Fitsiomax

Elevate Your Expertise With
FITSIOMAX’S
Virtual Physio Workshop
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Sumaiya Naaz - Sports Physiotherapist
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Founder & CEO of Fitsiomax
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INTRODUCTION
What makes us different ?

01 What is the need of online Physio ?
02 Assumption about online Physio ?
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DECODING
THE PAIN
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PATTERN
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STERNO CLEIDO MASTOID (SCM)
Representation:-
• Deep Aching – Ipsilaterally across cheek and into
the Maxilla, over the Supraorbital ridge and
deep within the orbit.
• The Pharynx and to the back of the tongue
during Swallowing, Crackling Sound in one
patient’s ear.
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Patient Presentation:- Differential Diagnosis:-
• Neck movement Restriction • Sinusitis
• Pain near Collar bone • Vertigo
• Dizziness while Changing Posture • Migraine
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TRAPEZIUS
Representation:-
• Posterolateral aspect of neck to mastoid process
• Temple and back of the orbit
• Angle of Jaw
• Lower Molar teeth
• Tension type Headache
• Posterior part of Cervical Spine
• Sensation of Tightness in Occipital Region
• Burning Pain between the Medial Scapular Border
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Aggravating Factor:-
• Driving, Cooking, Sitting for a long time
Patient Presentation:- • Desk Job
• Forward Neck posture
• One side Headache
• Stress
• Eye pain
• Mid Back Pain
• Restricted Neck ROM
• Numbness
Differential Diagnosis:-
• Cervical Spondylosis
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INFRASPINATUS
Representation:-
• Anterior aspect of shoulder
• Projects down the anterolateral aspect of arm,
lateral forearm to the radial aspect oh hand and
occasionally to the fingers
• Upper posterior cervical region and medial
border of the scapula
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• Radiating pain from neck till • Rotator cuff dysfunction
finger( tingling) • Shoulder impingement syndromes
• Supine lying aggravates
• Night pain will be high
• Taking things from the car back
seat
• Radiating pain in front of arm
till index finger side
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SUPRASPINATUS
Representation:-
• Deep pain around the shoulder, particularly over
the mid-deltoid region
• Extends along lateral shoulder, elbow and wrist
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• Pain while lifting arm • Adhesive capsulitis
• Pain during lifting bucket, kid • Subacromial impingement
• Pointed pain in shoulder • Glenohumeral arthritis
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SPLENIUS CAPITIS
Representation:-
• Extends through the belly of the muscle
• Refers at the vertex of skull
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• Pain in the vertex • Cervical spondylitis
• Pain at Back of head • Cervical disc degeneration
• Constant pain
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LEVATOR
Representation:-
• Refer pain laterally to the shoulder and along the
medial aspect of the shoulder blade
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• Side bending of neck • Ligament injury
• Turning neck on either side • Facet joint injury
• Neck stiffness
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DELTOID
Representation:-
• Extends anterior, middle, posterior area of shoulder
• Projects anterolateral aspect of upper arm
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• Pain while lifting the arm 90 degree • Acromioclavicular joint sprain
• Classic example: Sharp pain exactly at 90 • Subluxation / complete
degree and lifting above is less painful dislocation
• Sharp pain while taking hand behind • Frozen shoulder
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LATISSIMUS DORSI
Representation:-
• Inferior angle of scapula
• Ipsilateral mid- thoracic region
• Extends to posterior aspects of shoulder down
the medial aspects of arm, forearm and hand to
4th and 5th finger
• Extends to front of the shoulder and to the side of
torso above iliac crest
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• Inferior aspect of axillary fold
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• Overhead arm lift feels • Thoracic Outlet Syndrome
restricted • Bicipital tendinopathy
• Arm supported sitting • Cervical radiculopathy
aggravates the pain
• Supine lying aggravates the
pain
• Complains of back pain
radiating till hip
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RHOMBOIDS
Representation:-
• Extends to vertebral border of scapula and between
the scapula and Paraspinal muscles
• Projects laterally and superiorly over the
supraspinatus muscle and spine of the scapula on
affected side
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• Burning sensation • Cardiopulmonary
• Tingling sensation • GI systems
• Supine lying aggravates pain
• Radiating pain till the back of the neck.
