Q: Doctor my son is 14 years old, he has a swelling on his knee, he and his friends made a project that took a week and they sat on their knees while working, he has been complaining of knee ache since then and now the knee is swollen. Kindly guide.

A: He is probably having a condition known as “Prepatellar bursitis” or “Housemaid’s knee”. It is the inflammation of a fluid filled sac between the skin and a small bone of the knee called patella. It helps to reduce the friction. In this case the inflammation is non-infectious. The condition may be caused by a fall, direct trauma to the knee, friction, repeated blows to knee etc. There can be pain, swelling, warmth around the knee joint, reduced range of motion (fluid is drained out), fever and chills (in case of infection). The medical management includes injections of corticosteroid, non-steroidal anti-inflammatory drugs, topical creams etc. Surgical treatments are opted if the conservative management fails to work. A physical therapist takes a detailed history and examines the patient, the RICE protocol is taken into consideration after the signs of inflammation (Rest, Ice, Compress and Elevate). The modalities can also be used. A strengthening and stretching program is initiated once the inflammation is reduced in order to increase the range of motion and to strengthen the muscles. It is important that the patient avoids any activity that can cause friction or injury.

Q: I am a 34-year-old female and have been experiencing neck pain for about two weeks now. I also feel stiffness, what are the causes of neck pain, please guide about it.

A: Neck pain, just like back pain is a commonly occurring condition. Mechanical neck pain has various associated factors like smoking, posture, anxiety, depression, strain, occupation etc. Neck pain may also occur due to degenerative changes of the spine due to aging. It has been divided into grades, 1: There is no structural or pathological issue present behind the neck pain. 2: Neck pain is present but there is no structural pathology, the patient faces difficulty in daily life activities. 3: There are neurological signs associated with the condition like sensory issues, muscle weakness etc, there is no major structural issue. 4: Structural pathology is present like dislocation, fracture, spinal cord injury, systemic condition etc. It is to be noted that neck pain is not necessarily arising from the neck i-e not mechanical in every case. There may be any other pathology which is manifesting itself as neck pain like vascular conditions, malignancy, spinal cord injury, fracture, angina or any other systemic condition. Neck pain can occur due to cervical spondylosis (degeneration of the cervical spine) which is due to aging and can lead to radiating pain or stiffness of the neck. If there is a nerve that is getting impinged it can cause radiculopathy in which the pain radiates and other symptoms like numbness, needle like sensation etc can also occur in the distribution of the nerve. It may be caused by disc herniation, stenosis, osteophytes, swelling after injury or trauma etc. There can be neck pain associated with a brachial plexus injury. A physical therapist takes a thorough history and does examination to confirm the cause of neck pain. The management include the use of modalities like electrical simulation, ultrasound, etc to reduce pain. Various techniques for muscle relaxation can be used. A physical therapist guides about a strengthening program that includes exercises in order to work on the weakened muscles. It is important to consider the fact that ergonomics and posture effect the condition directly and modifications need to be made in order to prevent recurrence and chronicity.