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Physiotherapy for Multiple Sclerosis

What is multiple sclerosis and what’s important in Physiotherapy for Multiple Sclerosis?

Physiotherapy for multiple sclerosis is very important. Multiple sclerosis or MS is caused by damage to the nerve fibers within the central system (brain and spinal cord) affecting movement, cognition, and behavior.

MS has additionally termed a disease because the system attacks the myelin (protective sheath) that surround the nerve fibers disrupting signals traveling along these fibers resulting in a loss of muscle control, balance, coordination, difficulty walking, and changes in mood.

Every person with MS includes a unique presentation. Symptoms are wide-ranging and variable. It affects more women than men and is caused by a mix of genetic and environmental factors.

Physiotherapy for multiple sclerosis will help with the symptoms of MS-like mobility, spasm balance, and coordination making life a good deal easier.

Physio can promote recovery when relapses occur maximizing potential and keeping an individual with MS as active the maximum amount as possible for as long as possible.

Physiotherapy in Multiple sclerosis
Neurological physiotherapist supervising mobility exercises

Diagnosis of multiple sclerosis

Types of sclerosis

There are four main kinds of MS which include:

  • Benign MS – this can be the mildest kind of MS and involves few relapses (times when your symptoms flare up). However, someone with this kind of MS will have to have had only a few or no symptoms for about 15 years before a diagnosis is confirmed. this sort of MS may aggravate with age.
  • Relapsing-remitting MS – 80% of individuals with MS have this sort of MS. this implies you have got relapses followed by periods of remission when your symptoms reclaim. Relapses occur when new or old symptoms flare-up suddenly followed by a time of recovery or remission.
  • Secondary progressive MS – About 50% who have relapsing-remitting MS persist to develop secondary progressive MS within 10 years. The symptoms don’t heal once the relapse is over and slowly build up making everyday tasks tougher over time.
  • Primary progressive MS – this kind of MS implies that symptoms get steadily more severe with no periods of remission.

Diagnosis of sclerosis

Symptoms are very vague making diagnosis difficult. An individual may need to undergo many tests to substantiate a diagnosis and this could be a lengthy process.

If MS is suspected you may be remarked a neurologist who will conduct an in-depth neurological examination which can involve, magnetic resonance imaging (MRI), evoked potentials, or a lumbar puncture.

Physiotherapy For Multiple Sclerosis
Functional grip exercises for physiotherapy for Multiple Sclerosis

What causes multiple sclerosis?

MS is caused by the inflammation of nerve fibers in the brain and the spinal cord. This inflammation occurs because white blood cells start attacking the myelin covering the nerve fibers, which then develop scars called lesions, or plaques.

This slows down and can even stop the messages traveling along the nerve fibers. Over time, the myelin can be completely broken down and the nerve fibers themselves can become damaged.

It is not fully understood what causes this damage to the myelin. It has been suggested to have genetic and environmental components.

There is no single gene that causes MS, however, research into the possibility of a combination of genes that make MS more likely are under investigation.

Alternatively, people who are related to a person with MS are slightly more likely to develop MS.

MS is relatively common in the UK, North America, and Scandinavia, but hardly ever occurs in countries such as Malaysia and Ecuador so research suggests that MS is more likely to occur in countries north of the equator suggesting climate influences. It has been suggested that MS could be triggered by a particular bacteria or virus which thrives in cooler environments. However, more research is needed in this area.

What are the effects/symptoms of multiple sclerosis?

The symptoms of MS vary from person to person as well as day today.

The most common symptoms include:


  • Eye problems, including pain, double vision, some blindness, and difficulty focusing.
  • Bladder and bowel problems
  • Difficulty speaking and swallowing
  • Mood swings
  • Problems with learning and memory
  • Sexual difficulties


  • Fatigue
  • Muscle weakness, stiffness, and spasms (muscle contracting tightly and painfully)
  • Loss of balance, coordination, and dizziness making walking difficult
  • Pain (neuropathic or musculoskeletal)
  • Numbness or tingling of your skin

Physiotherapy will help with the physical symptoms of MS whilst also improving your energy levels and self-esteem.

