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Physiotherapy and Diabetes

Diabetes mellitus is a metabolic disorder characterised by high blood sugar (glucose) levels. The condition results from the body’s inadequate production of insulin or the body’s altered response to insulin, or both. Diabetes causes abnormally high glucose levels (hyperglycemia), circulatory problems, and nerve damage.
Diabetes is a chronic condition affecting people of all ages and walks of life. The disease can cause a number of long-term complications, resulting in disability, reduced quality of life, and premature death. Exercise plays an important role in diabetes. Physiotherapists are experts in exercise prescription for people with chronic illnesses and are therefore able to provide advice on physical activity and promote self-management practices. Physiotherapists also assist with the management of complications associated with diabetes.

Our highly skilled physiotherapists will use specific exercise programmes, manual therapy, massage and electrical devices to help treat musculoskeletal conditions which can develop with diabetes. After assessing your specific condition, a personalised treatment plan will be outlined to address all your needs.

The best results in managing diabetes come from a combination of resistance and aerobic exercises. Aerobic exercise is effective in strengthening the heart and respiratory capacity. It burns stored calories to help reduce unwanted fat. Resistance exercises strengthen the muscles and bones. It increases the body’s metabolic rate over time and can contribute to the control of your blood sugar.

Diabetic foot care is extremely important as leg and foot problems are the most common reason for diabetes-related hospitalisation. Our physiotherapists work closely with our consultants to ensure you are receiving all the appropriate care you need. Diabetics often have pain from nerve impairment. Electrical stimulation, sensory desensitization and targeted exercise help manage pain and let patients perform physical activity.

Physiotherapy treatments contribute to the prevention of the complications that can occur in diabetic patients. Those patients who are at risk can benefit from the involvement of their physiotherapist in developing the programs that support their goals. By understanding how exercise and nutrition affect blood sugar regulation, you and your physiotherapist can develop an exercise program that supports your long-term health.

  • Ankle sprain
  • Ankle strain
  • Bell’s palsy
  • Above knee amputation
  • Below knee amputation
  • Biceps tendinitis
  • Brachioradialis strain
  • Calcaneal spur
  • Carpel tunnel syndrome
  • Cellulitis
  • Cervical rib
  • Cervical spondylosis
  • Cervical strain
  • Chondromalacia patella
  • Coxygia
  • De-Quervain’s disease
  • Discectomy
  • Early cervical spondylosis
  • Facial palsy
  • Flexion deformity of knee
  • Foot pain
  • Fracture neck of femur
  • Fracture of hand
  • Frozen shoulder/Adhesive capsulitis
  • Genu valgum
  • Genu varus
  • Golfer’s elbow / Medial epicondylitis
  • Heel pain
  • Hemiparesis
  • Hemiplegia
  • Hip hemiarthroplasty
  • Knee bursitis
  • Knee total replacement
  • Lateral collateral ligament strain
  • Lateral meniscal tear
  • Low backache
  • Low back pain with sciatica
  • Lumbar disc bulge
  • Lumbar disc herniation
  • Lumbar disc prolapse
  • Lumbar disc syndrome
  • Lumbar spondylitis
  • Lumbar spondylolisthesis
  • Lumbar spondylosis
  • Medial collateral ligament strain
  • Medial meniscal tear
  • Neck pain
  • Olecranon bursitis
  • Osteoarthritis
  • Paraparesis
  • Paraplegia
  • Paravertebral strain
  • Parkinson’s disease
  • Peri-Arthritis of shoulder
  • Plantar fasciitis
  • Post-traumatic stiffness of knee
  • Pre-Patellar bursitis
  • Quadriparesis
  • Quadriplegia
  • Rheumatoid arthritis of hand
  • Rheumatoid arthritis of knee
  • Sacro-iliac strain
  • Shoulder pain
  • Shoulder strain
  • Suprapatellar bursitis
  • Tennis elbow / Lateral epicondylitis
  • Trapezius
  • Trigger finger
  • Urinary incontinence
  • Weakness – lower limb
  • Weakness – upper limb
  • Wound – lower limb
  • Wound – upper limb
  • Wrist strain

  • Computerised ultrasound therapy
  • Computerised pelvic traction
  • Computerised cervical traction
  • Computerised interferential therapy
  • Shortwave diathermy
  • Wax therapy
  • Electrical stimulation
  • IR red light therapy

  • Joint mobilisation
  • Strengthening exercise
  • Neuro muscular re-education exercise
  • Chest physiotherapy
  • Stroke rehabilitation
  • Gait training
  • Vertigo exercise
  • Stump exercise
  • Cryotherapy
  • Biomechanical analysis
  • Core exercises
  • Massage
  • Pilates
  • Posture correction
  • Resistance band exercises
  • Soft tissue injury care
  • Stretching exercises
  • Swiss ball eExercises

Diabetes and joint pain are considered to be independent conditions. Joint pain may be a response to an illness, injury, or arthritis. It can be chronic (long-term) or acute (short-term). Diabetes is caused by the body not using the hormone insulin correctly, or insufficient production of it, which affects blood sugar levels.
Diabetes can damage joints, a condition called diabetic arthropathy. Unlike pain caused by immediate trauma, the pain of arthropathy happens over time. Other symptoms include:

