puts you at risk of anemia.
  3. Menstruation. In general, women who haven’t experienced menopause have a greater risk of iron deficiency anemia than do men and postmenopausal women. That’s because menstruation causes the loss of red blood cells.
  4. Pregnancy. If you’re pregnant and aren’t taking a multivitamin with folic acid, you’re at an increased risk of anemia.
  5. Chronic conditions. If you have cancer, kidney failure or another chronic condition, you may be at risk of anemia of chronic disease. These conditions can lead to a shortage of red blood cells.
  6. Slow, chronic blood loss from an ulcer or other source within your body can deplete your body’s store of iron, leading to iron deficiency anemia.
  7. Family history. If your family has a history of an inherited anemia, such as sickle cell anemia, you also may be at increased risk of the condition.
  8. Other factors. A history of certain infections, blood diseases and autoimmune disorders, alcoholism, exposure to toxic chemicals, and the use of some medications can affect red blood cell production and lead to anemia.
  9. Age. People over age 65 are at increased risk of anemia.

Left untreated, anemia can cause many health problems, such as:

  1. Severe fatigue. When anemia is severe enough, you may be so tired that you can’t complete everyday tasks.
  2. Pregnancy complications. Pregnant women with folate deficiency anemia may be more likely to experience complications, such as premature birth.
  3. Heart problems. Anemia can lead to a rapid or irregular heartbeat (arrhythmia). When you’re anemic your heart must pump more blood to compensate for the lack of oxygen in the blood. This can lead to an enlarged heart or heart failure.
  4. Death. Some inherited anemias, such as sickle cell anemia, can be serious and lead to life-threatening complications. Losing a lot of blood quickly results in acute, severe anemia and can be fatal.

Eat a vitamin-rich diet

Many types of anemia can’t be prevented. But iron deficiency anemia and vitamin deficiency anemias can be avoided by having a diet that includes a variety of vitamins and nutrients, including:

  1. Iron. Iron-rich foods include beef and other meats, beans, lentils, iron-fortified cereals, dark green leafy vegetables, and dried fruit.
  2. Folate. This nutrient, and its synthetic form folic acid, can be found in fruits and fruit juices, dark green leafy vegetables, green peas, kidney beans, peanuts, and enriched grain products, such as bread, cereal, pasta and rice.
  3. Vitamin B-12. Foods rich in vitamin B-12 include meat, dairy products, and fortified cereal and soy products.
  4. Vitamin C. Foods rich in vitamin C include citrus fruits and juices, peppers, broccoli, tomatoes, melons and strawberries. These items help increase iron absorption.
  • Consider a multivitamin. If you’re concerned about getting enough vitamins from the food you eat, ask your doctor whether a multivitamin may be right for you.
  • Consider genetic counseling. If you have a family history of an inherited anemia, such as sickle cell anemia or thalassemia, talk to your doctor and possibly a genetic counselor about your risk and what risks you may pass on to your children.

How can physiotherapy help?

Your physiotherapist will help in diagnosing the abnormal posture and then work out a specific rehabilitation program for your child. There may be a need for some hands on therapy to help decrease muscle spasm and improve joint movement, but the biggest part of the rehabilitation process should be exercise and education. Taping and strapping may be a useful technique, but only in the short term. Braces and straps are not useful for muscular postural problems as they weaken the muscles even further.

The exercises should help stretch the shortened muscles and also strengthen the weakened muscles so that balance can be restored. The education of correct sitting and sleeping positions as well as chair desk and bed setup should also be discussed.

Common posture problems in children


When we view the spine from behind, the scoliosis can be seen with a change in curvature to one side and a compensatory curve to the other side either above or below. It is difficult to determine which was the first curve and which was the compensation.

The muscles on the side to which the spine curves are usually stronger and shorter than the corresponding muscles on the other side.this posture change can be seen when 1 shoulder is higher than the other or when there appears to be a difference in leg length.


