PAL Physiotherapy

Health Education for Patients



We aim to restore you to your previous functional level and help you fully understand why you are having ongoing problems. This helps you manage your problem more effectively and accelerates the long-term resolution of your problem. Treatment is based on a detailed examination that highlights the underlying cause(s) and we do not just treat the local area of pain with ineffective, passive treatments such as ultrasound. Our approach saves time and gets you better – often with stunning results.

It’s good to see you, but we prefer a quick resolution to your problem to get you back to normal. You can then tell your friends and family that PAL Physiotherapy Clinic is different... a team you can trust and that’s why the vast majority of our patients are recommended by family, friends, and colleagues.

Ankle Sprain

This is commonly a result of a twist of the ankle in which the ligaments are stretched resulting in pain, swelling, and an inability to put weight through the leg. Repeated ankle sprains can lead to the ankle becoming ‘unstable’ as the ligaments are repeatedly damaged and the normal control of the joint is lost. Additionally, joints and nerves around the ankle and foot can be involved in combination with ligament


In the acute (early) stage consists of ice, strapping and re-education of movement to prevent further damage and restore normal function. Early restoration of function is paramount to accelerate recovery as movement stimulates tissue repair. Treatment for the ‘unstable’ aims at strengthening and reactivating the muscles around the ankle to compensate for the damage to the ligaments

Whiplash Injury

This is usually following a road traffic accident during which the neck moves forwards, and then backwards, suddenly. This can result in damage to the neck muscles, joints, and even the nerves. Most ‘whiplash injuries’ resolve in time and the best advice is the keep the neck moving and return to normal functioning as soon as possible.

Treatment involves neck, upper spine and shoulder exercises to maintain and increase range of movement. If stiffness persists, mobilization of the spine will help to reduce symptoms.

Lower Back Pain/Acute Lower Back Pain

Most episodes of low back pain (with and without symptoms spreading into the buttock) are not serious and the symptoms will reduce over time. If you experience leg pain that moves into the calf and it is associated with numbness and/or weakness , consult your doctor as soon as possible.

The best advice is remain as active as possible, avoid long periods of rest, and keep moving. If the symptoms persist consult a Physical Therapist. Symptoms will re-occur with most forms of lower back pain and by consulting one of our Physical Therapists, they will fully assess your back and show you how to prevent future episodes. This will involve a combination of treatment and a home exercise program that will correct your spinal weakness.

Anterior Knee pain

This is usually a result of altered tracking of the patella (knee cap) as it runs over the anterior surface of the knee. Going down stairs or sitting with the knee flexed for long periods (sometimes called ‘movie goers knee’) can often elicit symptoms. Physical Therapy for most anterior knee pain requires that the alignment of the patella is changed by strengthening the muscles that control the tracking. Additionally, it is sometimes necessary to treat the hip and foot, as abnormal movement within either of these joints can lead to altered patella tracking.

Tennis Elbow pain

This is pain in the lateral (outer) aspect of the elbow. You don’t have to play tennis to have this problem and many structures both within (ligament, muscle and joint) and outside the elbow (neck, thorax and shoulder) can cause symptoms. Treatment is based on a full assessment of those factors that are contributing to the problem. Many ‘Tennis Elbow’ problems are caused by repetitive activities, for example, inputting data on a computer or gardening and pulling out too many weeds over a short period of time! Sports such as climbing or tennis can cause symptoms, especially if activity levels are increased rapidly without a graded exercise program.

Treatment / Medication

Common treatments for tennis elbow are to mobilize the elbow joint, begin strengthening exercises of the muscles that lift your fingers/wrist up (extensor muscles), and reduce the stress across the elbow by reintroduction of the correct use of the whole upper limb in specific activities.

