Q1: I am a 43-year-old female and have been diagnosed with sacroiliac joint pain. Kindly guide about the condition.

A: Sacroilliac joint is present at the sides of the spine; two pelvic bones are attached to the sacrum. The joint connects upper and lower body and has a great role in walking. There is cartilage at the joint surfaces and the joint is also fluid filled. In various cases, SI pain is also associated with the low back pain. The symptoms can be related to sacroiliitis (inflammation of the sacroiliac joint) or sacroiliac joint dysfunction (reduced or increased mobility of the joint). Trauma can also lead to SI pain; it may be sudden or gradual. The condition is common in pregnancy due to increase in laxity of the joint as a result of hormone release. The symptoms include pain over the buttocks, inability to sit for a long period of time, pain in lying, stair climbing and tenderness at the joint. A physical therapist assesses the patient using tests to confirm the diagnosis, he can utilise modalities and specialised techniques to deal with the condition. Strengthening exercises are incorporated in the plan to support the sacroiliac joint.

Q2: What is the physical therapy treatment for an ankle sprain?

A: In an ankle sprain, the ligaments of the ankle are either stretched or torn. It is a common injury of the ankle joint and occurs when the joint is out of the original position. Some factors that can increase the risk include previous ankle sprain history, gender, height, weight, dominant side, foot structure/anatomy, shoes etc. Symptoms include pain on weight bearing on foot, ankle joint tenderness, swelling, bruising and edema, limited movement, instability of ankle joint etc. An ankle joint sprain needs to be differentiated from tendon rupture, tendinopathy, fracture, tendon subluxation, and a number of other conditions. A proper history, examination and imaging needs to be done for the diagnosis. There are classifications of ankle sprain, Grade I: slight stretching and damage to fibers of the ligament, Grade II: partial tear of the ligament, Grade III: complete rupture of the ligament. On the basis of the severity of the condition the classification includes Grade I: Mild impairment – Minimal swelling and tenderness with little impact on function Grade II: Moderate impairment - Moderate swelling, pain and tenderness with decreased range of motion and ankle instability Grade III: Severe impairment – Significant swelling, tenderness, loss of function and marked instability. A physical therapist examines the patient for gait pattern, posture, deformity, mal-alignment, atrophy, presence of edema etc and performs tests. Depending upon the duration of the condition, four weeks or less is known as acute and more than four weeks is called chronic. In the acute stage a physical therapist manages pain and in chronic ankle sprain, the goal of a physical therapy is to focus on reducing pain and edema and restoring functional movement and stability. The common treatment protocol followed is the PRICE (Protect, Rest, Ice, Compress, Elevate) treatment. It involves resting the injured ankle for the first 72 hours and if necessary protecting the ankle joint through the use of crutches then applying ice can help with the swelling and pain and a compress using a bandage or a brace is used to stabilise the joint and finally elevating the ankle can also help with the pain and edema. Ankle taping and bracing may be used to help stabilise the joint by limiting motion and proprioception. Ankle taping is said to have a greater effect in preventing recurrent strains rather than an initial sprain. A physical therapist plans the treatment according to the stage of recovery and aims at maximum recovery and return to activity.

Q3: I am a 39-year-old woman and have pain and numbness in wrist, thumb and three fingers. I am unable to perform household chores and my grip is weak. Please guide about the condition.

A: It seems that you have Carpal Tunnel Syndrome, which needs to be assessed by tests conducted by a physical therapist for confirmation of diagnosis. A nerve called Median nerve is passing through the wrist inside a tunnel like structure, in CTS, the nerve gets entrapped and the symptoms are generated. Repetitive traction and wrist motion exacerbates the negative environment, further injuring the nerve. In addition, any of the nine flexor tendons traveling through the carpal tunnel can become inflamed and compress the median nerve. The most common causes of carpal tunnel syndrome include genetic predisposition, history of repetitive wrist movements such as typing, or machine work as well as , disorders such as rheumatoid arthritis and pregnancy. CTS onset is generally gradual with tingling or numbness in the median nerve distribution of the affected hand. Patients may notice aggravation of symptoms with static gripping of objects such as a phone or steering wheel but also at night or early in the morning. Many patients will report an improvement of symptoms following shaking or flicking of their hand. As the disorder progresses, the feeling of tingling or numbness may become constant and patients may complain of burning pain.

The final symptoms are weakness and atrophy of muscles of the thenar eminence. These combined effects of sensory deprivation and weakness may result in a complaint of clumsiness and loss of grip and pinch strength or dropping things. Ultrasound and MRI are the two imaging modalities which best lend themselves to investigating entrapment syndromes. Next to directly visualising direct causes and anatomical variants recognising pathological muscle signal patterns on MRI can point to the affected nerve. Electromyography and nerve conduction studies are the basis for carpal tunnel syndrome diagnosis. Other clinical or special exams do not confirm carpal tunnel syndrome but do assist in ruling out other diagnoses. These findings can prompt electromyography and nerve conduction studies. An X-ray is recommended to exclude other causes of wrist pain like arthritis or any other bony pathology. The patient is guided to avoid any repetitive movement, Non-surgical treatment comprises oral steroids, corticosteroid injections, NSAID, diuretics, vitamin B6 and splinting/hand brace. If conservative treatments are not successful, an oral or local glucocorticoid are used. The definitive treatment for persistent carpal tunnel syndrome is surgical intervention with carpal tunnel release after nerve conduction studies showing significant axonal degeneration. Carpal tunnel release typically is performed by an orthopedic surgeon or hand surgeon. This procedure can be performed either open or endoscopically.

A physical therapist can use various modalities for pain, specialised manual techniques are performed and exercises are incorporated into the plan in order to deal with the condition.