Pain In Palm And Wrist

Dr. Julie Mercy J DavidErasmus Mundus Master in Adapted Physical Activity, MPT, BPTh/BPTPhysiotherapist

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Shoulder / hand pain-right hand pain it might be due to carpal tunnel syndrome, where the pain will be felt in the wrist. You can do hot water fermentation/ wax therapy for shouldtreat carpal tunnel syndrome as early as possible after symptoms start. Take more frequent breaks to rest your hands. Avoiding activities that worsen symptoms and applying cold packs to reduce swelling also may help. Other treatment options include wrist splinting, medications and surgery. Splinting and other conservative treatments are more likely to help if you've had only mild to moderate symptoms for less than 10 months. Lifestyle and home remedies these steps may provide temporary symptom relief: •take short breaks from repetitive activities involving the use of your hands. •lose weight if you are overweight or obese. •rotate your wrists and stretch your palms and fingers. •take a pain reliever, such as aspirin, ibuprofen (advil, motrin ib, others) or naproxen sodium (aleve). •wear a snug, not tight, wrist splint at night. You can find these over-the-counter at most drugstores or pharmacies. •avoid sleeping on your hands. If pain, numbness or weakness recurs and persists, see your doctor. Alternative medicine integrate alternative therapies into your treatment plan to help you cope with carpal tunnel syndrome. You may have to experiment to find a treatment that works for you. Always check with your doctor before trying any complementary or alternative treatment. •yoga. Yoga postures designed for strengthening, stretching and balancing the upper body and joints may help reduce pain and improve grip strength. •hand therapy. Early research suggests that certain physical and occupational hand therapy techniques may reduce symptoms of carpal tunnel syndrome. •ultrasound therapy. High-intensity ultrasound can be used to raise the temperature of a targeted •area of body tissue to reduce pain and promote healing. Research shows inconsistent results with this therapy, but a course of ultrasound therapy over several weeks may help reduce symptoms. 

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Dr. Julie Mercy J DavidErasmus Mundus Master in Adapted Physical Activity, MPT, BPTh/BPTPhysiotherapist

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Start with your hands in a prayer position. They should be slightly lower than you chin. Slowly move your hands down towards your belly button. You should feel the stretch in your forearms and wrist. Hold for 30 seconds and repeat 3-5 times. Start by extending both of your arms in front of you. Make two fists, like you are punching the air. Move your fists downward, while keeping your arms straight. Hold for 10 seconds and repeat 1 time. Start with your arms out in front of you and make a fist with your hands. Open both of your hands, as if you were pushing on a wall in front of you. Take your right hand and pull the fingers back on your left hand and hold for 10 seconds. Repeat on your other hand. Repeat 3 times on each hand. 

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Dr. Julie Mercy J DavidErasmus Mundus Master in Adapted Physical Activity, MPT, BPTh/BPTPhysiotherapist

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Burning pain or tingling sensation in hands or feet if you are suffering from burning pain or tingling sensation in hands or feet; sharp shooting pain in legs; numbness in hands or feet, then you might be suffering from neuropathic pain what is a neuropathic pain? Neuropathic pain is a special type of pain which occurs when there is damage to nerve fibres, which produces tingling or burning type of pain. It is of two types: 1. Peripheral neuropathic pain: it occurs when there is an injury to peripheral nerve fibres (a-delta or c-fibers) which carries pain sensation to the brain (thalamus) for interpretation. 2. Central neuropathic pain: it occurs due to sensitization of central pain interpreting mechanisms (thalamus) to falsely feel pain when peripheral nerve fibres are no longer sending pain impulses to them. Worldwide-estimates of the prevalence of neuropathic pain is 7% i.e. 7 persons out of 100 people are suffering from different types of neuropathic pain. Symptoms: •tingling sensation or feeling of ants crawling under skin •burning sensation •sharp shooting pain or electric current-like sensation •stabbing pain •dull pain with numbness or heaviness reasons for neuropathic pain: •diabetes mellitus: most common cause worldwide due to uncontrolled blood sugar levels, causing damage to nerve fibres. •alcohol consumption/cigarette smoking: damage to nerve fibres or damage to blood vessels supplying nerve fibres. Burning pain in feet •neck pain/low back pain/glutei pain •vit. B12 deficiency •chemotherapy for cancer patients •post-herpes virus infection •post-spine surgery •post-amputation •diseases like spinal cord injury, multiple sclerosis, hiv, lead toxicity, etc. Special neuropathies: 1. Carpal tunnel syndrome: tingling, burning sensation in hand which occurs due to compression of median nerve in the wrist area. It occurs in women especially due to pregnancy, hypothyroidism, diabetes, etc. And in men due to improper position of the wrist during working on computers. 2. Cervical radiculopathy: pain in neck and shoulder region (which increases with neck movements), along with sharpshooting pain radiating from neck to hand occurs in cases of cervical radiculopathy. This is due to compression of the cervical nerve root by disc prolapse, facet subluxation, muscle spasm, trauma, etc. 3. Lumbar radiculopathy: pain in lower back or glutei region with sharp shooting pain radiating from hip to leg/foot region, occurs in cases of lumbar radiculopathy or sciatica. This is due to compression of lumbar nerve root or sciatic nerve by disc prolapse, facet joint, trauma, hypertrophied ligamentumflavum, piriformis syndrome, etc. 4. Meralgiaparesthetica: tingling or burning sensation in front of the thigh, occurs due to compression of lateral cutaneous nerve of thigh, near waist region. Usual causes are tight or constrictive clothing at waist region, prolonged sitting, protuberant abdomen, etc. Prevention of neuropathy: 1. Avoid alcohol consumption and cigarette smoking. 2. Maintain ideal body weight/bmi (body mass index) 3. Lifestyle changes: daily exercises (>30 minutes per day) or brisk walking or swimming; avoid prolonged sitting or standing (>30 minutes). 4. Food/diet should have following components: •green vegetables e.g. Spinach, fenugreek leaves (methi), radish, etc •coloured vegetables e.g. Tomato, carrot, capsicum (green/red), ladies-finger (bhindi) •milk products e.g. Milk, buttermilk, curd, cheese (paneer) •protein-rich foods e.g. Fish, egg, chicken, pulses (daal) •fibre-rich foods e.g. Bran, oats, brown-rice •fruits e.g. Apple, orange, guava, papaya, pomegranate, berries 5. Blood sugar control (in diabetics) 6. Care of feet: •regular inspection of feet (with mirror) •comfortable, well-fitted shoes •regular consultation with a podiatrist •treatment of wounds, foot deformities 7. Adequate sleep 8. Warm water bath (increases blood flow to the affected area) treatment: •consult pain medicine specialist. •neuropathic painkillers e.g. Amitriptyline, pregabalin, gabapentin, capsaicin, duloxetine, etc. •vit. B12 supplements, anti-oxidants, multi-vitamins. •transcutaneous electrical nerve stimulation (tens) •acupuncture •relaxation and yoga •neural prolotherapy. 