This can be seen when we are viewing the spine from the side. The upper back should have a slight curve and the head should be positioned so that the ears and shoulders line up. In a kyphotic posture, the upper back becomes too rounded and this results in the head being placed in the incorrect position. The body then compensates by pushing the chin forward so that the eyes stay in the correct position (poking chin).

This posture is very common in children due to poor sitting and computer posture. It can also develop because of poor eyesight. This results in shortening of the chest muscles in the front and weakening of the upper back muscles. At the same time, the muscles of the front of the neck become weak and the back neck muscles shorten.
This posture is often the cause of headaches in children!


This abnormal posture is best seen from the side and appears as a “hollow” lower back. In the normal position, the hips should be straight and line up with knees and ankles. When a lordosis occurs, the hips become more flexed and the knees start to hyperextend.

This is usually due to stomach muscle weakness and can come from inactivity. As the stomach muscles weaken, the lower back muscles get stronger and thus makes the hollow back worse. At the same time the hip muscles shorten due to too much sitting and the hamstring muscles get weaker.
This posture is often the cause of lower back pain in children!

Factors causing poor posture in children

Musculoskeletal system problems

This is the most common type of origin of poor posture. It happens because of continuous bad positions we use in activities of daily living that create the muscle imbalances over time. All activities have an influence on our posture including sitting, standing, walking and even sleeping.

Eye problems

Problems with vision can cause children to lean forward and poke their chin out to be able to see more clearly. This causes the upper back to become more rounded and causes shortening of the muscles at the back of the neck.

Ear problems

Hearing and balance are the 2 functions controlled by the ear and both can have an effect on posture. Hearing difficulty in 1 or both ears will result in the child adopting postures that will place the ear in a better position for hearing, but this may result in habitual movements and positions that can later develop into poor posture.

Balance is controlled by the eyes, middle ear and the feeling in the joints(proprioception). If the middle ear is not working correctly, the body has to work harder to compensate and change positions to prevent falling. These adaptions can lead to poor posture over time .

Central nervous system disorders

This is the least common cause of postural change in children. Any damage or disease of the brain or spinal chord will have an effect on posture. This system controls the way we use our senses and how the body responds to these and any changes to sensation or the muscle response will cause postural changes over time.

Peripheral nervous system disorders

Also very small cause of postural changes in children and works similarly to the changes of the central nervous system. The place where the abnormal sensation or muscle action is happening occurs outside of the spine (nerves of the arms and legs).


Chest Conditions

The respiratory system is essential in bringing new oxygen to the blood and removing harmful carbon dioxide from the body. Any changes to the airways due to infection or damage will limit the effectiveness of the lungs to perform this vital function. Here are some of the conditions that are commonly seen:

COAD – Chronic obstructive airway disease. This is a collective term for conditions that have chronic airway narrowing and can include emphysema, asthma, chronic bronchitis and bronchiectasis.

Emphysema – Enlargement of the air sacks in the lungs with destruction of the sack wall. This leads to problems with oxygen exchange and can cause breathlessness.

Asthma – Chronic inflammation of the airways which can cause airway obstruction and bronchospasm. It is a condition where breathlessness is due to difficulty in getting air out.

Bronchitis – Inflammation of the mucous membrane of the larger airways. This is usually due to a viral or bacterial infection.

Pneumonia – Inflammation of the smaller airways and alveoli (air sacks) in the lung. Again this can be due to viral or bacterial infection.

Pleurisy – Inflammation of the lining of the lungs (pleura). This can cause the lung to stick to the chest wall which causes pain with inhalation.

Bronchiectasis – Irreversible dilation of the airways which can cause airflow obstruction and increased chance of infection.

Cystic Fibrosis – Genetic disorder that leads to the production of thick and sticky secretions. This leads to frequent and recurrent lung infections.

Sinusitis – Inflammation of the sinus cavity causing mucous production. This can be caused by allergies, infections or auto-immune disorders.

Treatment can include deep breathing exercises, stimulated coughing, percussions and vibrations, postural drainage positions and suctioning. Home advice and exercises are often included.