Achilles Tendonitis

This is not an inflammation (‘tendinosis’ is a better term to describe this condition) of the long tendon that connects the calf to the posterior foot, but research suggests that the pain originates from degeneration of or micro trauma to the tendon over several years. Symptoms are experienced during exercise, but also after periods of rest (e.g. getting out of bed or after driving). Local treatment might be necessary, but part of a physiotherapy assessment should identify those factors that are causing the increased stress on the tendon. For example, running on the toes for prolonged periods, increasing training too rapidly, weakness in the calf muscle producing increased stress on the Achilles tendon, or poor hip control that prevents the upper part of the leg generating sufficient forces during walking or running (thus increasing the stress on the Achilles tendon as it tries to compensate for this weakness around the hip).

Treatment / Medication

Treatment aims to reduce the stress on the Achilles tendon by correcting faulty gait or running actions and by strengthening weakened muscles (both in the lower leg and hip/pelvis). Interestingly, as the person’s tendon recovers it is not uncommon to find that their running improves as optimizing running will reduce injuries and increase efficiency in running.

Shoulder Pain

There are many different problems within the shoulder that can cause pain. These are the most common:


The shoulder has a wide range of movement and requires the joint to have sufficient movement at allow normal shoulder function. The downside to this flexible joint is that following trauma or after repeated shoulder movements (e.g. prolonged swimming, throwing a javelin or just poor posture for many years), it is possible to lose the control of shoulder movement and a catching pain on certain activities may be elicited. The shoulder still has its normal range of movement, but the patient complains of a ‘catching’ pain and /or ‘clicking’ in the shoulder. This abnormal movement of the shoulder can produce structural damage to the joint and if conservative treatment fails, surgery may be indicated.

Treatment / Medication

Treatment is aimed at restoring the correct shoulder control around the joint (and surrounding joints) and addressing weakness of specific muscles within the shoulder that provides dynamic stability to the joint. Re-educating correct upper limb function is also important to prevent future problems and help the person manage their problem more effectively. Success is judged by returning you to your normal functional state, be that climbing to international standard or just being able to reach for objects ion a top shelf.


This is usually catching of a shoulder tendon or muscle (the Rotator Cuff) as it passes through a narrow opening within the shoulder joint. The problem may be the result of trauma or, more commonly, repeated stress on the shoulder following poor posture in which the shoulder moves forward (or protracted) when sitting at a computer or desk. Symptoms are experienced as the arm is moved away from the body (abduction) and often worse at 80 to 100 degrees of movement (an ‘arc’ of pain).

Treatment / Medication

Treatment restores the normal control of the shoulder and prevents the tendon ‘impinging’ on specific structures within the shoulder. This may include mobilizing stiff joints, reducing scar tissue at the site of injury, strengthening weakened muscles and re-educating faulty movement patterns in symptomatic directions.

Stiff Shoulder

Shoulders become stiff for many reasons and it is important to exclude the neck or thorax as a source of the problem. ‘Frozen shoulder’ is caused by tightening of the sac surrounding the shoulder (or capsule) and this condition is hard to manage and people can have symptoms for years. Fortunately, most stiff shoulder problems (including many diagnosed as ‘frozen shoulder’) are easily treated by mobilizing the shoulder and home stretching exercises. Incorrect shoulder movement during a specific activity, e.g. lifting at work or playing a specific racquet sport can cause structures in the shoulder to tighten and produce symptoms. Pain is usually encountered at the end of the available range, for example reaching to a high shelf or using a hairdryer.


Coccyx is a small triangular tail bone at the base of the spine. It is situated between the cleft of the upper part of the buttocks. When you run your finger on the spine it is the last bone you feel above the anus.

Why do people develop pain in the coccyx?

No specific reason however it may be due to a fall or sitting too hard on a chair, during child delivery, poor posture or due to back pain.

How is it diagnosed?

Physical examination and if an injury is suspected an X-ray or in severe cases MRI or a Scan.

Treatment / Medication
  • Avoid sitting for a long period of time and in hard surfaces.
  • Use a donut shaped cushion.
  • Avoid constipation.
  • Maintain good posture.
  • Avoid uncomfortable work positions.
  • Physiotherapy treatment:
  • Physiotherapist will be able to educate you re: good posture and working environment.
  • Ultrasound, gentle massage and stretching exercises will help to reduce pain.
  • Hot or cold packs can be used.
  • Back exercises will additionally help to reduce pain.
  • Medical Treatment
  • Painkillers or anti-inflammatory medication will relieve the sharp and often severe discomfort.
  • Cortisone injection at the coccyx area
  • In long standing severe pain surgery is advised.