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BICEPS BRACHII
Representation:-
• Upward over the biceps brachii muscle and over
the anterior deltoid region of shoulder
• Occasionally, over suprascapular region
• Refer less intense pain downward in antecubital
space
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• Clicking of Biceps tendon at • C5-C6 Radicular pain
Bicipital groove • Bicipital Bursitis
• Pain in driving, sweeping and • Glenohumeral arthritis
other household activities
• Pain when using mobile,
reading book
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PECTORALIS
Representation:-
• Starts in the front of shoulder and extend down
the inside of the arm, elbow, forearm, palm of the
hand, and into the pinky, ring, and middle fingers
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• Radiating pain from chest • Pleuritic chest pain
through front side of arm till • Pericarditis
fingers • Inflammatory bowel disease
• Chest burn feeling • Pleural effusion
• Rounded shoulder, heavy bust
• Deep breathing difficulty
discomfort and pain
• Reaching arm straight will be
difficult
• Reaching arm back
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TRICEPS
Representation:-
• Extends from neck, upper trapezius, deltoids,
upper arm and the elbow
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• Dough making • Posterior impingement syndrome
• End range elbow extension • Ulnar collateral ligament injury
painful
• Table elbow support sitting
elicit pain
• Sharp pain in back of elbow
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BRACHIORADIALIS
Representation:-
• Extends from lateral epicondyle to lateral side of
forearm
• Extends from base of thumb and base of index
finger
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• Pain while using keys • Tendinopathy
• Difficulty in eating and • Radial tunnel syndrome
wringing clothes • Radio capitellar pathology
• Pain on shaking hands and
weight bearing on hand
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DIAPHRAGM
Representation:-
• Central dome portion - refers pain to upper
border of ipsilateral shoulder
• Peripheral portion - refers as an aching pain to
the region of adjacent coastal margin
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• Difficulty in deep breathing • Rib articular dysfunction
• Sharp pain at the back • Thoracic radiculopathy
• Fibromyalgia
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OBLIQUES
Representation:-
• Pain reaches up into chest, travel straight or
diagonally across the abdomen and extend
downwards
• Produce pain in epigastric region, occasionally
extends to other parts of abdomen
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• Painful Bed mobility • Rhabdomyolysis
• Difficulty in lifting objects • Hernia
• Pain while Turning to either • Gastritis
sides • Diverticulitis
• Pain on sneeze and cough • Fibroids
• Hepatic abscess
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RECTUS ABDOMINIS
Representation:-
• Pain is referred to the mid-back
bilaterally,(horizontal across both the sides at
thoracolumbar level)
• Refer pain to the xiphoid process, upper abdomen
between the costal margins
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• Pain on lifting objects and • Ilioinguinal–
bending forward Iliohypogastric nerve
• Band like lower back pain entrapment
• Pain described as fullness, • Slipping rib syndrome
burning, bloating or gas • Hernia
• Painful cough and sneeze • Xiphodynia
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QUADRATUS LUMBORUM
Representation:-
• Posterior to SI joint
• Extending to lower buttock
• Anterior crest of ilium
• Lower quadrant of abdomen and groin
• Extending to greater trochanter
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• Turn over in bed • Trochanteric bursitis
• Standing upright • Gall stone, kidney stone
• Painful cough/sneeze • Diverticulitis
• Increasing abdominal pressure during • liver disease
defecation
• Lifting objects from ground
• Pain in scrotum / testicles, groin pain
• Pain on sexual intercourse
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ERECTOR SPINAE
Representation:-
• Mid thoracic level-Extends up towards shoulder
and laterally to the chest wall
• Lower thoracic level- extends upwards across the
scapula, around abdomen and downward over
the lumbar region
• Upper lumbar level- concentrates on the mid-
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• Pain on prolonged sitting & • Disc pathology
standing • Renal colic
• Constant pain at the back • Ureteral colic
• Spot pain and no radiating • Acute lumbar muscle strain
pain
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GLUTES
Representation:-
G maximus:
• Superior medial region of muscle.
