Physiotherapist advice

As well as the 'tricks' which come from our personal experience, and the experience from others, referring to dystonia and other movement disorders, we have at our disposal several specialists who can advice us the best way to move forward. In fact, carrying out a simple exercises table is sometimes enough to relieve, as it happened to me, a so very acute lumbar pain that I suffered due to my postural problems. For this, and also for other symptoms (specifically, an acute thoracic pain owing to anxiety), I must share I have been helped by a fantastic and reliable physiotherapist, also a close friend of mine.

From now on you can also take advantage of the same specialist and friend of mine about your particular symptom(s watching the section of videos directed directly by him with my little help as the sick that I am.

This way, if you think you can take interest in physical guideline that will help you to get by better with the commonest symptoms in dystonia (spaticity, pain, anxiety, etc.) or if you even want good advice for your concrete disorder (blepharospasm, dysphonia, writer's cramp or musician's dystonia, spasmodic torticollis, jaw dystonia, Parkinson, etc.), now you have got some specialized help.

  • This very practical page deals first with the best advice for those symptoms which are potentially common to most of dystonias and related disorders.

  • Aftwerwards more specific symptoms or focal dystonias are examined and shown going into details.

  • Finally, you are invited  to visit and suscribe in distoweb, in youtube, with the knowledge and skills of my dear physiotherapist (collegiate nbr. 3.017 from the distinguished Official Physiotherapy College from the Comunidad Valenciana, Graduate by the University of Valencia-Spain,  long time experienced in hospitals and outpatient's departments), who will clarify many of your doubts about your particular symptoms need. Watch below please.

 

 

 
Dystonia's most common symptoms.

 

Spasticity, stiffness, spasms. Common symptoms to all kinds of dystonia, whether it is a generalized or focal one, these can benefit from the following activities which are worth practicing (as it is immediately shown):

 

o         Breathing techniques.

o         Jacobson muscular relaxation.

o         Stretching.

 

 Breathing

Relaxing breathing technique

Relaxing countdown

1.     Breathe in through your nose in a deep and prolonged way, first filling your lungs' lower zone, and then the upper zone.

2.     Hold your breathe and count to three..

3.     Breathe out  very slowly through your mouth by pursing your lips, while you relax the muscles in your face, your jaws, your shoulder and your stomach. 

 

WATCH RELAXING BREATHING DEMO VIDEO AT -->   http://www.youtube.com/watch?v=RiOnskW5TEY

 

 

1.    Breathe in through your nose in a deep and prolonged way, and breathe out slowly while quietly pronouncing the word 'relax'.

2.     Close your eyes and imagine your body starts to relax.

3.     Breathe softly and naturally ten times. Every time you breathe out, count down starting by 'ten'. While you comfortably breathe, watch out for any tension that may arise, maybe in your jaws, front or stomach. Imagine that tension does release.

4.     When you get to 'one', open up your eyes.

 

  

Jacobson relaxation technique

  • Jacobson‘s method is based on:

1.       The whole attention to a specific muscular area.

2.      Applying some tension on this muscular area, without sensation of pain, and keeping this kind of stress for 20-30 seconds.

3.       The muscular relaxation, paying attention to the pleasant sensation it produces. 

  • It can be carried out at almost every different muscular groups, but the normal indication recommends keeping an order:

1.       Right or left hand (and then the other, and the same for every one).

2.       Right and left forearm. .

3.       Back: Dorsal area / Lumbar area.

4.       Neck.

5.       Face. Eyes.

6.       Upper trunk / Abdomen.

7.       Right foot. Left.

8.       Right calf. Left.

9.       Right thigh. Left.

 
  • It is essential to enjoy the muscular relaxation phase, paying speciall attention to: 1. how the relaxation is taking place, and 2. how the psychic tension comes to diminish gradually , and even disappears.
  • Once you have finished your exercises, you can stay sitting for some minutes enjoying the sensation of relax that automatically comes to appear. Then you should breathe softly while becoming aware of your interior state of calm and tranquillity.
  • Finally, open and close strongly your hands, breathe in and out twice with some intensity, and open your eyes as the final stage of the relaxation exercise. 

  • You must do these exercises sitting, although they can also be done lying down (maybe a better alternative for beginners with so similar effects).

 

Stretching

The muscular stretching pursues the main objective of adapting the right way our muscles to the daily routines, the sports practice and, of course, to tone the muscles up to prevent somehow the typical spasms in dystonia. The phyisical mechanisms involved are:

  • Uniform lengthening of muscular tissues (there usually exist fibers shorter than others due to different reasons as posture (sometimes at work) problems, disorders, etc.
  • To achieve a better balance between the intramuscular temperature and the external or envorimental (the rule says you must stretcht more and better when it is cold).