Cervical Radiculopathy ("Pinched Nerve")

Degeneration of the cervical spine can result in several different conditions that cause problems. A cervical radiculopathy is a problem that results when a nerve in the neck is irritated as it leaves the spinal canal. This condition usually occurs when a nerve root is being pinched by a herniated disc or a bone spur.


When a nerve root leaves the spinal cord and the cervical spine it travels down into the arm. Along the way each nerve supplies sensation (feeling) to a part of the skin of the shoulder and arm. It also supplies electrical signals to certain muscles to move part of the arm or hand. When a nerve is irritated or pinched - by either a bone spur or a part of the intervertebral disc - it causes problems in the nerve and the nerve does not work quite right. This shows up as weakness in the muscles the nerve goes to, numbness in the skin that the nerve goes to and pain where the nerve travels. In the neck, this condition is called cervical radiculopathy.


A cervical radiculopathy causes symptoms that radiates out away from the neck. What this means is that although the problem is in the spine, the symptoms may be felt in the shoulder, the arm, or the hand. The symptoms will be felt in the area where the nerve that is irritated travels. Sometimes patient may develop pain at the back of the head also.


Medications are commonly used to control pain, inflammation, muscle spasm, and sleep disturbance. Mild pain medications can reduce inflammation and pain when taken properly. Medications will not stop degeneration, but they will help with pain control.

Cervical Pillow

A special pillow may help your pain at night and allow you to sleep better. These cervical pillows are specially designed to place the right amount of curvature in the neck while you sleep and decrease the amount of irritation on the nerve roots.

Physical Therapy

Physical therapist work on an exercise program developed just for you. The physical therapist will teach you ways to prevent further injury to your neck. Many problems in the cervical spine can be improved greatly with a good exercise program and good education on neck mechanics.

Modalities are also used such as Ice.Heat, Interferential therapy, Ultra sound, Short Wave Diathermy and Cervical traction to reduce pain and decrease symptoms.

Periarthritis Shoulder

What are the signs of Periarthritis Shoulder?
  • Reach up toward the sky with both arms.
  • Reach your arms out straight in front of you.
  • Raise your arms out to the sides of your body.
  • Pretend that you are trying to unzip the back of your dress or pull your wallet from the back pocket of your pants.
  • If you have pain or stiffness in your shoulder when you do these things, you may have Periarthritis.
  • Your doctor may be able to tell you have periarthritis just by talking to you and watching you move.
  • Your doctor may press on parts of your shoulder to see what might be causing the pain.
  • Sometimes, your doctor may want to take an x-ray of your shoulder to look for other problems.

Periarthritis Shoulder What is Periarthritis Shoulder? If you can't move your shoulder around like you used to, you could have periarthritis shoulder. When it hurts to move your shoulder or you don't have as much movement in your shoulder as before, your shoulder may become "frozen." Because of this, doctors sometimes refer to this problem as Adhesive capsulitis or Frozen Shoulder. What are the signs of Periarthritis Shoulder? You should be able to move your shoulder in all directions without pain. To test yourself, do these things: Reach up toward the sky with both arms. Reach your arms out straight in front of you. Raise your arms out to the sides of your body.


Pretend that you are trying to unzip the back of your dress or pull your wallet from the back pocket of your pants. If you have pain or stiffness in your shoulder when you do these things, you may have Periarthritis. Your doctor may be able to tell you have periarthritis just by talking to you and watching you move. Your doctor may press on parts of your shoulder to see what might be causing the pain. Sometimes, your doctor may want to take an x-ray of your shoulder to look for other problems. Does my shoulder actually freeze? No, it just won't move. If you don't use your shoulder enough (because it hurts to move) or if you use it the wrong way, your shoulder will develop scar tissue that stops it from moving much. Your shoulder may go through several stages as the scar tissue forms. The painful stage.