Physiotherapy for multiple sclerosis

Physiotherapy can be of great benefit to people with MS. It helps maintain independence by improving symptoms such as fatigue and muscle spasm, as well as preventing loss of mobility, strength, and balance. Physiotherapists play a key role in the treatment of MS. Our specialized neurological physiotherapists at are experienced in treating people with MS.

Our dedicated physiotherapists at will help you achieve your maximum potential for physical independence, flexibility, strength, and fitness levels, and provide advice and support on any new movement problems that may arise. Physiotherapy for multiple sclerosis is important when the physical symptoms are changing, or during the recovery phase after a relapse. Physiotherapy aims to:

  • Help control and co-ordinate movement patterns.
  • Reduce spasticity and encourage more normal movements.
  • Regain functional abilities.
  • Keep muscles strong and strengthen those that are weak.
  • Keep joints mobile and prevent stiffness
  • Improve coordination and balance.
  • Prevent pressure sores.
  • Prevent muscle contractures
  • Reduce the risk of falling
  • Promote recovery

Physiotherapy treatment will depend on which symptom you are experiencing at the time and treatment programs will be tailored to your individual needs.

At we understand that MS not only affects you but those close to you. A structured program will be developed to incorporate family and carers and will be centered around:

  • Correcting posture with particular emphasis on the right way to stand, to walk, to rise from a sitting or lying position, and how best to position oneself for sleeping.
  • A range of exercises and physical activity to improve muscle strength and functional ability.
  • Specialized stretches to relieve stiffness or spasms
  • Exercises to build stamina and reduce fatigue
  • Exercises to promote coordination and balance
  • Advice on walking aids, ankle braces, or orthotic devices to aid everyday activities and minimize injury.
  • Hydrotherapy can help people with MS stretch tight muscles and improve posture in standing and walking.
  • Promoting normal and easier movement so that you can enjoy a more active life.

The treatment program is adjusted appropriately, following re-assessment when you have made progress or when your symptoms change.

At our motivated physiotherapists will therefore promote your independence by showing you how to help yourself in trying to regain your movement and coordination.

Physiotherapy for multiple sclerosis will also focus on activities of daily living and will maximize your potential and enhance your recovery.

Physical therapy should commence as soon as possible following an initial attack to allow you to reach your full potential and limit the progression of your symptoms.

Physio-services for MS often have a long waiting list and treatment is restricted to a few sessions. Our specialized neurological physiotherapists at are able to provide physiotherapy assessment and treatment as soon and as often as is required.

To book an appointment call 8800901567book online, or alternatively request a free phone consultation.

Physiotherapy for Rheumatoid Arthritis

Rheumatoid Arthritis

What is rheumatoid arthritis?

Rheumatoid arthritis is an inflammatory condition which might affect a variety of joints within the body. Usually, the articular surface (lining) and synovium (fluid-filled sac coving the joints surface) become inflamed which may then interfere along with your normal hobbies or activities of daily living. The inflammation occurs as a result of the body’s system attacking various joints although the explanation for this is often not known. The inflammation may additionally affect the cartilage and also the ligaments within a joint which might be very painful.

There are a variety of symptoms which will be experienced if you have got autoimmune disorder and these can vary at different times. Physiotherapy may be a very effective way of reducing these symptoms and has specialist physiotherapists that may provide you with a comprehensive treatment programme that’s appropriate to satisfy your individual needs.

