TKR: Knee Pain Recovery

Painful knees are a very common occurrence among the elderly and fear about knee pain recovery makes it even worse. So was the case with Mr Narayanaswamy. He continued to live with painful knees which eventually hampered his everyday activity. There was chronic knee pain and despite medication his walking and general movement continued to decline. He consoled himself that the reduced activity and stamina were owing to his increasing age.
After a period of about two years, by when he was bed-ridden and almost totally inactive – he underwent total knee replacement as advised by his doctor.
After an initial rehab of knee replacement, an average person usually reports significant improvement in walking and other movements. Unfortunately Mr Narayanaswamy was not showing any signs of recovery. Instead he consistently suffered from fever and weight loss. Eventually a TB infection was diagnosed that had affected the TKR implant too. So a revision surgery had to be performed on him shortly, thereafter.

Tips for an Injury-free Run

For runners taking on a run for the first time, the key is to have a solid training base and a detailed plan that allows for a gradual increase in SPEED as well as DISTANCE. Here are Five tips for an injury-free run:

5 Tips to Prepare for an Injury-free Run

  1. Strength train two or 3 times a week, functionally. Running is great. Nevertheless, it can create muscle imbalances or increase ones that you already have. Your core, calves, quads, hams, hip muscles and arms need to work equally well for efficient running. When you strengthen all the links in the chain and maintain good flexibility from top to bottom, you will run stronger and stay injury-free.
  2. Wear the right kind of shoe for your running. See that they are not worn out and make sure that you replace them after every 500 miles of running. Have one pair of shoes for longer runs and another pair of shoes for shorter runs and fast speed workouts. IF possible, get a gait analysis
  3. Have proper warm ups and cool downs. Pre- and post-run stretching is very important in preventing injury. Dynamic stretches before a run and static stretches after a run work best.
  4. Keep yourself well hydrated in order to prevent depletion of electrolytes, and eventually muscle cramps.
  5. Correct your running biomechanics and run at the right skill level. Your trainer or physical therapist will best be able to help you with that. The basic aim is to avoid over striding and allow your feet to act as shock absorbers while running.

After these quick tips, let us look at the five most common mistakes new marathon runners can avoid and ensure a smooth injury free running stint.

A. Too Much. Too Soon. Too Fast

The most common issue that we see is the Terrible Too’s. You suddenly get up and start to train without a plan and end up doing “Too much. Too soon, Too fast”
And that is the most common cause of Injury!
Chalk out a plan of training! Even better, if you do it along with a trained expert. The training plan should strike a balance between speed and strength. It would help you build up stamina, strength and endurance gradually, without causing any injury.

B. Prevention is better than Cure

Always remember to warm up, before you start running. Many injuries can be avoided by:
warming up  and stretching regularly
Spending 10 minutes to warm up before each run will definitely cost you much lesser time than if you injure yourself and wait back to recover.
However if you do injure, it’s best to see a physiotherapy expert immediately to chalk out a quick recovery plan.

C. Mix Things Up

It is very easy to get into a habit of running the same route, at the same pace during your training. That begins to limit your muscles and their strength.
“Mix things up!”
Challenge your body with harder runs on certain days and recover at a slower pace another day. This will work-out many more muscles in a much more variety and keep them prepared against injuries.

D. Keep Moving

Any good training plan needs no more than four days of running or walking every week. That’s not too much to do!
It is important that you don’t overdo it! And equally important, that you keep doing it sincerely! You can make the switch from run & Walk to only run if you
find it too easy. The day you feel, you’re not ready, continue to do walking! But ensure that you ‘Keep Moving’.

E. Look after your Body

While you train for your run, your body and muscles undergo a lot of wear and tear. Listen to your body! If you are tired, it’s a sign that the body needs rest! Overtraining immediately shows in form of decreased performance and injuries!
Look after your body. Swimming, Sauna or steam room can really help relax and stretch on a bit.

With these 5 things you can easily train for your run without worrying to injure yourself. Enjoy every step that you take to prepare yourself. Remember – “It only makes you stronger and better than what you were before!”


Plantar Fasciitis: Heel Pain


Plantar Fasciitis may be the reason for your foot problems. If you are experiencing heel pain which is usually most severe when taking the first few steps of the day or after long hours of standing, then chances are that it is Plantar Fasciitis. Physiotherapy is an excellent way to cure this condition and reduce the heel pain.
Plantar Fasciitis is mainly caused due to the inflammation of the plantar fascia, a dense fibrous connective tissue connecting the heel to the toes.
Plantar fasciitis is the most common cause of heel pain presenting in the outpatient setting1. The exact incidence and prevalence of plantar fasciitis by age are unknown, but estimates do show that approximately one million patient visits per year are due to plantar fasciitis

Did you know that Runners are more likely to have Plantar Fasciitis?