  • Thick skin
  • Changes in the feet
  • Painful shoulders
  • Carpal tunnel syndrome

A joint is a place where two bones come together. Once a joint wears down, the protection it provides is lost. Joint pain from diabetic arthropathy comes in different forms

Charcot’s joint occurs when diabetic nerve damage causes a joint to break down. Also called neuropathic arthropathy, this condition is seen in the feet and ankles in people with diabetes. Nerve damage in the feet is common in diabetes, which may lead to Charcot’s joint. A loss of nerve function leads to numbness. People who walk on numb feet are more likely to twist and injure ligaments without knowing it. This places pressure on the joints, which can eventually cause them to wear down. Severe damage leads to deformities in the foot and other affected joints.
Bone deformities in Charcot’s joint may be prevented through early intervention. Signs of the condition include:

  • Painful joints
  • Swelling or redness
  • Numbness
  • An area that is hot to the touch
  • Changes in the appearance of feet

If your doctor determines that your joint pain is related to diabetic Charcot’s joint, it’s important to limit use of the affected areas to prevent bone deformities. If you have numb feet, consider wearing orthotics for additional support.

Osteoarthritis (OA) is the most common form of arthritis. It may be caused or aggravated by excess weight, which is a common problem in those with type 2 diabetes. Unlike Charcot’s joint, OA is not directly caused by diabetes. Instead, being overweight increases the risk of developing both type 2 diabetes and OA.
OA occurs when the cushioning between the joints (cartilage) wears down. This causes the bones to rub up against each other, and results in joint pain. While joint wear-and-tear is natural to some extent in older adults, excess weight speeds up the process. You may notice increasing difficulty in moving your limbs, as well as swelling at the joints. The hips and knees are the most commonly affected areas in OA.
The best way to treat OA is to manage your weight. Excess weight puts more pressure on the bones. It also makes diabetes harder to control, so losing extra pounds can not only alleviate chronic joint pain; it may ease other diabetes symptoms.
Losing 15 pounds may decrease knee pain by 50 per cent. Regular exercise can do more than maintain weight. Physical movement also helps lubricate your joints. As a result, you may feel less pain. Your doctor may prescribe pain medications to use when joint discomfort from OA becomes unbearable. Surgery, such as knee replacement, may be required in severe cases.

Codman introduced the term “frozen shoulder” in 1934 to describe patients who had a painful loss of shoulder motion with normal radiographic studies. In 1946, Neviaser named the condition “adhesive capsulitis” based on the radiographic appearance with arthrography, which suggested “adhesion” of the capsule of the GH joint limiting overall joint space volume. Patients with adhesive capsulitis have a painful restriction of both active and passive GH joint motion in all planes, or a global loss of GH joint motion
People with diabetes are up to twice as likely to suffer from frozen shoulder due to effects on collagen in the shoulder, which holds the bones together in a joint. Collagen can become sticky if sugar molecules become attached, resulting in movement being restricted and the shoulder beginning to stiffen. This process is known as glycosylation.
Poorly controlled diabetes has long been linked to muscular and skeletal problems, with consistently high blood sugars likely to increase the risk of complications such as frozen shoulder.

Back pain is a problem that affects many people including those with diabetes. Often people with diabetes have other conditions that could cause back pain, such as arthritis, fibromyalgia or kidney problems.
More than half of people with diabetes report they have chronic pain. The most common types of chronic pain are back pain and pain in the feet or hands as a result of neuropathy. Chronic pain can make it more difficult to handle diabetes self-management activities and may lead to elevated blood sugar levels. It is important to deal with back pain so it does not have a negative impact on your ability to sleep, work, function physically and have positive relationships.
There are ways to relieve pain, improve your mood and enjoy a better quality of life:

  • The first step is to discuss back pain with your doctor. Learn the difference between acute and chronic pain. Acute pain is a reaction to an injury. This is what we feel when we touch the hot stove, realized we are burned and seek immediate help. Chronic pain might start with an acute injury but remain long after that initial problem. It can be related to irritation or inflammation, which is often associated with diabetes. Factors such as fear, stress, anger and trauma can lead to chronic pain. If left untreated, pain can lead to sleeplessness, tension, depression and anger. All of these emotions can contribute to chronic back pain. Your health care team can help determine whether the pain is caused by physical, emotional and/or mental factors to figure out the best way to treat it.
  • There are a variety of physical treatments that can relieve chronic back pain. This might include applying heat or cold to the area. Massage is a good way to relieve the symptoms of pain, including shiatsu and acupressure. Rest can help and the doctor might prescribe something to help you sleep or reduce tension. Exercise is often a very effective way to relieve back pain, including certain types of weight and resistance training to strengthen the supporting muscles and ease pressure on your joints and tendons. Do not start any exercise routine without consulting with your doctor. Your health care team might recommend a physiotherapist or dietitian. Excess weight can contribute to back pain. Losing just 10 per cent of your body weight can relieve this pressure and reduce back pain. Your doctor may also prescribe certain anti-inflammatory medicines such as aspirin, ibuprofen or naproxen. You may have to take steroids to alleviate back pain which could lead to elevated blood sugars.
  • There are also neurological and mental ways to approach back pain and relieve overactive nerves. This may include antiseizure medications. Electrical stimulation may also help. Often a TENS (transcutaneous electrical nerve stimulation) unit is used to send electrical pulses from the surface of your skin to your nerves to help reduce pain. Relaxation techniques can also relieve back pain such as meditation, yoga, deep breathing