Potential symptoms may include:

  • Pain
  • Swelling of certain joints
  • Stiffness which occurs especially within the mornings
  • Redness over the joints
  • Heat within the joints
  • Unable to hold out your normal activities of daily living
  • Tiredness
  • Anxiety and depression
  • Anaemia (reduced red blood cells)
  • Weight loss
  • Joint instability
  • Deformities
  • Rheumatoid nodules (lumps) over the joints

The most commonly affected joints are:

  • Shoulders
  • Wrists
  • Metacarpophalangeal( MCP) joints (knuckles)
  • Proximal interphalangeal (PIP) joints of the hand (middle joints of fingers)
  • Knees
  • Ankles
  • Proximal interphalangeal (PIP) joints of the foot (middle joints of toes)

Most people with atrophic arthritis experience flare ups at different times and it’s during those times that symptoms are most severe. Therefore it’s important to develop an action plan together with your physiotherapist at Tvastacare which will facilitate your manage your flare ups most effectively to permit you to stay as active as possible during these times.

How is atrophic arthritis diagnosed?

There are variety of tests wont to diagnose arthritis and it’s often the combined results of those tests that confirm the disease. If you’re experiencing any of the symptoms mentioned above, it’s important that you just attend your GP as soon as possible. Early diagnosis of atrophic arthritis will provide a more practical treatment. The tests used include:

  • Blood tests
  • X-rays
  • Ultrasound scanning

Number of symptoms once arthritis has been confirmed, it’s important that you just begin physiotherapy as soon as possible to optimise the management of your symptoms. will provide you with a full assessment and comprehensive treatment programme including a home exercise programme to assist you are taking control of your condition.

How will physiotherapy help with rheumatoid arthritis?

Physiotherapy can help manage and reduce your symptoms in different ways. Your physiotherapist at Tvastacare will encourage you to require a lively role in your treatment programme which is able to facilitate your to figure towards your goals.

Physiotherapy can help within the following ways:

  • Pain control
  • Reduce inflammation and joint stiffness
  • Help you to return to your normal activities of daily living or sports
  • Reduce tiredness
  • Increase range of movement at joints
  • Increase muscle strength
  • Relaxation
  • Improve cardiovascular fitness levels

What physiotherapy are used for rheumatoid arthritis?

There are a range of physiotherapy options that may be wont to treat autoimmune disease. the selection of treatment will rely on variety of reasons including your symptoms and therefore the severity of the condition.

Your physiotherapist at will work with you to style an individually tailored programme to optimise your treatment and help your remain as active as possible.

Potential physiotherapy treatments may include:

  • TENS (transcutaneous electrical nerve stimulation)
  • Massage
  • Acupuncture
  • Cardiovascular activity (swimming, cycling)
  • Hydrotherapy
  • Pacing advice
  • Range of movement exercises
  • Strengthening exercises
  • Wax therapy
  • Gentle mobilisation techniques
  • Cryotherapy (ice therapy)
  • Heat therapy
  • Provision of splints
  • Provision of adaptations to assist round the home
  • Electrotherapy techniques (including Megapulse)


Rheumatoid arthritis is an inflammatory condition that mainly affects the joints of the shoulder, knee, wrist, hand and foot. The inflammation is caused by an attack of the body’s own system on the tissues in these joints. you will experience stiffness, swelling, tiredness and pain as symptoms of arthritis. Physiotherapy is a good thanks to reducing these symptoms and helps promote self-management so you’ll be able to keep doing all the activities of daily living that you just usually do. Please call Tvastacare at on +918800901567 today to book a rendezvous with one among our specialist physiotherapists. You’ll also book an appointment online.

Chest Physiotherapy for COVID-19 Cases


Coronavirus Disease-2019 (COVID-19) as we all know is extremely communicable. WHO has announced a fresh name for the COVID-19 outbreak as Coronavirus-2 (SARS-CoV-2) severe acute respiratory syndrome.

Latest, findings show that patients aged 60 years are at greater risk than children who could even be less likely to become compromised or may have milder or perhaps asymptomatic symptoms. In the intensive care units approximately 5 percent admission rates and approximately 42 percent of admitted patients might need oxygen.

This varies from other respiratory viruses which are transmitted between 2 to 10 days before symptoms occur. This virus is transmitted by droplet from sneezing and coughing within 2m of the infected person from person to person via respiratory secretions. This virus remains live for a minimum of 24 hours on the hard surfaces and approximately 8 hours on the soft surfaces.

