32-year-old female with bilateral knee joint fusion due to Rheumatoid arthritis
It seemed like a bare routine phone call when I first spoke to Komal (name changed) in my hurry entering the driving seat of my car. She said that she was diagnosed with arthritis (not mentioning the type) asking for a home visit. Being reluctant for a home visit I replied “Arthritis is commonly a treatable condition and we treat it in clinic regularly.” I subtly hinted her a clinic visit. The call was long forgotten and the next evening my assistant came to me saying that she can’t get a patient in because she cannot walk. I asked her to repeat her sentence. She said the new patient can’t walk. While my mind went through all the possible reasons of disabilities I managed to arrange for a wheelchair. As this lady came in my cabin, I learnt that she was a young and beautiful woman who had not walked for about 2 years which further raised my curiosity about the reason for her disability.
Diagnosis: Komal was suffering from a chronic case of rheumatoid arthritis with fusion of both her knees in flexion positon, the chair sitting position to be precise. Her legs could not be straight in spite of all the efforts of many doctors in Pune city. Finally she was suggested a surgery. Komal had outright refused for a surgery and came to Mumbai for seeking another opinion.
Treatment: I started her treatment with gentle manual therapy of Mulligan. Slowly releasing her stiffness from knee joints. I expected that pain would be my biggest constraint. Rheumatoid arthritis is usually considered as a relative contraindication to manual joint glides therefore many doctors fear to explore further joint range. But my knowledge and experience with knees did help me to explore further, which turned out to be a challenge worth taken. Slowly and steadily we could bring her joint to 90 degrees (which felt impossible at that time). This first milestone gave us encouragement to proceed further with strengthening exercises and knee mobilization.
Results: Within a month’s time Komal could stand on her feet with support. She went back to Pune with this result and in a few days she messaged me that she is managing to take a few steps with a walker. Komal has continued her knee rehabilitation program and now walks with braces.
Suffering from Slip Disc – Lumbar PID
It was Saturday early morning, a reputed lawyer working in a prestigious firm stepped into my waiting area unable to sit nor stand. I was doing my routine, treating patients when I saw his discomfort from behind the curtains. I stepped out of my cabin and asked him, “Can you tell me one movement which eases your pain?” His response was, “I cannot sit, cannot stand but I can walk.” So I sent him for a walk. While I quickly finished my previous patient I observed that he was walking with a limp but no list.
When he entered my cabin he felt slightly better than before after having a walk. I assessed him thoroughly with my mechanical diagnostic tool going slow with every step. I was fairly sure of my diagnosis when I completed the assessment details. I gave him the static prone position for 5 mins which stabilized him. But the moment we tried any movement of the spine he was getting sensitive.
Diagnosis: After a good amount of sixty minutes of assessment I was assured of my diagnosis of derangement responding to extension.
Treatment: I added IFT therapy to relieve him of his pain and gave him similar repeated exercises as a home program.
The next day when I saw him his limp was better and pain had traveled towards the spine. This is a positive phenomenon called centralization which further confirmed my diagnosis. I again gave him IFT in the areas for pain and did a vigorous repeat of exercises under my supervision.
As per my expectation, the very next day he came to my clinic walking confidently with minimum pain. His MRI had confirmed a disc protrusion. His 90 percent pain had vanished he was getting better and better.
I would like to mention in a note here that this lawyer was a self-motivated man and he followed all his exercises at home religiously. This quality got him out of pain faster than expected.
Result: His colleagues at work could never believe that he suffered a lumbar slip disc because he went to work on the third day