At first, your shoulder may ache and feel stiff. Then it may get very painful. This stage may last about 3 to 8 months. The adhesive stage. During the second stage, you may not actually have as much pain, but your shoulder keeps getting stiffer. This stage usually lasts about 4 to 6 months. The recovery stage. The final stage, which usually lasts about 1 to 3 months, isn't very painful. It becomes very hard to move your shoulder even a little bit. Then after a while, the stiffness slowly goes away. You can move your shoulder again.

'Bad' back

By far the most common site of back pain and injury is the lumbar region. Your lumbar spine bears the brunt of bending, stooping, sitting and worst of all, lifting. Low back pain usually emanates from degenerative changes to the lumbar discs.

With aging, the resilient disc material dries out, shrinks and loses some of its "spring". Under the stress of lifting, coughing or sitting improperly, the deteriorated disc can bulge or even rupture, spilling its spongy pulp into the surrounding space.

This herniated disc can press on the adjacent nerve root.

This irritation can cause pain, numbness and tingling, or painful muscle spasms. Loss of disc thickness can also cause wear and arthritic enlargement of the facet joint, constricting the space between the vertebrae leading to abnormal pressure on the nerve. Avoiding Back Injury


Bed Rest. For 48 hours or until the acute period passes stay in bed- even for meals, if possible. If your bed sags in the middle, add a board under your mattress. Heat or ice may help ease muscle spasm and aid circulation.

Pain Medication

Pain medication prescribed by your physician will help get you through the period of most severe pain.


Your physical therapist will plan a treatment regimen suited to your individual problem, and begin working to restore flexibility and ease discomfort. Treatment may include heat, cold, massage, traction, manipulation and exercises for relaxation, conditioning, and restoring range of motion.


You don't need to become and expert to avoid or overcome injury, but you may need to learn some new habits. Your physical therapist will help you continue therapy on your own with a home program designed to fit your needs.


Osteoarthritis (OA) is a degenerative disease of the cartilage and bone that results in pain and stiffness in the affected joint. It is a chronic condition and there is no cure for arthritis. The good news is that tremendous strides have been made in the management and treatment of arthritis and related conditions. In addition, there are many things you can do to make living with arthritis easier and less painful.

Osteoarthritis (OA) is characterized by pain, stiffness, limited range of motion, and mechanical irregularities in the affected joint. While inflammation is not directly caused by OA, it is not uncommon for arthritic joints to swell due to erosion of the joint tissue. OA may also create bony enlargements around the joints. Although OA can occur in any joint, it usually affects one or more of the following areas: the hand, shoulder, neck, lower back, hip, and knee.

The likelihood of OA increases as we age; it is estimated that nearly 75% of people over age 60 will experience OA.

The joint cartilage is normally smooth, shiny, and wet; in a healthy joint, the cartilage-covered surfaces move against each other with very little friction, like "glass on glass." Cartilage normally absorbs nutrients and fluid like a sponge, and this keeps the cartilage healthy and smooth. In osteoarthritis, however, the cartilage does not get the nutrients and fluid it requires. Eventually the cartilage dries out and develops cracks- instead of moving smoothly like glass on glass, the roughened cartilage moves like sandpaper against sandpaper. In extreme cases of cartilage loss there may be actual bone-on-bone contact within the joint. As we noted, osteoarthritis is not always associated with aging; a traumatic injury or abrupt impact can trigger the disease as well. Falls, car accidents, and sports injuries are often implicated in the onset of OA.

Extreme cases of OA may require surgery. However, OA responds well to conservative treatment. People with OA can directly influence the course of the disease through physical therapy and a regular program of moderate stretching and strengthening exercises. A positive mental attitude can also work wonders in helping you maintain a degree of control over the disease.


Your treatment will depend to a large extent on the precise nature of the condition- whether you have OA or something else. Even so, there are certain common denominators in the treatment of arthritis, such as special exercises for strength, flexibility, and range of motion. Other treatments (or modalities) that may be used by your physical therapist include heat, cold, massage, and hydrotherapy. If necessary, your physical therapist may fit you with orthotics, splints, or other devices to allow you to rest inflamed joints. Some of these modalities, such as the application of heat and cold, can be performed at home as long as you have guidance from your physical therapist.

