The Power of Physiotherapy -Part2

 The Power of Physiotherapy 

         One morning Mr. Sangeeth (Name Changed) woke up with a sharp, severe pain on the outer side of his left thigh. The pain was so intense, he could not walk or put any weight on his leg. Years back in 2009, he had been diagnosed with bilateral hip necrosis, a condition where bone tissue dies due to lack of blood supply, caused by a medication he took for his kidney disease. At that time doctors advised him to give rest to the joint (not to exercise) or get a hip replacement. But Mr. Sangeeth was very careful, managed his hip condition without surgery till 2025, and continued his daily activities carefully.  

        When new pain stuck, it was natural for him to assume it was related to his hip. He again consulted an orthopedic surgeon, who advised X-ray and MRI. But surprisingly his hip condition hadn’t changed much. The investigation continued with blood (calcium, magnesium, potassium levels), nerve conduction study and electromyogram to check his muscles, but everything was normal. The consensus among the orthopedic surgeon, physician, and neurologist was a dead end-they, could not pin point the cause.

     What next? – was a big question mark.

    Mr. Sangeeth endured the pain for more than ten days. In a moment of sheer desperation, he decided to see a physiotherapist, an experienced and empathetic. She listened care fully to his history and examined him. Her diagnosis was immediate and simple; his thigh muscle had gone into wasting and severe spasm due to lack of exercise. And also sitting for long hours while working, added to it.

        For two weeks, she treated him in first session and for 7 days in second session over the period of 2 months, with specific stretching, muscle strengthening and weight bearing exercises. Mr.Sangeeth diligently continued these at home and his work place. The result was a miracle; and now he is on his road to recovery.

The great science we overlooked.

            This experience was a profound lesson for me. As doctors with over years of experience in allopathic medicine, we often focus on diagnosis and prescription, sometimes underestimating the other fields of science and medicine like physiotherapy. It is a science in its own right, one that focuses on restoring movement and function through physical and anatomical intervention.

    We frequently see patients with severe muscle cramps, muscle pain, low back ache, upper back ache, neck pain. These symptoms are often a result of our modern sedentary life style. We are glued to our chairs for 8-10 hours, whether we are lawyers, engineers, chartered account, computer operators or doctors. This lack of movement leads to muscle weakness and tightness making us prone to issues like the one Mr. Sangeeth experienced.

Beyond the burn

            And beyond the challenge itself, this experience has gifted me a profound and lasting lesson, probably to many others also, who read this article. Sangeeth started getting intense hypoglycemia(even though he is not diabetic) everyday early hours of the morning at around 4to 5am. The hypoglycemia was to the extent of 40 mg/dl.This went on for two months, and no one was able to find out the cause. Mr. Sangeeth was taking Apple, sweet potato and proteins (complex carbohydrates), which stabilizes blood sugar for long time), but still hypoglycemia was the common occurrence. Again, underwent investigation and many concluded to rule out Insulinoma, which is a very difficult condition to diagnose in renal failure patients and difficult to manage also. So we started thinking out of the box, and thought to shift these 90 minutes exercise to the morning, instead of evening. For our surprise, he didn’t get early morning hypoglycemia afterwards. Did literature search again, and many articled explained that exercise induced hypoglycemia occurs when blood glucose level drops significantly during or shortly (up to 24hours) after intense physical activity. For most people, the body compensates for increased glucose uptake in the muscle by reducing insulin production or releasing stored glucose from the liver.

     But during exercise two things happen simultaneously.1.Increased sensitivity-Muscle cells become much more sensitive to insulin, allowing them to pull glucose from blood stream 2.The muscles use up their stored glycogen and begin to rely on circulating blood sugar.

    Timing and pattern of hypoglycemia-1 Immediate (during exercise)-often happens during prolonged aerobic activity (like long walking and cycling),if food intake is not sufficient. This could be a reason for death during Gym.2. Delayed(post exercise)-known as “lag effect”. This can occur up to 24 hours after a work out or muscle stretching and weight lifting exercise. This is what happened in Sangeeth s case.

        Management of this life-threatening Hypoglycemia in susceptible individuals-Consume complex carbohydrates like sweet potato or apple along with proteins before and after exercise. Monitor the sugar level if you feel shaky, sweaty with palpitation and blurring of vison during exercise. If sugar level drops below 70mg/dl, consume 15gm of fast acting carbohydrate like honey, jaggery, sugar or juice. More importantly do the exercise or walking in morning rather than evening in susceptible individual. Now Sangeeth is doing his exercise without hypoglycemia. A small observation saved his life, because night hypoglycemia is dangerous and can kill a person, if it goes un noticed.

        So, if any of you are struggling with persistent muscle cramps(after ruling out calcium, magnesium and potassium deficiency), muscle pain like calf and thigh, low back &neck pain, or have trouble with movements like squatting, or difficulty in getting up after sitting on the floor for long time, or if you get back pain after sitting in western closet for 5-10 minutes etc., please consider consulting a physiotherapist, provided you have consulted an ortho surgeon before and done relevant investigation to rule out any underlying pathology.

        An orthopedic doctor can help with proper diagnosis, a physiotherapist can provide targeted stretching, strengthening and weight bearing exercises, that might just simple but powerful solution you have been looking for.

    “Ensuring musculoskeletal comfort and metabolic safety is essential for any successful exercise prescription. As clinicians, integrating physiotherapy with proactive glycemic management even in non-diabetics allows us to provide a truly holistic and safe path to patient wellness”.