Ligaments are short fibrous bands that exist at joints to hold the joint together and to prevent movement beyond a certain point. They have some degree of elasticity, in that they should be able to stretch and recoil. When a ligament is sprained a varying proportion of the fibers are torn. To effect a rapid a good blood supply is required, further strain on the ligament needs to be initially avoided and then a graduated regime of exercises followed until the ligament can be stretched without pain.

The ligament in the wrist are at either side of the joint and injury to them commonly occurs as a result of falling awkwardly, mistiming a shot in any of the racquet sports, or unskilled use of heavy tools (e.g. sledge hammer, chain saws etc)

Treatment initially should consist of some form of support, ice and rest for 48 hours After that, gentle pain free movement can begin. If it is npot too severe no further treatment may be needed, but if there is a lot of swelling and pain, physiotherapy will help, with the use of ultrasound and other electrotherapy, to speed up the repair process that otherwise would be quite slow. Even so a moderate to severe ligament sprain will take at least 6 weeks to heal

At the wrist this is commonly known as carpal tunnel syndrome. The carpal bones are the bones of the wrist and together they form a tunnel through which the tendons, blood vessels and nerves of the wrist pass. Anything that causes the diameter of the tunnel to diminish may cause compression on these structures. The typical symptoms are numbness and/of tingling in the fingers and hand, which is commonly worse at night.

Loss of diameter of the carpal tunnel can occur after fracture at the wrist, as a result of arthritis, because of hormonal changes, because of repetitive finger and wrist movements giving tendon thickening. Symptoms can be compounded if a neck problem coexists with any of the above.

Treatment varies but will probably involve the use of wrist splints to keep the wrist in an extended position when the width of the tunnel is naturally larger. Nerve conduction studies may be done and physiotherapy may be required to both mobilize the neck, as well as to advise on better working positions and posture. There are also some specific exercises that help to loosen nerves whose movement may be impeded by changes both in the wrist and in the neck.

The commonest form of arthritis is osteoarthritis which is sometimes also referred to as “wear and tear”. Naturally it tends to occur more often in the dominant wrist. It involves a thinning of the protective cartilage layer that lies over the bone, subjecting he latter to increasing stress. This responds by thickening and becomes les “plastic” in nature. It is this thickening of the bone that may contribute to the development of carpal tunnel syndrome(see above). The capsules and ligaments that surround and support the joint also become thickened and because the joint gets stiffer these structures lose some of their tensile strength, leaving the joint more vulnerable just at the wrong time! To add insult to injury the associated muscles also begin to weaken partly as a reflex reaction and partly because the stiffness in the joint means the muscles are not used as much.

Treatment will often include some use of anti inflammatory drugs together with some analgesics if required. Wrist splints are often helpful in that they do give some support to the wrists but simultaneously allow functional use of the hands. If the wrists have become or are beginning to get stiff a physiotherapist should be able to show some useful exercises to minimize this and to improve muscle strength.

The nature of the condition is that it tends to have periods of activity and then remains quiescent for some time. During acute attacks some forms of electrotherapy (ultrasound, interferential) may be helpful in reducing swelling and pain.

The knee joint is constructed in such a way that it depends on several ligaments to maintain its integrity. The bony anatomy balances one knuckle shaped bone(femur) on another fairly flat bone(tibia) and on that rather unlikely surface we put all our weight, trusting that all is secure. Most of the time it is, thankfully, due to both the ligaments and to the strength and coordination of muscles at the front(quadriceps) and back(hamstrings) of the thigh.

The surface of the joint is further deepened by two crescent shaped menisci or cartilages that sit on top of the tibia. This adds more stability to the joint and provides extra shock absorbance.

Ligaments are rather like tough elastic bands. Their job is to stop the joint from being moved too far. They have a poor blood supply and therefore heal slowly.

The commonest way to injure either ligament or cartilage is to have most of your weight on the le with the knee bent and then to twist or be tied forcefully. It is more common to sprain the medial than the lateral ligament. Pain is normally immediate with ligament injuries and the joint swells within a few hours. Cruciate injuries often involve a sudden deceleration or a slow sitting back maneuver, particularly common in skiing debacles. Menisci or cartilages are damaged in the same way as ligaments and injury can vary from a mild fissuring to major tears where a loose flap develops that blocks the joints movement.

The simplest exercise suitable for almost every injury is to lie with the leg outstretched and tighten the thigh muscle so pushing the back of the knee down onto the bed/couch etc. If this is impossible take two or three paper back books covered with a towel, put this under the knee and try again! Try to do at least 10 repetitions 3 hourly. If that is easy increase the number of repetitions until it isn't!

Keep using the ice until the swelling has almost gone. All the time there is significant swelling it will be impossible to bend the knee fully and the thigh muscles are inhibited from working properly.

It is vital to regain full muscle strength as soon as possible. The quadriceps on the front of the thigh is responsible for the dynamic stability of the joint. They prevent the knee from giving way; they are also superb shock absorbers and obviously the stronger they are the more efficient they are at performing this role. It is very important that specific exercises are done to regain strength. Walking is insufficient as a strengthening exercise. A physiotherapist will give you a progressive exercise regime suitable for you to do at home or even in the office!!

The pain is normally caused by a weakness in the muscle on the front of the thigh which controls the movement of the knee cap. When the muscle is weak is weak the knee cap is pulled by other structures into a painful position which is made worse by certain movements e.g. going down stairs or hills, sitting with the knees bent and then having to get up.

A very effective treatment for this is a proper assessment by a physiotherapist who will then show you appropriate exercises and if necessary some specific taping techniques.

It is a common problem, but one that can be dealt with easily in the majority of cases.

The majority of knee problems benefit immensely from specific regular exercise. Some will resolve completely with this approach, particularly in the early stages when it will help prevent the development of more severe symptoms.

If you would like to make an appointment or require further advice please phone on +91- 281-2463405.

Neck pain is something that many of us will experience at some time in our lives. Much of it is thankfully self limiting. There are some situations however where some form of medical intervention is necessary

Some RELEVANT ANATOMY will help to understand the background to many neck problems

-tightness and shortening of the muscles at the base of the skull and back of the neck, which usually leads to headaches,

-stretching of the ligaments of the middle part of the neck resulting in excessive

-movement in the joints, leading to pain and eventually to pressure on the nerves as they emerge from the neck. It is also a major reason for developing what has come to be called a dowager's hump. The lower neck joints are held continually in a forward position and get stuck there. To compensate the very mobile joints directly above arch backwards so putting more emphasis on the disfiguring “hump”. This can become very painful.

Because no two neck problems manifest themselves in exactly the same way it is difficult to produce a universal panacea, but the following will be helpful in the majority of people. Do not do anything that markedly increases pain.

Neck pain is perhaps the single most common problem we see affection office workers. It can be caused by several factors inherent in the modern office, including;

The position and height of the computer monitor keyboard height

The position of information being transposed onto the computer in relation to the monitor

The firmness of the chair back and its relation to posture

Holding the phone with your shoulder

In order to improve posture while at work and decrease the chances of developing neck pain it is important that the factors a described above be addressed.