The term arthritis literally means inflammation of the joints and can affect any synovial joint in the body.
In broad terms, there are two types of arthritis namely osteoarthritis and rheumatoid arthritis.


Osteoarthritis is due to normal stress and strains of everyday activity. It is the normal wear and tear of use and is usually age and activity related. The bone is continually in a cycle of building up and breaking down the joint surfaces. As we get older the body builds up the bone less uniformly and can put excess bone in places of stress. This leads to a rough joint surface that can cause pain and inflammation.

Rheumatoid arthritis

Rheumatoid arthritis is part of a family of similar diseases called auto-immune diseases. This occurs when the immune system causes repeated inflammation and over a period of time this can cause the damage to the joint surface. Symptoms can include stiffness, swollen joints, fatigue and joint aches.
There are a variety of different inflammatory arthritis, but the following are the some of the other inflammatory arthritis conditions most commonly seen:

Often called a soft tissue rheumatism as it affects the muscular system and not the joints. It is associated with widespread muscular pain and generalized fatigue and is more common in women. On examination there are active tender points in the muscles that are causing the pain and can be found in a characteristic pattern around the body.

Systemic Lupus Erythemaosus(SLE)
This is a chronic rheumatic disease that affects many parts of the body including joints, muscles, skin, heart, lungs, kidneys and eyes. The cause of Lupus is unknown.

A collection of diseases fall into this group including ankylosing spondylitis, psoriatic arthritis and Chrohn’s disease. The most common type is ankylosing spondylitis which produces pain and inflammation in the lower back (the sacroiliac joint) is more common in males than females.



Early diagnosis is important in the management of arthritis. This will involve completing a full medical history of symptoms and a physical examination of the joints. Blood and other laboratory tests are also useful in determining the cause of certain conditions, but may not detect all arthritis problems. X-ray investigation may be required and will show any joint deterioration that is seen in osteoarthritis and later stages of rheumatoid arthritis.


Treatment for arthritis can be very effective and requires a team approach. Your rheumatologist will put a plan that is appropriate for your condition and which will generally include medications, regular follow up and testing, and physiotherapy.


Your physiotherapist can help you with the management of arthritis in a number of ways. The first involves treatment of symptoms such as joint pain, stiffness and swelling during times of flare up. Soft tissue massage, joint mobilization and electrotherapy are used at this stage as well as splinting and strapping to support the joint.

Once the joint is more stable and the episode of flare up has passed, prevention and management of future episodes is important. Your physiotherapist will guide you through and advice on appropriate exercises that should be done to strengthen muscles supporting the joints and to maintain range of motion.

Arthritis need not be a condition to be feared. With early detection and management, both medical and physiotherapeutic, the disease can be managed completely. There is no need to be living in pain or fearing joint deformity and you can lead an active healthy lifestyle.


The nervous system is an electrical system that controls all our functioning from voluntary movement to the involuntary working of our organs. The nerves also conduct sensation signals from all over our body to the brain. Any disruption of the electrical signals will result in either a loss of function, loss of sensation or a combination of both.

There is a large number of neurological conditions, most of which are treated in specialized hospital rehabilitation centers. The conditions we treat at PhysioArt include Bell’s Palsy and Carpal Tunnel Syndrome.

  • Bell’s Palsy
  • Carpal Tunnel Syndrome

Bell’s Palsy
This occurs when the facial nerve swells at the point where it leaves the skull. This is usually due to infection and can result in the muscles on one side of the face becoming temporarily paralyzed.


Includes ultrasound for swelling, electrical stimulation and muscle re-education together with antibiotics and cortisone. Recovery time can range from a couple of days to 6 weeks.




Carpal Tunnel Syndrome

The nerve that supplies the thumb, index and middle finger is the median nerve and it enters the hand under a thick ligament. Certain common and repetitive activies we do with our hands such as typing on the computer may cause, overtime, thickening or swelling of this ligament.
This, in turn, puts pressure on the median nerve causing pain and changes of sensation. Typically, this pain travels from the wrist through the and increases mostly at night.



