Q: Doctor my son is 2.5 months old and has torticollis. How can physical therapy help in this condition?

A: Congenital torticollis (CMT) is a condition in infants commonly diagnosed at or soon after birth. This condition is also known as twisted neck or wry neck.

CMT occurs when there is reduced length and increased tone of sternocleidomastoid (SCM) on one side. Infants present with same side bending and opposite rotation. Treatment approaches for CMT include manual therapy (e.g. therapist-led stretching exercises), repositioning therapy (e.g. tummy time), botulinum toxin (botox) / surgery may be necessary for more severe cases that do not resolve.

A physical therapist first examines the child for passive cervical range of motion with arthrodial goniometer, active range of motion, global assessment, neurological, auditory and visual function assessments to rule out other conditions, Physiotherapy (stretching, strengthening and developmental facilitation) and aggressive repositioning are first-line treatments. Education, guidance and support can reassure and help parents. It is important to educate parents/caregivers on positioning and handling skills to encourage active neck rotation towards the affected side and to discourage side flexion to the affected side. Kinesio taping is an alternative intervention for CMT. It has been suggested that kinesio taping might decrease treatment duration for CMT and that it can have an immediate effect on muscular imbalance in children with CMT. There are certain measures that caregivers can take at home to help their child with CMT, place toys/decorations to encourage infant to turn to other side, position the crib or changing table, so the infant must turn to the other side to see / interact with caregivers. If conservative treatment is not successful, botox or surgical options may be considered. Surgical may be indicated for the following, no improvement after six months of manual stretching, there is a deficit of more than 15 degrees in passive rotation and lateral bending, tight muscular band is present, there is a tumour in SCM.

Q: Doctor what is the physical therapy treatment of Achilles rupture in athletes?

A: The Achilles Tendon, a robust fibrous band linking the calf muscles to the calcaneus bone, represents a critical anatomical structure. A prevalent pathology, Achilles Tendon Rupture (ATR) stands as the most frequently occurring tendon rupture within the human body. The impact of Achilles tendinopathy extends beyond the physical realm, adversely affecting both physical and mental well-being. The inherent characteristics, function, and blood supply of the Achilles Tendon contribute to its susceptibility to both acute and chronic ruptures.

In instances of acute rupture, athletic engagement often precipitates the injury, accounting for a substantial 68% of cases. Particularly prevalent in stop-and-go sports like badminton, soccer, volleyball, basketball, tennis, racquetball, and squash, these activities subject the tendon to significant stress due to eccentric movements. Several factors increase the likelihood of rupture, with certain conditions predisposing individuals to injuries that may be overlooked during initial examination. These conditions encompass the natural aging process, participation in recreational sports, obesity, use of specific medications (e.g., fluoroquinolone and steroids), poor running mechanics, and altered biomechanics such as flat foot (pes planus), high foot arch (pes cavus), and leg length discrepancy.

Traditionally, Achilles tendon tears have been categorized into four types based on severity and retraction degree. Treatment approaches have historically considered individual factors like age, desire to return to sport, and personal preference. Surgical intervention aimed to reduce the risk of future re-rupture, involving sewing torn ends together followed by immobilization in plaster, presented potential complications such as wound infection, scar adhesions, loss of sensation, deep vein thrombosis (DVT), and infection. Recommendations favored operative repair for younger individuals, while conservative approaches with immobilization in a cast were advised for the elderly, those with co-morbidities like diabetes and peripheral neuropathies, and less active patients.

Post-operative rehabilitation emphasizes strengthening the foot core, avoiding excessive Achilles Tendon stretch, and incorporating gait re-education to correct any faulty patterns. Plantar flexion strengthening is initiated through isometric and sustained heel raises, progressing from both legs to a single leg. Eccentric loading, achieved through heel raises off the edge of a box, further enhances tendon strength. A comprehensive rehabilitation program is crucial, and periodic evaluations are necessary to assess tendon healing and functionality.

Subsequent physiotherapy sessions may be recommended based on the evaluation, and a gradual return to sports is advised. Before engaging in contact sports, patients are advised to wait at least 6–9 months post-injury, ensuring a thorough recovery and minimizing the risk of re-rupture.