Positive lifestyle habits can help you achieve healthy blood sugar levels and reduce back pain. Losing weight takes pressure off your back, hips, feet and knees. Choose whole foods rather than packaged or processed ones with additives. Avoid pushing yourself until you feel fatigued. Work at a steady pace and plan your day to avoid stress. Take time to smile and laugh to boost your mood and minimize pain. Get enough sleep each night. Make sure your mattress is firm enough to support you comfortably. Take breaks when sitting and pay close attention to your posture. Do stretching exercises which may loosen tight back muscles.

More than half of all Indians are suffering from pain. Whether it is a recent episode or chronic, many studies have revealed that pain in India is a serious problem. However, many do not even know that physiotherapy is well equipped to not only treat pain, but also its source.
Physiotherapists are experts at treating movement and neuro-musculoskeletal disorders. Pain often accompanies a movement disorder, and physiotherapists can help correct the disorder and relieve the pain.

You should wear loose-fitting clothing so you can expose the area that we will be evaluating and treating. For example, if you have a knee problem, it is best to wear shorts. For a shoulder problem, a tank top is a good choice, and for low back problems, wear a loose fitting shirt and pants so we can perform a thorough examination.

Treatment sessions typically last for 30 to 60 minutes per visit.

This is highly variable. You may need one visit or you may need months of care. It depends on your diagnosis, the severity of your impairments, your past medical history, etc. You will be re-evaluated on a monthly basis and when you see your doctor, we will provide you with a progress report with our recommendations.

You will be evaluated by one of our licensed and highly trained physiotherapists and he/she will also treat you during subsequent visits. Unlike some clinics, where you see someone different each visit, we feel it is very important to develop a one-on-one relationship with you to maintain continuity of care. Since only one physiotherapist knows your problems best, he/she is the one that will be working closely with you to speed your recovery.

For many patients, one of the primary objectives is pain relief. This is frequently accomplished with hands-on techniques, modalities such as ultrasound, electrical stimulation, and/or heat or cold therapy. Movement often provides pain relief as well. Your physiotherapist will provide you with the appropriate exercises not only for pain relief but to recover range of motion, strength, and endurance.

In some cases, physiotherapy techniques can be painful. For example, recovering knee range of motion after total knee replacement or shoulder range of motion after shoulder surgery may be painful. Your physiotherapist will utilize a variety of techniques to help maximize your treatment goals. It is important that you communicate the intensity, frequency, and duration of pain to your therapist. Without this information, it is difficult for the therapist to adjust your treatment plan.

Massage may be part of your treatment. Rehabilitation specialists are trained in a variety of techniques that may help with your recovery. Deep tissue techniques may be part of the rehabilitative process. Massage is used for three reasons typically – to facilitate the venous return from a swollen area, to relax a tight muscle, or to relieve pain. Contrary to common thought, massage does not increase circulation.

Flare-ups are not uncommon. If you have a flare-up (exacerbation), give us a call. We may suggest you come back to see us, return to your doctor, or simply modify your daily activities or exercise routine.

Physiotherapists cannot make a medical diagnosis. This is something that your medical doctor will provide for you.

Physiotherapists are important members of your medical team. At this point in time, physicians are typically the health care providers that will provide you with a medical diagnosis.

Some patients will need to continue with home exercises. Some may choose to continue with a gym exercise program. Others will complete their rehabilitation and return to normal daily activities. It is important that you communicate your goals to your therapist, so he/she can develop a custom program for you.

Physiotherapists (PTs) and physiotherapist assistants (PTAs) are licensed by their respective university.

These are some things you may consider when seeking a physiotherapy department:

  • The therapist should be licensed.
  • The first visit should include a thorough medical history and physical examination before any treatment is rendered.
  • The patient goals should be discussed in detail during the first visit.
  • Care should include a variety of techniques which might include hands-on techniques, soft tissue work, therapeutic exercises and in some cases heat, cold, electrical stimulation or ultrasound.
  • Do they have a service that can address your problem?
  • Do they take your insurance or are they willing to work with you if they are not a preferred provider?
  • They should be conveniently located. Since sitting and driving often aggravate orthopaedic problems, there should be a very good reason for you to drive a long distance for rehabilitation.
  • What are the hours of operation?
  • Can they provide satisfaction survey results?
  • The therapist should provide the treatment.
  • Can you briefly interview the therapist before the first visit?
  • Ask your family and friends who they would recommend.

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