     Every stretching must be done in a soft, progressive and sustained way (avoiding any brusque 'rebound’ which could produce a reflex contracture in the muscle, just the opposite effect that we want). There exist these modes (among others):

  • Active: auto-stretching (carried out by oneself).
  • Pasive: with the help from other person.

     The rule says you must stretch before and after doing physical exercise, it doesn’t matter if it is housework, sports, therapy, etc.

     As a general rule, the optimum stretching of a muscle (or a concrete muscular group) must last about 30 seconds, with a frequency of 1-3 repetitions at the most.

     The appropriate stretching table for any particular activity and, mostly, for any specific symptoms or disorder, depends on the muscular area which is directly affected. This way, for further information about the stretching  exercises that would probably help you, please feel free to email our physiotherapist (see at the bottom of this page) and you will be personally answered.

 

Muscular pain. Every muscular pain, on account of its particular features, must be treated specifically. Muscles are structures more irrigated and oxygenated than others as bones, cartilages and even tendons (ending from the muscles which insert themselves into the bones). As a normal rule (notice every case is unique and has its own specific treatment), muscular pain usually gets better with heat because it takes the blood vessels to dilate and, consequently, pain and any underlying inflammation tend to diminish.

 

The most affordable and advisable methods to give heat are:

 

 

 

WATCH BACK LOWER PAIN RELIEF VIDEO DEMO VIDEO AT -->   http://www.youtube.com/watch?v=UD0-GYfST1Q

 

 

Joints pain.   Joints are made up of a collection of elements: bones, tendons, ligaments, meniscus, synovial cavities, etc. On the other hand, evey joint is unique. For instance, a finger joint has nothing yo do with a shoulder joint, probably the most complex one in human body because of covering some different joints and having a lot of mobility (the rule says the more mobility, the more possibilities of unnatural movements and so the risk of an injury). It is highly advisable to consider a specific treatment for any particular joint and personal case.

Depression, anxiety. It is a fact that body and mind are intimately related. It is easy to check how a mental energy drop produces automatically a physical energy drop which is commonly known as a 'somatic reaction'; kind of a unpredictable reaction, for example, when coming from anxiety, depression or emotional stress. Indeed there exists bibliography defending a theory that links every physical pathology to a concrete emotional problem. From this point on, we can consider more efficient and practical exercises to face anxiety or depression syndrom:

 

More specific symptoms. Focal dystonias. Other related movement disorders*.

Blepharospasm.  The recommendation to try to control the sudden and remaining spasm affecting mainly the orbicular muscle consists of putting any of the relaxing techniques described before (breathing, Jacobson) into practice. The alternative could be the visual yoga, developed by Dr. William H. Bates in the beginning of 20th century. It is based on the evidence of many eye illnesses to be due to the atrophy or degeneration of the most of the muscles involved for falling into disuse. Recovering the use, you contribute positively to a complete eye irrigation and oxygenation. A simple visual exercises table (to be done once or twice a day) could be: 

    1.    Eyeball warming: rub strongly and quickly both your hands and then set you palms over your eyelids during some seconds (obviously you must keep you eyes closed).

    2.    Eyeballs bilateral movements to their full extension:

o       up - down (7 times),  left - right (7 times), diagonal (7 times each).

o       circles clockwise (7 times), circles counter-clockwise (7 times).

    3.    Eye relaxation: with both eyes closed, you should give some soft knocks with your fingertips over your eyelids (you can use both your forefingers).

 

 

WATCH VISUAL YOGA DEMO VIDEO AT -->   http://www.youtube.com/watch?v=Jsvz50DH3oQ

 

 

Cervical dystonia (Spasmodic tortícollis). To face this particular disorder (which is characterized by a typical brusque spasm in the cervical musculature which takes this to one side), it is really advisable to receive an additional treatment appart from the doctor’s prescription. Cervical area is kind of a very complex muscular area, and so the best treatment is using bilateral superficial heat (over both sides of the neck). But, on the other hand, we know our main objective against any spasm, and this is exactly the antagonistic effect: The opposite of a sudden spasm, relaxation as the principal key. As a result of this, the local inflammation and pain, and also the posture should get gradually better.