The virus may additionally be transmitted by hand contact from person to person if it’s touched on contaminated surface then touched by the nose, mouth and eyes. This can be often often possible that closed environments make a secondary impact COVID-19 dissemination and promotion of super spreading events. Virus stays 3 hours viable within the air.

The range of illness varies from mild which is commonest to severe illness which needs treatment monitoring and mechanical ventilator. Individuals infected with COVID-19 produce symptoms like fever, sneezing, raw throat, cough, fatigue, sputum & shortness of breath. The extent varies from asymptomatic infection or mild URTI with respiratory failure and death may occur to pneumonia.

Present reports are estimated to be asymptomatic in 80 percent of cases, severe in 15 percent of cases requiring oxygen, and significant in 5 percent requiring ventilator and life support. within the pneumonia is that the foremost typical serious appearance of infection within which about 81% patients were laid low with mild infection and about 43% of patients had only fever and about 13% patients no symptoms throughout the illness.

Mostly the affected population is that the elderly and folk having severe co-morbidities like diabetes, cardiac diseases, cancer or on chemotherapy drugs, chronic nephrosis on dialysis, post transplant and patients having lung disease are mostly affected. Children’s were rarely affected and if they get infected usually have a light-weight disease.

It also finally ends up in various complications i.e Severe pneumonia, Acute respiratory distress syndrome, Sepsis, Septic shock, Multiple organ failure, Acute kidney injury, Cardiac injury. Chest x-ray indicating pneumonia, but initial results indicate that chest x-rays in COVID19 could have diagnostic limitations clinicians do must be mindful that lung CT scanning findings show significant mottling and ground glass opacity. Lung ultrasound is additionally a diagnostic tool which might be used on the bedside, displaying effects of multi-lobar B lines distribution and diffuse lung consolidation.

Physiotherapy for Covid Patients

Physiotherapy is an well-known profession everywhere the planet, which they work mostly in hospital wards and ICUs to treat acute likewise as chronic cases. specifically, acts on patients with acute and chronic respiratory problems by cardio respiratory PT.

There are attempts to boost physical and mental disability in patients. Physiotherapy may additionally be important to patients with COVID19 within the respiratory care and physical treatment. For this case, sputum secretion could also be a smaller amount normal (34 percent), physiotherapy should only be performed if patients have excessive airway secretions that can’t be independently clear.

High-risk patients can even get pleasure from prior co-morbid conditions with elevated rates of secretion within adequate cough (for example patients of hereditary condition, neuromuscular disease and respiratory disorder).

Physiotherapists employed in ICU provide patients with intubation with airway clearance techniques and folk showing signs of inadequate airway clearance can even be useful in patients with serious respiratory failure with COVID19 (prone to maximizing oxygenation position). future ventilation, continuous sedation and use of neuromuscular blocking agents may intensify their morbidity and mortality by those admitted to ICU with high risk of developing ICU acquired weakness. Therefore, initiating early physiotherapy care after the acute respiratory distress stage is incredibly important so on stop the impairment acquired by the ICU and to market functional recovery.

Physiotherapy’s job is to produce therapies, organize patients and rehabilitate those critically ill related to COVID19 to form patients functionally independent.


Indications for physiotherapy treatment

Patients with dry and non-productive cough with lower involvement within the tract are typically not reported to possess pneumonitis during this case. during this case physiotherapy is usually recommended to patients who experience exudative aggregation, secretion and difficulty in removing the secretions also ICU patients developed weakness.

Treatment is additionally indicated in Patients with pneumonia or lower tract infection with elevated oxygen requirements, fever, breathing difficulties; regular, efficient coughing and ultrasound changes within the throat, CT or lung.

Goals of physiotherapy management

To retaining bronchial hygiene and airway clearing, to scale back phases of shortness of breath, to cut back the prospect of a mechanical ventilator, to remain up active range of motion in ventilated patients, to cut back infection spread, to want care of mobility of the chest wall, to cut back reliance on a mechanical ventilator, to revive muscular and pulmonary functions.