You’ve probably heard about the connection between running and Plantar Fasciitis. Well, here’s why! The impact your feet absorb when you run can be as much as four times your bodyweight!

Studies indicate that Plantar Fasciitis accounts for about 10% of runner-related injuries and 11% to 15% of all foot symptoms requiring professional medical care2.

Can Plantar fasciitis go away on its own?

Usually Plantar Fasciitis gets resolved on its own in around 6-8 months, in 80% of cases with simple stretching / exercises but if the pain is persistent and not reducing even a bit, then you need to consult a doctor for treating the same with medical management.3

What are some of the Plantar Fasciitis remedies at home?

Plantar Fasciitis can be managed at home with simple methods as mentioned below:

  • Rest
  • Apply ice
  • Wear supportive shoes
  • Replace old athletic shoes
  • Stretch
  • Massage
  • Lose weight

But if above methods do not work, please consult a doctor or a physiotherapist for the same.

What is the best treatment for Plantar Fasciitis?

Medical management of Plantar Fasciitis usually includes a variety of measures. It is best managed non-invasively by physiotherapy in 90% of the cases. However, surgical intervention may also be considered, generally as the last option.

Your treatment options include the following:

  • NSAIDs (ebuprofen)
  • Physiotherapy management
    1. Ultrasound (reduces inflamation)
    2. TENS (reduces pain)
    3. Stretching (sole of foot, calf, Achilles tendon, plantar fascia)
    4. Contrast bath (reduces inflammation and relaxes sole of foot)
    5. Strengthening of foot muscles (to avoid re-occurrence)
  • Corticosteroid injection
  • Surgical intervention

How does Physiotherapy help treat Plantar Fasciitis?

Physiotherapy in the acute/early phase of Plantar Fasciitis focuses on pain relief methods along with the various passive and active stretching techniques to relieve the stress posed on the fascia along with reduction in the inflammation present.
plantar fasciitis treatment

Can Plantar fasciitis go away on its own?

  1. Therapeutic ultrasound is used over the posterior surface of the heel to reduce the pain as well as the inflammation.
  2. Contrast bath, i.e. keeping the foot dipped in hot water for 10 minutes followed by cold water immediately forms a very important part of the home program which helps in reduction of pain.
  3. Other methods like using taping may be used for correcting the alignment of the bones of the foot which would be contributing to the pain and inflammation because of increased load on the fascia.
  4. Along with this, stretching of the plantar fascia, calf muscles and tendon Achilles (fibrous band connecting the calf muscles to the heel bone) is taught to the patient and performed by the patient.
  5. As a part of chronic management of this condition, other therapeutic techniques like deep friction massage and inotophoresis could also be used, along with the basic stretching and pain reliving techniques.

Curing plantar fasciitis also involves few lifestyle modifications that not only help cure but also prevent the re-occurrence of this condition.

  • Basic changes like using a firm and comfortable footwear and avoiding wearing heels for women are very essential.
  • Footwear modifications like inserting an insole or using cushioned heel insets helps provide support as well as makes the surface more stable and comfortable.
  • Long hours of standing must be avoided and frequent short breaks must be taken to relieve the foot of the constant pressure.
  • Reduction in body weight in case of over-weight and obese individuals also helps decrease the load on the foot/heel.

Plantar Fasciitis Heel Pain

Is walking good for Plantar Fasciitis?

Heel pain is a common foot condition. One may experience intense pain while you place weight on your heel. The pain usually builds up gradually and gets worse over time. Walking usually improves the pain, but it often gets bad again after walking or standing for a long time.

Is standing ok for Plantar Fasciitis?

Standing for long periods of time can put you on the fast-track to developing Plantar Fasciitis.

Sometimes all it takes is standing still to develop heel pain. While standing in one place causes strain to be placed on a few muscles over a long period of time, rather than spread over numerous muscle, standing in place is much more conducive to the development of plantar fasciitis.

What are the causes of Plantar Fasciitis?

  • Increased load on the fascia is the major cause of developing pain and inflammation, leading to stiffness.
  • You are at a greater risk of developing plantar fasciitis if you are overweight or obese.
  • Sudden weight gain may also lead to development of plantar fasciitis.
  • Pregnant women often experience bouts of plantar fasciitis, especially during late pregnancy. 
  • If you are a long distance runner or athlete, or have an active job that involves being on the foot often may also pose increased risk of developing this condition.
  • Having foot problems like very high arches, flat feet and tight Achilles tendons also contribute to the factors causing pain and stiffness. =

What are the symptoms of Plantar Fasciitis?