A so very pleasant and advisable exercise, even as a preventive meausure, consists of doing kind of a cervical auto-strectching. This can help you to increase your muscular flexibility and then to reduce the risk of a spasm. It is obvious this auto-stretching is carried out by every patient, and includes next steps:

 

WATCH CERVICAL SELF-STRETCHING DEMO VIDEO AT -->   http://www.youtube.com/watch?v=B2wWXTPIDg8

 

 

Oromandibular dystonia (and Meige Syndrom). Although there exist several forms of this disorder, the most common symptom is usually de sudden close of the patient’s mouth owing to a spasm (billateral the most) affecting the muscles involved in the temporo-mandibular joint (commonly known as 'TMJ'). The TMJ complex presents a high contractile capacity, and then the spasms are usually very intense. In a practical way, it is highly recommended to take notice of the directions just told in connection with the other symptoms:                                 

Just as a remider, when blepharospasm and oromandibular dystonia coexist in a patient, then it is called Meige Syndrom, and phisitoherapist treatment must consider both symptoms.

 

Spasmodic Dysphonia (Larynx dystonia). From the physiotherapist point of view, it'd rather be called 'vocal chords dystonia' instead of larynx dystonia. In fact, the vocal chords in dysphonia change and alter their position and state and so modify the voice’s tone and timbre. This way, the result of the vocal chords approaching (called 'adduction') or moving away (called 'abduction') means a different malfunction afeccting the voice in one or other way.

Muscles involved in dysphonia are internal and so not approachable directly. However, it can be improved by respiratory physiotherapy. When our respiratory muscles work, we facilitate the air to go through, and somehow we get to improve the vibration of vocal chords.

The most important respiratory muscles system consists of the couple diaphragm/abdominals. Diaphragm is responsible for the inhalation, and abdominals for the exhalation.

Therefore, as a practical exercise we can use the relaxation breathing video (see above) with certain modifications:

We should carry out this cyclical exercise during 5-7 minutes, 1-2 times a day.

It is also effective in some cases the application of humid heat (e.g. using the jet of hot shower, but at a comfortable temperature) just over the larynx area
(caution: do not apply over the carotid sinus), to produce relaxation in the muscular area involved.

 

Writer's cramp (also Musician's dystonia).  In general terms, this disorder means a psychomotor (oculo-manual) loss of control and coordination (or synchronization) specifically shown in the distal inter-phalanx joints, although there can also be directly affected other parts from the hand or the forearm. The loss of control forces the body (maybe only part of it) to make a compensatory movement (sometimes called 'vicariant movements') with the objective to recover somehow some coordination and control.

There are some possible treatments, although new trends point at sensory re-training guidelines. For example, we could try:

On the other hand, it is also worthy trying to handle the so called 'anti stress balls', with a specific resistance for any patient. It is pretty good to play with every individual finger, changing the position of the fingers and the pressure areas distribution around the ball. This way you can avoid some postural habits and also work for a better coordination.

Hemifacial spasm*. Consisting of a generalized and sustained spasm in one side of the face's muscles, it usually also affects the eyebrow, the eyelid and the mouth, although it can reach any other facial muscle in that side. The guideline, as it is every example of spasticity, recommends relaxation according to the preference of each patient, but it is an advisable treatment to be considered the applying of wet heat over the whole affected area for some minutes. This way, for example, you can point for some minutes at the spastic area with hot water (not scalding, of course, but enjoying the temperature) from the shower head, from such a reasonable distance and not much pressure. After some sessions of combined thermotherapy/hydrotherapy you will probably get to relieve gradually the contracture, and so the inflammation and pain.

Parkinson's disease*. As a result of an imbalance of the chemical agents responsible for the nerve impulse transmission (more specifically the dopamina) this disorder shows a typical tremor in state of repose and other symptoms. Now, when trying an initial physiotherapist approach, there are some relevant aspects to be considered:

So, in a practical way, there are some generic exercises to be recommended:

Essential Tremor*. This disorder may affect the whole body of any personal patient profile (about race, sex, etc.). The most of the academic studies consider this as an active tremor or, in other words, kind of a tremor which comes when the patient's body is moving somehow, maybe through any specific posture to compensate the gravitational force, maybe simply in motion, or whatever.


Note: In every single case where focal spasticity occurs, it is recommendable to consult the doctor about the convenience of using thermogenic creams (for external use and therapeutic massages) in order to favor the relaxation (checking if it can be used safely without risk of allergy or interaction with other medicines) It’s obvious to understand very clearly every single physiotherdapist advice shown in this page for the different dystonias here considered. Please do not forget to inform your doctor(s) about them all.