Besides a history and physical examination, an MRI may be requested to diagnose a case of carpal tunnel syndrome.



Involves ultrasound, electrical stimulation, stretching and night splinting. Recovery time varies from 1-6 weeks and in some cases a minor surgery done by a neurosurgeon may be required to release the median nerve under the ligament.


Physiotherapy Treatment

Physiotherapy should always start with a good examination of the child and a thorough history taking. Once the diagnosis is made, the treatment program can be planned and is usually designed to correct muscle imbalances and decrease joint stiffness.

However, when dealing with children, it is vitally important to provide education to the child and the parents about the condition. This is because the child will continue growing and small problems can worsen if not corrected early. The importance of correct postures, schoolbags, beds and chairs should be understood as well as the need for correct exercise and appropriate lifestyle modifications.

Scheuermann’s Disease

Spinal condition in children and adolescents that results in a spinal kyphosis ( hunch back). It is a bone condition that results in an abnormal curvature of the thoracic spine which cannot be corrected voluntary. This can lead to pain and stiffness and can worsen during growth phases if not detected early.

Treatment usually involves physiotherapy to decrease stiffness and correct muscle imbalances and bracing. Exercise is an important part of the rehabilitation process.

Sever’s Disease

Is a condition that occurs in children experiencing a growth were the tendon attaching at the back of the heel is stretched as the bone grows too quick leading to a tendinosis (tendon inflammation).

It can occur in children that are over active or are starting a new activity which places a lot of stress on the tendon. In some cases being overweight or having pronated feet (flat feet) can worsen the situation. Treatment can include rest from activity, ice, orthotics, and anti inflammatories. Physiotherapy will help stretch the muscles, correct muscle imbalances and decrease inflammation.


Congenital hip dislocation

This can be present from birth and results in the ball of the hip joint not being in the correct position in the socket. This can lead to leg length discrepancy and eventually result in postural changes. The condition is 4 times more common in girls than boys and is often called hip dysplasia. If diagnosed early, it can be treated by bracing or replacing the hip under anesthesia. More severe cases may need surgery followed by physiotherapy to help restore normal muscle and joint functioning.

Growing pains

This often occurs in children undergoing a growth spurt or when they have been extremely active. This can lead to pain from muscle tightening due to activity levels or from shortened muscles due to the fast growing bone. Home treatment consists of rest from activity and applying heat. Physiotherapy can help by giving the correct stretches and massage treatments.

Greenstick fractures

The bones of children are not as hard or brittle as those of adults. When a child falls his or her bones in most cases break in a specific manner: the break is closed (closed fracture), stays in position, and is usually treated conservatively often with casting or splinting.

Sport Injuries

Children are very active and are involved in sport activities and general play. This can lead to common injuries such as ankle sprains, muscle tears and general cuts and bruises(hematomas). These injuries are treated similarly to soft tissue injuries and include:

  • Rest, Ice, Compression, Elevation – RICE treatment post injury
  • Physiotherapy to correct muscle or soft tissue injury
  • Bracing and or slings and crutches

Postural problems in children

The increasing availability to computers, phones, tablets and televisions is changing the way children are growing up and this can be clearly seen in their increasing prevalence of poor posture, muscle weakness and back pain.

Musculoskeletal system problems is the most common origin of poor posture. It happens because of continuous bad positions of daily living that create the muscle imbalances over time. All activities have an influence on children’s posture including sitting, standing, walking and even sleeping. Other common factors may include poor vision, hearing and middle ear or balance problems. If not detected and treated early on, these postural issues can develop into more serious conditions such as scoliosis.

Your physiotherapist can help by assessing your child’s posture. This is done by visual assessment using a posture grid and specific functional tests and may in some cases recommend additional tests such as X-rays.

If an abnormal posture is detected, a specific rehabilitation program will be worked out. The biggest part of the rehabilitation process remains exercise and education.

