Q: I am 38 years old female (housewife) 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 if I should frequently visit a physiotherapist for general relaxation and modalities.
Being a homemaker is a tough job, it is often fueled by neglecting oneself to fulfill tons of responsibilities which has deleterious effects on the health. It is appreciable that you visited a professional for your concern. The source was targeted and treated with 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 heating pad / hot water bottle etc for muscle relaxation, but it should be noted that general relaxation and the use of modalities has short living effects and weakness of muscles need to be targeted if a long term complete / maximum recovery is required. 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.

Q: I am a 42 years old female and have been diagnosed with osteoarthritis of the knee, but it is common in old age, please guide. I am a housewife.
Osteoarthritis is a chronic condition which mostly effects old people but it can be present in young as well as athletic population. A proper diagnosis is made by a professional based on history, examination, imaging etc in order to rule out any other condition. The risk factors for the condition include 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 utilization of techniques, muscle strengthening, relaxation and conditioning in order to improve the status of the patient and to ensure maximum efficiency.

Q: My son is about a month old and has been diagnosed with torticollis, please explain the condition and the role of a physical therapist.
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 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 ultrasound (to check the mass that is present in the muscle and to rule out any tumor), 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 type 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 depends 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 neck due to position of child in the womb, reduced blood supply to the muscle etc. A fibrous palpable mass is usually present in early stages which is then replaced by 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 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 handling and positioning of the child. A home plan is vital to ensure maximum gain. The motive is avoiding contractures, stretching the muscle, strengthening the muscles, preventing any delay in the neck activities, facilitating the development of balance in 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 cap or jacket splint, wearing the splints for a long period of time can cause hindrance to neck muscle activation hence it is not preferable.
It there is no improvement, invasive methods can be opted 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.