Physiotherapy Management

Chest Physiotherapy

Techniques for clearing airways include positioning, active breathing cycle, manual and/or ventilator hyperinflation, percussion, vibrations, positive expiratory pressure therapy (PEP) and also the insufflation-exsufflation mechanical.

Non-invasive ventilation and inspiratory positive pressure breathing

Inspiratory positive pressure breathing is used by physiotherapists (e.g. rib fractures). Airway clearance strategies may include non-invasive ventilation in Respiratory malfunction control, or during exercise.

Techniques for supporting the clearance of secretions 

Techniques for promoting the clearance of secretions include helped or induced cough manoeuvres and suction by airway.

Other Therapy

Physiotherapists advise exercises, and help mobilize patients. Physiotherapists also play a giant role in treating tracheostomy patients.

Tracheostomy management

Closed in line suction is used to chop back the assembly of aerosols. Inspiratory muscle training shouldn’t lean until the chance of transmission is lower.

Guidelines for patients with COVID-19 taking respiratory treatment

Patients should cover their mouth once they’re coughing through their elbows or sleeves or in an tissue and also the tissue should be disposed of and hygienized by hand. If necessary physiotherapists should be quite 2 m far from the patient. there isn’t any evidence to support incentive spirometry in COVID19 patients. If possible avoid the employment of non-invasive ventilation, mechanical insufflation / exsufflation, inspiratory positive pressure breathing devices or if they’re indicated and alternative options are ineffective, then confirm that machines with viral filters are going to be decontaminated after use over machine ends and patient ends and machines. Disposable circuits should be used for these devices. Physiotherapist should wear full airborne PPE if physiotherapy is required to push a sputum examination. When a sample has been collected a biohazard label should be labelled. A staffer wearing PPE will put it double bagged and within the isolation room. Specimen should be presented by the one who understands the laboratory by hand character of specimen. Saline nebulisation mustn’t be used.


Physiotherapists are likely to be in direct contact with the patient when delivering care like mobilization and activities that really need support which they will use a high filtration mask, i.e. P2 / N95, when providing care. Sometimes mobilization and exercise might also produce cough in patients, ensuring that patients wear a mask while mobilizing patients outside the isolation room. Patients should be treated with physiotherapy only those with severe functional disabilities (ICU acquired disability, frailty, various comorbidities) and a stronger aged category. we should encourage early mobilization to attenuate further complications. Patients will get out of bed ready and elicit basic exercises and ADL’s. The equipment required for the treatment should be negotiated with the local authorities Service personnel monitoring and prevention of infections before use. Use resistant elastic bands instead of distributing hand weights so it are often used alone. Larger equipment like walking aids, chairs, cycle ergometer, and tilt tables must be decontaminated with ease.


The importance of physiotherapy within the treatment of covid19 patients in ICU with appropriate guidelines is discussed during this study. The special environment for Physiotherapists is ICU and also they’re integral component of multi disciplinary group. In COVID 19 ICU cases, the employment of chest physiotherapy methods helps control symptoms faster along with treatment and contributes to reduced risk of developing hospital infection. the foremost widely used methods in hospital environment & ICU treatment management by the physiotherapist are handiest strategies in bronchial hygiene during clinical practice. Effective upper and lower limb movement on a mechanical ventilator in patients during ICU can decrease the complication and help to preserve peripheral oxygen delivery along with inactive blood supply for better health. This blog also suggests that the involvement of the chest physiotherapist within the medical care unit leads to the patient’s early recovery and reduces the duration of be artificial ventilation and hospitalization.
































Therapy Found Effective for Carpal Tunnel Syndrome

Carpal Tunnel Syndrome has been a critical issue in India and a lot of our patients are searching for the Best Physiotherapist in Gurgaon. Carpal tunnel syndrome (CTS) is an entrapment neuropathy caused by compression of the median nerve as it travels through the wrist’s carpal tunnel. Our physyiotherapists in Gurgaon can suggest appropriate precautions and exercises.