Scoliosis, kyphosis and lordosis

All postural problems that occur from poor positioning in daily activities such as sitting, walking and sleeping. They develop because certain muscles become stronger than others from overuse. This leads to an imbalance of the muscles working to control the spine and pulling out of position. The most common seen posture problems are:


Sideways curvature of the spine when viewed from behind. This happens when the muscles on, for example, the left are stronger than the right causing the spine to be pulled away from the straight line. It usually is followed by an opposite cure higher or lower as a compensation.


Also called a hunchback posture as the upper back becomes excessively round. The most common cause is shortening of the chest muscles and weakness of the upper back muscles.


Called the hollow back posture. This appears as an excessive hollow lower back and is caused by strong lower back and hip muscles together with weakness of the stomach muscles and hamstrings.


During pregnancy, and the period that follows it, a lot of changes will occur in a woman’s body, some of which can be painful or uncomfortable. The hormone levels fluctuate, the weight of the baby places stress on the spine and lower limbs and fluid retention is also common. This can result in swollen legs, low back pain, pelvic pain and carpal tunnel syndrome.


Looking after yourself during these times is very important and a good exercise program and balanced diet are always recommended. Physiotherapy is useful to treat and manage pregnancy induced pains. Your physiotherapist can also prescribe exercises that can be done safely, even late into pregnancy. This helps keep mother and child healthy, maintain a healthy weight and decrease problems such as low back pain.

Pre and Post Natal Yoga and Pilates classes are a very good and safe form of exercise during and after pregnancy when conducted under the supervision of reliable and expert instructors.


The pelvic floor is a hammock of muscles that supports all the lower organs including the bladder, uterus, and rectum. It attaches to the pubic bone in the front, the tail bone at the back and from the base of the pelvis. These muscles give you control over your bladder and are involved in urinating. They prevent leaking of urine and incontinence, especially when coughing, sneezing, lifting something heavy or exercising, as well as uncontrolled wind and stool. The muscle tone of the pelvic floor also helps vaginal tightness and prevents possible prolapse which happens when the organs it supports such as the uterus fall down or slip out of place. The pelvic floor also contributes to the stability of connecting joints around it including the hip, sacroiliac joint and the lumbar spine. Therefore, weakness in these muscles can cause hip or lower back pain. Unfortunately, there is a general lack of awareness about these facts.


What is pelvic floor rehabilitation?

The Pelvic Floor (PF), like any other muscle group, can loose strength, go into spasm or stress and dysfunction. This is especially common following pregnancy and delivery, episiotomy, and any strain or sprain in the area, all of which can result in pain and different types of incontinence. PF rehabilitation, carried out under the guidance of a qualified physiotherapist, can help the PF regain its strength. Rehabilitation involves:


Teaching the patient to locate and correctly contract the pelvic floor, understand the role of the pelvic floor in the movements of everyday life, giving instruction of bladder/bowel health, teaching bladder re-training exercises and habits.

Exercise and manual therapy:

Stretching, soft tissue massage and joint mobilization, developing the qualities of the pelvic floor including flexibility, muscle tone, and endurance, relaxation exercises Pelvic Floor Electrical Stimulation is a non-invasive treatment which activates natural nerve and muscle mechanisms to strengthen and tone the sphincter and pelvic floor muscles in case of weakness as well as calming involuntary bladder muscle contractions on other cases as urge incontinence.


Is a non-painful treatment to help patients to learn to strengthen and relax their pelvic floor muscles by using special electrical sensors on the skin inside the vagina to measure the electrical activity of the muscles at rest and when they contract. The reading is shown on a screen so the patients become more aware of their rehabilitation progress.

Who can benefit from pelvic floor rehabilitation?

PF rehabilitation is proposed according to the pathology of the person and is generally offered to women during the period that follows childbirth (postpartum), but is also prescribed in the following cases:

  • Women in the pre and post-natal periods
  • Women suffering from stress urge or mixed incontinence, Overactive/Under active Bladder
  • Women in Preoperative or postoperative treatment of pelvic organ prolapse.
  • Women In post-surgical cases such as hysterectomy, C-section, bladder suspension.
  • Women suffering from pelvic or genital pain as: Painful Episiotomy, Urethral or Anorectal Pain, Vulvar Pain Syndrome.
  • Women experiencing musculo-skeletal dysfunction as: Sacroiliac and Lumbo-sacral Pain, Coccygodynia (tailbone) Pain,Hip or Low Back Pain, Diastasis Rect


How long does it take to recover function of the PF?