Weight control is another important component of self-management. Excessive weight puts stress on joints, including the lower back, hips, knees, and feet. Even a modest weight reduction-a loss of 5% to 10% of total body weight-can make a noticeable difference in the condition of your joints (as well as in your overall health).


Medications. Physical therapists do not prescribe drugs. However, self-management of arthritis usually entails some use of drugs (whether prescription or over-the-counter) to control pain and inflammation. The most common of these medications are NSAIDs- non-steroidal anti-inflammatory drugs. This class of drugs includes readily available medications such as aspirin and ibuprofen. Another widely used over-the-counter medication, acetaminophen, is useful for controlling pain but does not control inflammation. Discuss with your Dr.and be sure to find out if there are possible interactions with other medications you may be taking.

Living After a Stroke

It is important to know about stroke especially after you or your loved one has had one, because stroke need not mean the end of a productive life. The effects of every stroke is different and it needs determination to work hard with therapies and support and understanding of family and friends. By learning about stroke family and friends can understand what kinds of behaviour can be expected from the patient and decide what actions they should take to help the patient recover as fully as possible. A stroke may cause serious changes in a person's life.

Common effects:

Paralysis: Loss of control and feeling on one side or parts of the body. • Aphasia: loss of ability to speak, read or write, loss of ability to understand spoken language, or to name objects or express oneself. It can range from temporary slurring to complete inability to communicate.

Other possible effects:

Depression: person who had a stroke may become depressed. Frustration, low self-esteem, and crying are all common. If depression interferes with the persons progress by draining strength and the will to recover, professional help is needed. •

Memory loss: a person affected by a stroke can have trouble recalling things which happened recently (SHORT term memory loss) It affects their ability to learn and retain new information. This normally returns with time.

Emotional upsets: the person may seem irrational, laugh at inappropriate times, cry, swear or behave in a way that is unlike the person's former self.

Judgement difficulties: people with left brain damage are usually overly cautious, anxious, hesitant slow , disorganized. People with right brain damage usually are impulsive, unrestrainable and not personally very safe.

The sooner the therapy begins the better the chance for recovery. Therapies requires a team effort on the part of the patient, physician, family, therapists, and nurses.

Early Physical therapy is needed to regain the lost functions like moving around in the bed, getting in and out of the bed, transferring to the chair and toilet, and walking/climbing stairs.

Occupational therapy helps with self reliance and skills for self care, independent living and employment. It includes visual, vocational, memory training , home making etc.

Speech therapy: enables to find out the best mode of communication to and by the person affected by the stroke. It also includes helping with swallowing difficulties, problem solving skills,

Nursing care for the bed ridden person to prevent pressure sores, teaching a person with his medications.

Making the home comfortable for the recovery process: Discuss with your therapists, they can provide suggestions on modifications to be made to your home to make it easily accessible, safe and clear of tripping hazards, and positioning in bed to encourage independence.

Devices for the recovery process: ask your therapist about simple devices which can help with independent basic functioning, like a long handled shoe horn, special eating utensils, western commodes etc.


Understand the persons strength's and weaknesses. Remind on how much progress he has made and encourage to move ahead.

Steer his attention away from stroke and encourage him to be involved in his favourite hobbies, outings and friends.

Learn more about stroke to help him better.

Maintain a positive outlook even if some days are better than the others.

Recognize that emotional ups and downs are expected.

Take care of yourself , share the responsibilities with others, set aside some time for yourself and relax.

Join our Family Support Network to share your feelings with other family members who have been through care giving before, or going through now.  

Sector 41, Gurgaon

  • Plot-5P , Basement, Sector- 41
  • Near Shaktipeeth Mandir, Gurgaon
  • Helpline: +91 9811 3434 17
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Sector-56, Gurgaon

  • 560 -P, Basement
  • Near Alpine public School, Sector 56
  • Helpline: +91 9811 3434 17
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