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ASK A PHYSICAL THERAPIST
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- EXPERT ADVICE
Q1: I am a 43-year-old female and have been experiencing pain in my wrist and four fingers excluding a little finger along with numbness for about two weeks. Kindly guide me, I am unable to do household chores.
A: You are having a condition known as Carpal Tunnel Syndrome, which is diagnosed by tests conducted by a physical therapist. It is caused by compression on the Median nerve (a nerve that passes through the wrist). The symptoms include pain, numbness, and paresthesia in the distribution of the nerve and weakness in hand movements and gripping. The condition can cause weakness and wasting of the muscles of the hand if it gets chronic. CTS occurs in people who are involved in repetitive wrist movements (e.g. typing, household chores, machine use), obesity, rheumatoid arthritis, and pregnancy. Carpal tunnel syndrome usually occurs between ages 36 and 60 and is more common in women. You need to make some amendments while working and avoid any repetitive movements, a PT can use modalities and various specialized techniques for this condition.
Q2: Doctor I am a 31-year-old female and have my third trimester going on. I have severe back pain and it is very difficult to stand and walk, please guide me.
A: Low back pain is a common concern during pregnancy. It may be caused by mechanical changes like increased laxity in the structures due to relaxin hormone, postural changes and increase in weight, hormonal and circulatory changes as well as psychosocial factors also contribute to low back pain. The risk factors include previous back pain history, previous abortions, number of previous pregnancies, weight, sedentary lifestyle, etc. The pain is properly diagnosed by a physical therapist. Weakness of muscles needs to be properly countered; a physical therapy plan can be initiated before conception and followed after delivery to ensure optimal muscle strength. A physical therapist can use conservative management options for the condition and guide proper ergonomics and posture to avoid undue stress on the spine. Activities need to be modified including rest breaks, exercises can be guided for strengthening of the muscles. You can use a pillow between your legs while sitting, avoid sitting or standing for a long time, and use rest breaks like walking or stretching, keep your back supported with sitting, while lying on one side keep the top leg on a pillow, avoiding spine twisting while lifting, do not lift heavy, use a small footstool for one foot in sitting or standing (alternate feet), you can use a heating pad or a hot water bottle for pain.
Q3: I am a 44-year-old female and have been experiencing severe pain in my heel for a week and cannot walk or stand for a long time, the problem is worst in the morning, I am a housewife.
A: You may have a condition called “Plantar Fasciitis”, it is diagnosed by a physical therapist after proper examination and testing. Plantar fascia is a thick connective tissue in the feet, it provides support to the arch it is a shock absorber. The condition is characterized by degenerative changes in the fascia. Symptoms include medial heel pain that worsens with weight-bearing, as well as after rest or non-weight bearing. It is often an overuse injury, due to repetitive strain plantar fascia experiences micro tears. The risk factors include high-arched feet, flat feet, foot deformities, prolonged standing, running, improper footwear, obesity, muscle tightness, etc. A physical therapist can use modalities and specialized techniques for plantar fasciitis. You can be guided by an exercise plan, using a cold pack, rolling a ball/bottle under the feet, and having appropriate footwear to deal with the condition.
Q4: Doctor I am a 37-year-old female and have had pain below my thumb of the right hand, near the wrist for about a week or so. I work in an office and cannot type. Pain increases when I try to grip and move my thumb. Please guide me about the condition.
A: You have a condition known as “De Quervain’s Tenosynovitis”. The condition is diagnosed by tests conducted by a physical therapist. It is the inflammation and degenerative change in the tendons of two muscles of the thumb (Abductor pollicis longus and Extensor pollicis brevis). Symptoms include pain at the side of the wrist at the base of the thumb. There can be swelling at the anatomical snuffbox. Pain increases with the thumb, wrist movements, and gripping activity. It is commonly caused by overuse and repetition (e.g. office workers, household chores, carpenters, etc). A physical therapist can use various specialized techniques and modalities to deal with the condition. An exercise plan for strengthening can be prescribed. Please make sure you avoid repetitive movements.
Q5: Doctor I am a 29-years-old male. I fell on my hand about three to four days ago, I have severe pain in my wrist and there is swelling. I have my x-rays and there is no fracture, kindly guide me.
A: You are probably having a wrist sprain. The diagnosis needs to be properly confirmed after examination by a physical therapist. Inspection, palpation, ranges, muscle strength, provocative tests, etc can be used by the therapist. There can be injury (partial/complete tear) to the ligaments of the wrist. Sprain can be divided into three categories 1: mild ligament stretch without joint instability 2: mild ligament rupture without joint instability / mild instability 3: complete ligament rupture with severe joint instability. The physical therapy management in the mild phase utilizes a protocol known as RICE (Rest: stop the activity, repetitive movement, and use of the injured structure, wait for about 48 hours so that the swelling and pain reduce, Ice: Use crushed ice in a bag or a cold pack wrapped in a towel and apply at the wrist for about 15 minutes for some days, Compression: Use an elastic compression bandage to deal with swelling, it should be used with caution as the circulation should not be compromised, Elevation: The wrist is kept above the level of the heart for about two days as frequently as possible to reduce the swelling and helps with fluid drainage). A PT guides about the protocol for proper management. In moderate or severe sprains immobilization by using braces and even surgery may be required. The physical therapy treatment progresses to retraining and strengthening exercises for improving flexibility and range. It reduces stiffness and weakness of the wrist. A physical therapist can use various specialized techniques and modalities in this condition. The sessions are designed for the progression of rehabilitation to help the patient attain maximum functional status.
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