The tone of the pelvic floor is achieved over time. Generally, between 10 and 20 sessions with your physiotherapist are needed to find a sufficient elasticity and tone of your pelvic floor. However, it is imperative to follow the self-rehabilitation exercises which will be explained and shown you by your therapist

About the sessions:

The sessions are prescribed 2 to 3 times per week. During your first session, your therapist will talk to you, ask you questions related to your condition and examine you. This meeting will provide an opportunity to explain the causes of your symptoms and discuss the treatment plan including duration, frequency, and expected outcomes. The following sessions will involve a combination of education, electrical stimulation, manual and exercise therapy for muscle training.

Successful rehabilitation requires the presence of a skilled therapist at your side to guide you through the sessions by giving constant feedback and helping you achieve the correct muscle contractions. However, your engagement in the rehabilitation program remains one of the most important success factors to recovery.


Incontinence occurs when the muscles controlling bladder or bowel function stop working properly. This results in “leaks” as the patient does not have the muscle strength or endurance to control these body functions. The cause of incontinence can vary, but is usually due to aging, multiple pregnancies, organ prolapse or nerve dysfunction. The treatment received will depend on the type and cause of the incontinence.

Stress incontinence

– occurs when the pressure in the abdomen increases and the pelvic floor muscles are not strong enough to prevent leaking when coughing, laughing, sneezing, exercising or heavy lifting.

Urge incontinence

– occurs when a patient cannot keep urinary control when they feel the urge to urinate. The ability to hold the muscle contraction is lost and results in leaking.

Mixed type incontinence

– This is when both of the above mentioned problems occur together in the same patient


This includes all the muscles, tendons and ligaments in the body. A muscle is a soft tissue that can contract to shorten and lengthen to create movement. A tendon is a type of soft tissue that cannot contract and it attaches a muscle to the bone. The ligaments are the same type of tissue as tendons, but they only attach bone to bone (over a joint) and can also not contract.

Tears and Sprains

Injury can occur in of these tissues is overstretched or is suddenly placed under abnormal stress. This can result in small tears developing which can cause localized bleeding and inflammation. If enough force is applied to the soft tissue, they can tear completely which will result in a loss of function as well as create an unstable joint. These type of injuries include ligament sprains/tears, muscle tears and tendon tears.



Repeated strain of the tissue can lead overuse injuries that can become chronic. There is no trauma involved and the injury usually develops over a couple of days to weeks. The repeated strain can create inflammation in the tissue which can cause pain and loss of movement. Muscle weakness can develop over time as the patient tries to avoid the painful movements, thus making the problem worse. This group of injuries includes:

  • Tendonitis and tenosynovitis
  • Rotator Cuff Syndrome
  • Tennis Elbow
  • Golfer’s elbow
  • Plantar fasciatis
  • Jumper’s knee


The diagnosis of soft tissue injuries starts with a good clinical evaluation. If trauma is involved and a tear is suspected, then an ultrasound can be sufficient to determine any damage and the underlying inflammation, and exclusion of more severe injuries.If this is unclear, a CT scan or MRI scan can also be used.


If there is a complete tear, then surgery is required to repair the injury and is followed by physiotherapy rehabilitation to recover full movement and muscle strength. If there is only a partial tear, then the correct bracing and rest can be sufficient to help the recovery process. The role of the physiotherapist is then to protect the structure from further damage, decrease any pain and swelling and to maintain and improve movement and strength.

Overuse injuries can become chronic and may respond slower to treatment. The physiotherapist should try and determine the underlying cause of the injury and try to modify this activity. This can include changing the office/computer set up or by providing bracing for a limited period. Treatments then focus on decreasing pain and swelling by using soft tissue massage, ultrasound and electrotherapy. Movement and strength are then improved with mobilization, stretches and rehab strengthening.