  • It is the most common nerve entrapment neuropathy, accounting for 90% of all neuropathies.
  • Early symptoms of carpal tunnel syndrome include pain, numbness, and paresthesias.
  • Symptoms typically present, with some variability, in the thumb, index finger, middle finger, and the radial half (thumb side) of the ring finger.
  • Keeping your arm straight in front with your palm facing down ,gently bend your wrist down.Use the opposite hand to press the stretching hand back towards your body and hold for 15-30 seconds. Straighten your wrist. Gently bend the stretching hand backwards and use the opposite hand to pull the fingers back.

get in touch with us at Tvastacare to know more.

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Read These Three Tips For Long Car Rides

Remaining in a seated position for extended periods of time can restrict blood flow to your lower extremities, causing flexion, which is a compressive force in the spine. Stopping to stand and stretch is critical for your spine, as it releases the compression, allows for blood to flow to the nerves, and helps maintain flexibility.

1. Take frequent breaks during travel

Sitting in one position for an extended period of time can tighten your back muscles, which in turn can lead to pain and even muscle spasms. So then, it’s a good idea to schedule stops every 30 to 60 minutes so you can walk around and stretch your lower back. This activity loosens your muscles and encourages blood circulation, bringing nutrients and oxygen to your lower back.

In addition to scheduling regular stops, try adjusting the position of your seat every 15 to 20 minutes. You can also pump your ankles to stimulate blood flow and to provide a slight hamstring stretch. Basically, any movement that’s safe to perform while driving can contribute to the relief of your back pain.

2. Carry a cold pack for relief

More often than not, back pain is accompanied by inflammation. Applying a cold pack for 15 to 20 minutes can reduce this inflammation and numb sore tissues, both of which can relieve your pain.

Of course, finding relief through cold therapy on a road trip requires advanced planning. Here are a few simple options you can consider:

  • Before you leave on your trip, fill a cooler with reusable ice packs. You can also make your own customizable ice packs at home and toss them in the cooler.
  • Purchase instant ice packs at a pharmacy or general merchandise store. You can store these instant packs in the glove compartment of your car.
  • If you’re in a pinch, you can purchase ice and plastic bags on your trip—just make sure the bags are leak-free.

Regardless of which option you choose, remember to place a protective barrier between your skin and the cold pack to avoid ice burn.

3. Divide Journey

It seems counterintuitive, but sitting places more pressure on your spine than standing. So if your lower back pain is severe, consider breaking up your road trip into manageable stages. For example, rather than traveling 12 hours in one day, try 2 travel days instead. This strategy can help reduce the pressure on your spine—and it may encourage you to seek out unique tourist destinations.

Dividing your journey may cost you additional time and money—but it’s worth it if you can avoid lower back discomfort.

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Lower back injuries

Avoiding Low Back Injuries With Squatting

Let’s talk about some tips to get rid of lower back injuries from squats. In most cases, pain from squatting comes to technical errors; whether the pain is in the lower back or in the knees. Sometimes, the lower back pain can actually originate from the hips.

Understand first the technique for a safe and effective squat.

In a squat, you want to sit back and down — producing the movement from the hips and knees, and not the lower back.

If your hips roll underneath you and your back rounds, you place your lower back in a position that is at a greater risk for injury. The more your back rounds the greater the shear force on the spine, which is dangerous.

Likewise, if you overarch your lower back when your hips tip forward and your butt pops out, you’re not only compressing the spinal segments but using the muscles of the lower back to keep your spine from rounding forward. While preventing the spine from rounding is a good thing, doing so by only using the muscles of the low back will overwork those muscles and create soreness and potential injury. You can tell this happens when you complete the squat and your lower back feels overworked and tight.

Aim to keep your back neutral throughout the movement, meaning you don’t allow it to round or overextend. Use a mirror to monitor your low back position. This might be helpful for you to reduce your lower back injuries.

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