• Lower mid portion overlying posterior region of ischial
tuberosity
G Medius:
• Crest of ilium, SI joint, sacrum, lower lumbar region
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G Minimus:
• Extending from lower part of butt till lateral part of
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• Difficulty sleeping on the affected side • Coccydynia
• Unable to sit /stand for long time • Sacroiliitis
• Rising from sitting • Mechanical low back pain
• Radiating pain down the leg • Piriformis syndrome
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PIRIFORMIS
Representation:-
• Two strong zones of pain
1) 3 cms lateral to coccyx
2) 7 cms zone postero-lateral buttock region
• Broad spillover of diffuse pain between point 1 & 2 and
down thigh above knee
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• Radiating pain down the leg • SI joint syndrome
• Taking first leg out of the car • Disease such as appendicitis,
• Cross leg sitting uterine disorders, prostate
• During defecation • Gynaecological conditions
• Sexual intercourse
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IT BAND
Representation:-
• Lateral aspect of the thigh
• Radiates down the leg laterally up to knee
• Concentrates on the lateral knee aspect
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• Outer Knee Pain • Pes anserine bursitis
• Radiating pain like sciatica • Lateral meniscus tear
• Pain at the hip joint • Lateral collateral ligament sprain
• Steps Climbing
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HIP FLEXORS
Representation:-
• Vertical pattern ipsilaterally along lumbar
spine
• Extending downwards to SI region,
sacrum, buttock
• Extending to groin
• Upper antero-medial aspect of thigh
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• Sitting cross-legged, Cross-legged sitting • Avascular necrosis
on floor • Femoral nerve compression
• Sitting with narrow leg • Kidney issues
• Pain is presented vertically in low back • Hernia
• Getting up from deep seated chair
• Abdomen pain lifting the leg while
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ADDUCTOR
Representation:-
• Antero-medial aspect of the thigh & groin
• Pain travels downward to the knee and shin
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• Groin & medial thigh pain • Adductor insertion avulsion
• Pain while sudden twist of the hip syndrome
• Localized to the vagina or rectum • MCL and meniscus injury
• Pain & discomfort during sexual • Genitofemoral nerve
intercourse entrapment
• Walking, running
• Taking leg inside the car
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QUADRICEPS
Representation:-
• Rectus femoris - ASIS, ilium superior to the
acetabulum
• Vastus lateralis - lateral side of upper three
quarters of posterior femur.
• Vastus medialis - posteromedial aspect of the
shaft of the femur.
• Vastus intermedius - anterior and lateral
surfaces of upper 2/3 rd of the shaft of the
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femur.
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• Stair climbing • Femoropatellar joint
• Unable to bear weight in single leg dysfunction
• Unable to extend knee • Osteoarthritis
• Anterior knee pain • Chondromalacia patella
• Pain while getting up from the floor & • Jumpers knee
deep seated chair • Plica synovitis
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HAMSTRING
Representation:-
• Semimembranosus, semitendinosus - strong 10 cm zone
of pain, inferior gluteal fold, with diffuse pain
posteromedial legs to achilles tendon area
• Biceps femoris - diffuse pain, posteromedial leg with
strong 10 cm zone posterior to knee joint
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• Pain behind knee • Sciatica
• Unable to bend and straighten knee • Lumbosacral referred pain
• Getting down from stairs syndrome
• Pain in gluteal fold • Piriformis syndrome
• Ischial bursitis
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TIBIALIS ANTERIOR
Representation:-
• Antero-medial aspect of ankle
• Dorsal and medial surface of great toe
• Spill over pattern down from shin to ankle
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• Pain below the knee • medial tibial stress syndrome
• Unable to stand/walk/jog/run-5 mins • Airline crack of fibula/tibia
• Pain on sajda namaz position • L5 radiculopathy
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PERONEAL MUSCLES
Representation:-
• Extending over lateral malleolus above, behind
and below it, also along lateral aspect of foot
• Spill over pattern over lateral middle third of leg
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• Pain and tenderness over ankle • lateral compartment
• Pain while turning foot inwards syndrome
• Balance issues • Ankle fracture
• Outer side knee pain when sitting
cross leg on floor
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CALF
Representation:-
• Gastro - Extending postero-medial aspect of ankle, calf,
back of knee to lower posterior thigh
• Soleus - Extending over posterior aspect and plantar
surface of heel, distal end of achilles tendon
• Plantaris - Back of knee and extending down to calf
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• Early morning heel stiffness and intense • Baker's cyst
pain • Varicose vein
• First few steps is difficult • DVT
• Calf cramp • Achilles tendinitis
• Unable to extend the knee • Bursitis
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“People wellness is our mission and our
journey to build a healthy society”
THANK YOU!
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