Q1: I am a 37-year-old female and have been experiencing low back pain for two months. I visited a physiotherapist two weeks ago and he guided me thoroughly after a session and prescribed exercises. The pain subsided after the session but returned last week. Kindly guide me if I should frequently visit a physiotherapist for general relaxation and modalities.

A: Being a homemaker is a tough job, it is often fuelled by neglecting oneself to fulfill tons of responsibilities which has deleterious effects on health. It is appreciable that you visited a professional for your concern. The source was targeted and treated with a prescription of exercises and precautions/modifications. It is important that the patient considers the precautionary measures seriously and implements them in daily activities. The exercises should be performed as guided by the therapist. Sometimes the repetition is minimal or the exercises are being performed incorrectly. Physiotherapists recommend a heating pad/hot water bottle for muscle relaxation, but it should be noted that general relaxation and the use of modalities have short-living effects and weakness of muscles needs to be targeted till maximum recovery. Start the exercise plan as guided by your PT and take precautions, after two weeks reassess and determine if you need to visit your PT.

Q2: Doctor my brother experienced a car accident last month and the doctors have used the term whiplash injury. Kindly guide how physical therapists can help patients.

A: Whiplash injuries are commonly sustained in motor vehicle accidents due to sudden acceleration and deceleration movement of the cervical (neck) spine. There is a proper diagnosis based on the clinical picture of the patient to rule out any fracture, disc herniation, artery rupture, spinal cord injury, ligament injury, or subluxations. A physical therapist takes detailed history with examination to proceed. There are three stages of the injury, 1: Flexion (bending) of the cervical spine, 2: S shape cervical spine, 3: Extension (backward bending ) of the cervical spine which can lead to compression. The condition has been graded as 1: The patient has neck pain, stiffness, or tenderness with no positive findings on physical examination, 2: Decreased range of the neck and tenderness, 3: Neurological signs and symptoms like sensory disturbances and muscle weakness. The condition is not only confined to motor vehicle accidents, it can also occur in sports injuries and falls. It is more common in women as compared to men. The condition depends on various factors including impact, gender, and age. The prognosis is variable for every case, there is a complete recovery in most of the cases, in about 25% of cases experience some disability. A multidisciplinary program is initiated for the patients, and a physical therapist encourages a return to activity and utilises relaxation techniques, mobilisations/manual techniques, strengthening, or postural education to ensure maximum rehabilitation.

Q3: I am a 35-year-old female and have been diagnosed with osteoarthritis of the knee, but it is common in old age, please guide me. I am a housewife.

A: Osteoarthritis is a chronic condition that mostly affects old people but it can be present in young as well as athletic populations. A proper diagnosis is made by a professional based on history and examination to rule out any other condition. The risk factors for the condition include a sedentary lifestyle, postural issues, jobs like prolonged sitting and working on a computer, obesity, activity that requires a lot of running like athletes, birth injury, hormonal issues, joint injuries, accidents, and family history. The treatment protocol is initiated by a PT by utilisation of techniques, muscle strengthening, relaxation, and conditioning to improve the status of the patient and to ensure maximum efficiency.

Q4: My son is about a month old and has been diagnosed with torticollis, please explain the condition and the role of a physical therapist.

A: Congenital muscular torticollis is a musculoskeletal condition that is diagnosed shortly after birth. The sternocleidomastoid muscle (SCM) is a neck muscle that is short on one side. The child has a typical presentation of the same side bending and opposite rotation of the neck, hence it appears to be twisted. The child faces difficulty while moving the neck to the opposite side. The diagnosis includes an ultrasound (to check the mass that is present in the muscle and to rule out any tumour), MRI (to check if there is any other cause than the SCM muscle itself), range of the neck, palpable mass, and head position preference. The condition has been divided into three types 1: Postural: The child only prefers one side and there is no muscle tightness on the side. 2: Muscular: There is tightness of SCM muscle and there is restricted movement 3: Sternocleidomastoid muscle mass: It is the most common type with sternocleidomastoid muscle thickening and restricted range. The treatment time and aggression in physical therapy protocol depend on the type of congenital muscular torticollis. The exact cause is unknown, there are various theories. It may be caused by traumatic delivery, pressure on the neck due to the position of the child in the womb, reduced blood supply to the muscle, etc. A fibrous palpable mass is usually present in the early stages which is then replaced by a fibrous band. The condition can lead to deformity when the child is 3-4 years old. It can also lead to asymmetry. A physical therapist examines the patient and also refers them for neurological examination, auditory examination, etc. With proper treatment, 90% to 95% of children improve before the first year of life and 97% of patients improve if treatment starts before the first six months. A physical therapist educates the parents regarding the handling and positioning of the child. A home plan is vital to ensure a maximum gain. The motive is avoiding contractures, stretching the muscle, strengthening the muscles, preventing any delay in neck activities, facilitating the development of balance in the child, and maintaining sound posture. A physical therapist uses modalities, ice, ultrasound, massages, relaxation, stretching, and other positioning techniques to deal with the condition. Other conservative management options include collars and splinting like a cap or jacket splint, wearing the splints for a long period can cause hindrance to neck muscle activation hence it is not preferable. If there is no improvement, invasive methods can opt that include botox injections and surgical options like tenotomy. After surgery, a physical therapist starts therapy to maintain the gain and promote righting reactions in a child. The home plans include active exercises and techniques taught by PT to the caregivers.