Healing time will depend on the severity of the injury and the nature of the problem. Surgical repairs and physiotherapy rehabilitation usually follow a pre-set program and can last 6-12 weeks. For the overuse injuries this may be longer or shorter depending on how severe the injury is and how well the home/work modifications can be done.


For the body to move we need to joints. These joints allow us to move in various directions and are usually surrounded by a capsule of ligaments and are controlled by muscles. The bony surfaces of the joints are covered with a softer cartilage that allows for the movement to be smooth and even.

As we age, this softer tissue can become worn down by over use and can lead to the bony surfaces touching each other. The surface of the joint also becomes less even and can produce rough edges that can cause irritation to the surrounding soft tissue. This can lead to inflammation and swelling of the joint and can become a chronic problem which results in pain and loss of movement and function.


This will depend on the severity of the symptoms and the amount of joint damage present. Conservative treatment will include physiotherapy to decrease swelling and inflammation, improve muscle strength and length and produce normal movement patterns. Bracing or strapping may also be used at this stage, together with crutches and slings to protect the joint.

If conservative treatment doesn’t work, a surgical solution may be needed. This can vary from the arthroscopy to cleanup the rough surfaces to complete joint replacement. A joint replacement is when the moving parts of the joint are replaced by synthetic or metal parts to help restore the smooth surfaces and increase the joint space thus allowing for normal pain free movement. Some common replacements include:

  • Knee replacement
  • Hip replacement
  • Shoulder replacement
  • Ankle replacement
  • Radius head (elbow) replacement

Rehabilitation following surgery is important to achieve full range of movement, decrease swelling and restoring normal muscle action. The recovery period can range from 6-12 weeks post surgery.


Traumatic injuries to the bone can happen by falls, abnormal movements or direct force to the bones. This can result in the bone breaking and is referred to as a fracture. There are many types of fractures and the nature of the injury will determine the treatment.

Closed Fracture
Closed fractures occur when there is no piecing of the skin

Open fracture
Open fractures occur when the bone pushes through the skin producing an open wound

Non displaced fracture
Non displaced fractures occur when the bone breaks, but the pieces stay in position

Displaced fracture
Displaced fracture occur when the bone breaks and the pieces move out of position


Sometimes, when the soft tissue is stronger than the bone, a small piece of bone can tear off with the muscle or tendon and create an avulsion fracture. Children have softer bones and can bend easily which makes it more difficult to break. However, if the bending or twisting is too much, the bone can snap causing a “greenstick” fracture. Other bone injuries that can occur are stress fractures and these develop as an overuse injury of repetitive small trauma. This causes small cracks in the bone that can be painful and restrict movement.


To diagnose a fracture, your physician will order an x-ray. If this is not conclusive or your symptoms persist an MRI or CT scan may be requested. Ultrasound is used to determine if there are any avulsion fractures.

The radiological findings are matched with the history and mechanics of the injury as well as a good clinical examination. Treatment is then determined accordingly.



The treatment of bone stress fracture injuries usually starts with rest from the activity and in severe cases wearing a protective brace or cast.

For traumatic fractures the treatment will be determined by the orthopedic surgeon and will depend on the alignment of the bone and if there is an open wound. The treatment can include surgery to correct the bone position or casting and rest to give the bone time to grow and heal.



Healing will usually take about 6 weeks, depending on the injury. The role of the physiotherapist after the bracing is removed is to decrease the joint stiffness that has occurred and to strengthen the weakened muscles. This is done manual techniques such as mobilization and stretches, soft tissue massage, electrotherapy and strengthening exercises.

The process of physiotherapy rehabilitation can last from 2- 12 weeks depending onthe injury and weakness involved. The aim of the rehab is to achieve maximal possible range of movement, good muscle strength for daily activity, return to sport/exercise and to be as pain free as is possible.

How can Physiotherapy help?

