Q: I am a 40 years old female and have neck pain for about a month. Kindly guide about physical therapy.
A physical therapist has to take a detailed history with proper assessment and evaluation for the condition. Once a final diagnosis has been made, physical therapist can proceed with variety of available treatment options like mobilisations, modalities, stretchings, exercises for cervical/scapulothoracic regions: neuromuscular exercises (eg, coordination, proprioception, and postural training), endurance training, aerobic conditioning, dry needling, laser, intermittent mechanical/manual traction etc. A physical therapist can also work on patient education and counselling strategies that promote an active lifestyle and address cognitive and affective factors.

Q: My mother is 47 years old and has Rheumatoid Arthritis. It is very painful and difficult for her to perform her activities. Please guide.
Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting the hand joints and leading to impairment in hand functions. The hand is one of the main elements of the rehabilitation of patients with rheumatoid arthritis (RA) due to deformities, which occur in approximately 90% of patients. It is a serious problem, both in the psychological and functional aspect, connected with muscle strength reduction, a limited range of motion and non-acceptance of the changes in the shape of the limb. Progressive hand dysfunction contributes to various limitations in the personal, social and professional aspects of life.

Most commonly joint involvement occurs insidiously over a period of months, however, in some cases, joint involvement may occur over weeks or overnight. Stiffness in the joints in the morning may last up to several hours, usually greater than an hour. On examination, there may be swelling, stiffness, deformity, and tenderness of the PIP, MCP wrist, synovitis, and there may be a decreased range of motion. Rheumatoid nodules may be present in 20% of patients with rheumatoid arthritis; these occur over extensor surfaces at elbows, heels, and toes.

Rehabilitation is a long-term process depending on the grade and type of deformity and activity of disease. Exercises which strengthen muscles and increase joint mobility are beneficial. Exercise intensity needs to be constantly controlled and adjusted to the activity of disease. During the exacerbations, the exercises should be performed in hospital or on an outpatient basis under strict supervision of a therapist. Numerous therapeutic regimens are introduced during the chronic stage. These address both the dysfunctions and individual needs of the patient, including professional activity or hobbies. Irrespective of the activity of disease, it is extremely important to teach the patient how to behave and perform activities of daily living in a safe way in order to limit excessive joint loading. The improved function of the hand may be maintained with the continuation of an exercise programme at home. Functional assessment is a basic tool to determine hand dysfunction severity.

Q: My mother has severe pain in the left shoulder, she had stroke of the same side, Kindly guide about it.
It is also known as Post-stroke complex regional pain syndrome or reflex sympathetic dystrophy of upper limb. Shoulder-hand Syndrome (SHS) is a multifactorial disorder characterised by edema and swelling of the hand, hyperalgesia, sever pain and loss of function in the shoulder joint with changes in the skin colour and temperature. The cause is still unknown, but it may be due to one or multiple causes one of which may include prolonged immobility.

The intervention is Multidisciplinary approach that include medication and Physical Therapy. The physical therapy treatment can include mirror therapy which has been found to be effective in improving sensory-motor function and reducing pain and edema in the upper limb in post-stroke patient, Orthoses, a functional shoulder orthoses helps prevent and shoulder subluxation in post-stroke patients and reduces the risk of shoulder-hand syndrome, Modalities like laser and TENS, which are effective in reducing pain and edema in the affected hand and shoulder, improves R.O.M. and Promotes Independency in post-stroke patients etc can be used by a therapist according to the condition.