Heel pain is the primary symptom of plantar fasciitis. People often report their pain and stiffness are most intense during their first steps after getting out of bed or after prolonged periods of sitting; which may be exacerbated with following:

  • prolonged standing
  • stair climbing
  • toe raises


Plantar Fasciitis is a condition where there is inflammation of the fibrous connective tissue present in the soul of our foot. The fascia extends through the longitudinal arch of the foot and connects the heel to the front of the foot. This is an important static structure supporting the foot, taking up all the strain posed on the foot and hence helps us walk. As the load increases the fascia elongates to act as a shock absorber and support our body. Inflammation may start setting in due to the repetitive micro trauma to the tissue and the stresses placed on it, this leads to:

  • Heel pain,
  • Decreased mobility and
  • Stiffness

Benefits of Physiotherapy in heel pain

Physiotherapy helps in dealing with the symptoms of plantar fasciitis like reducing pain, stiffness and inflammation. It helps make life more comfortable, less dependent and also prevents the consequences if treatment is taken well in time.



The most comprehensive range of therapy options :

  • The largest range of wave forms, available in the industry.

  • Protocols organised by the required therapy effect.

  • Programmable sequences.

  • High voltage therapy.

  • Constant current and constant voltage modes.

  • Suitable for combine therapy(simultaneous ultrasound and


  • Fast therapy option using the quick screen, and east navigation

    according to the body parts treated, all of them being clearly

    visible on the device, large colored touch screen.

  • Connection to the new vacuum unit by means of suction cup

    electrode (optional).



The new advanced series of ultrasound therapies offers:

  • Easy operation.

  • Therapy can be started with a single touch possibility to select up to 8 quick protocol for each therapy.

  • Body parts navigation for fast access to localised protocols.

  • Heated multi frequency applicators: 1 and 3 mega hertz.

  • Ergonomic heads with visual accessories identification / visual

    patient contact indicator.

  • Suitable for combined therapy ( simultaneous ultrasound and




Combining electric current of various shapes, types, frequency modulation
in association with therapeutic ultrasound. This helps to bring:

  • Muscle strengthening,

  • Muscle relaxation,

  • Analgesia,

  • Hypermia,

  • Iontophoresis.



Shock wave therapy (SWT) is new non invasive solution for chronic
musculo-skeletal pain, frequently used in physiotherapy, orthopaedics
and sports medicine.


  • Analgesic Effect –Elimination of Pain- decrease of muscle tension,

    inhibition of spasms and enhanced dispersion of substance P

  • Acceleration of healing- increase of collagen production and

    improved metabolism and microcirculation.

  • Mobility Restoration- helps in dissolving calcified fibroblasts.


  • Painful shoulder (calcification, tendonitis, impingement syndrome)

  • Carpal tunnel,

  • Tennis elbow- Epicondylitishumeri radialis/ulnaris,

  • Exostoses of small hand joints,

  • Pain in the groin area,

  • Bursitis trochanterica,

  • Jumper’s knee-Patella tip syndrome,

  • Pain in the hamstring insertions,

  • Achillodynia,

  • Heel spur-calcar calcanei Planter fasciitis,

  • Tibialis anterior syndrome.



A high intensity laser therapy (HIL) is based on the proven principle of low
level laser therapy (LLLT). A high power upto 12 W allows for unlimited
pain therapy. Its maximum power is more than 50 times higher than LLLT.


  • mmediate and long lasting ain relief,

  • Bio stimulation,

  • high penetration depths guarantees efficient simulation of tissue and pain receptors up to 12 cm depths,

  • Micro circulation supports.


  • Cervicobrachial syndrome,

  • Painful shoulder- impingement syndrome, tendonitis, rotator cuff


  • Bursitis,

  • Epicondylitisradialis/ulnaris,

  • Low back pain-osteoarthritis, disc herniation, muscle spasms,

  • Muscle strain,

  • Knee arthritis,

  • Trigger point, muscle spasms,

  • Ankle sprain-tibiotarsal distortion,

  • Planter fasciitis/heel spur.



We offer comprehensive workouts with a focus on the following:

  • Strengthening and toning abs,

  • Creating leaner, longer muscles,

  • Improving posture,

  • Preventing injuries,

  • Enhancing athletic performance,

  • Improving body balance,

  • Improving concentration.



Hands on physio-techniques that include:

  • Manual mobilisation,

  • Myofascial release,

  • PNF stretching,

  • Neural mobilisation,

  • Muscle energy techniques,

  • Kinetic control for muscle imbalance,

  • Postural alignment specific rehab.