The aim of physiotherapy is to decrease pain and improve movement in the spine. Your treatment will be designed based on your condition and its underlying causes and will include a selection or combination of the techniques listed below:

  • Soft Tissue Massage and Joint Manipulation – to decrease muscle spasm and regain normal joint movement
  • Dry needling (acupuncture) – to decrease muscle spasm
  • Exercise – to help improve movement (stretching), and strengthen core and target muscles
  • Electrical therapy – to decrease pain and inflammation
  • Posture corrections and home/office advice – to sustain results, prevent recurrence and correct underlying factors

Duration of treatment

Acute conditions: duration of treatment can range from just a couple of days to up to 12 weeks, with frequency of sessions been 2-3 per week.

Chronic conditions: may require continuous follow up treatment to prevent episodes of flare up or to the need for surgery. This is often the case for patients with arthritis or severe disc issues. The frequency of treatment will depend on the condition and symptoms, but can vary between once a month to once every three months.

Treatments for pain should be comfortable as we don’t want to flare up the condition. Treatment can be more uncomfortable if stiffness is the underlying cause of the problem as therapy tries to stretch tissues and move joints to gain movement. This should, however, always be in tolerable levels of discomfort for the patient.

Diagnosis and Management

The first step would include taking a full history of symptoms followed by a comprehensive clinical examination. This is used to determine the likely origin of the symptoms and helps to prepare the appropriate treatment approaches.

If the cause of pain is associated with any kind of trauma or the patient has more severe symptoms such as pins and needles, weakness or numbness, then an X-ray or MRI may be indicated to look at the bony structure of the spine (X-ray or MRI), or the soft tissues of the spine (MRI). Other tests may be indicated to help determine the origin of the symptoms, such as nerve conduction tests.Referral to a specialist may be required to exclude other possible causes of the problems including vascular (circulation and heart), systemic (rheumatoid arthritis) or endocrine (hormonal) causes for the pain.

If you have any of the following symptoms, please consult your doctor immediately.

  • Loss of bladder or bowel control
  • Legs collapsing
  • Loss of feeling in the pelvic region
  • Difficulty swallowing

Neck and Back Pain

  • Neck and back strain
    Occurs when the back/neck is placed in a wrong position during certain activity such as driving long distances, or sleeping in the wrong posture. This causes tension on the joints and ligaments and can produce protective muscle spasms, pain and stiffness. This is usually a sudden onset condition which responds quickly to therapy and conservative management.
  • Postural problems
    This usually develops over time as muscle imbalances occur due to a variety of factors. These muscle imbalances keep the neck/back in an abnormal position and can cause pain and headaches. Click here for “Posture” education and advice.
  • whiplash
  • Whiplash
    Involves an uncontrolled fast movement of the head and usually occurs in car accidents. The uncontrolled movement leads to the soft tissue (muscles, ligaments, discs and nerves) to overstretch and can result in tears. This produces bleeding and inflammation in the tissues. The joints can also be compressed resulting in joint inflammation and in severe cases, fractures. It is essential that X- Rays be done after any suspected whiplash.

  • Slipped disc
    The discs between the bones consist of a jelly like substance and act as a shock absorber in the spine. If the disc gets injured due to abnormal positions or forces, the jelly can leak out and put pressure on the nerve, which is then called a pinched nerve. This can cause pain and/or numbness down the arm/leg or into the hand with weakness or certain movements.

    In severe cases it can cause loss of bladder and bowel control, difficulty with swallowing (neck), difficulty
    walking or decreased sensation in the pelvic area. If you experience any of these symptoms, contact your
    doctor IMMEDIATELY.

  • Post-surgery and other spinal conditions
    Any disc replacement or fusion surgery will need to be followed by some kind of physiotherapy to decrease pain and improve movement. A specific protocol will be followed depending on the nature of the surgery or injury. Other conditions include:
  • spondylolithesis (slipped vertebra)
  • spinal stenosis (spinal canal narrowing)
  • facet joint degeneration/spondylosis
+971-4-5897110 +97155-269-8877