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Dr. Julie Mercy J DavidErasmus Mundus Master in Adapted Physical Activity, MPT, BPTh/BPTPhysiotherapist

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Burning pain or tingling sensation in hands or feet if you are suffering from burning pain or tingling sensation in hands or feet; sharp shooting pain in legs; numbness in hands or feet, then you might be suffering from neuropathic pain what is a neuropathic pain? Neuropathic pain is a special type of pain which occurs when there is damage to nerve fibres, which produces tingling or burning type of pain. It is of two types: 1. Peripheral neuropathic pain: it occurs when there is an injury to peripheral nerve fibres (a-delta or c-fibers) which carries pain sensation to the brain (thalamus) for interpretation. 2. Central neuropathic pain: it occurs due to sensitization of central pain interpreting mechanisms (thalamus) to falsely feel pain when peripheral nerve fibres are no longer sending pain impulses to them. Worldwide-estimates of the prevalence of neuropathic pain is 7% i.e. 7 persons out of 100 people are suffering from different types of neuropathic pain. Symptoms: •tingling sensation or feeling of ants crawling under skin •burning sensation •sharp shooting pain or electric current-like sensation •stabbing pain •dull pain with numbness or heaviness reasons for neuropathic pain: •diabetes mellitus: most common cause worldwide due to uncontrolled blood sugar levels, causing damage to nerve fibres. •alcohol consumption/cigarette smoking: damage to nerve fibres or damage to blood vessels supplying nerve fibres. Burning pain in feet •neck pain/low back pain/glutei pain •vit. B12 deficiency •chemotherapy for cancer patients •post-herpes virus infection •post-spine surgery •post-amputation •diseases like spinal cord injury, multiple sclerosis, hiv, lead toxicity, etc. Special neuropathies: 1. Carpal tunnel syndrome: tingling, burning sensation in hand which occurs due to compression of median nerve in the wrist area. It occurs in women especially due to pregnancy, hypothyroidism, diabetes, etc. And in men due to improper position of the wrist during working on computers. 2. Cervical radiculopathy: pain in neck and shoulder region (which increases with neck movements), along with sharpshooting pain radiating from neck to hand occurs in cases of cervical radiculopathy. This is due to compression of the cervical nerve root by disc prolapse, facet subluxation, muscle spasm, trauma, etc. 3. Lumbar radiculopathy: pain in lower back or glutei region with sharp shooting pain radiating from hip to leg/foot region, occurs in cases of lumbar radiculopathy or sciatica. This is due to compression of lumbar nerve root or sciatic nerve by disc prolapse, facet joint, trauma, hypertrophied ligamentumflavum, piriformis syndrome, etc. 4. Meralgiaparesthetica: tingling or burning sensation in front of the thigh, occurs due to compression of lateral cutaneous nerve of thigh, near waist region. Usual causes are tight or constrictive clothing at waist region, prolonged sitting, protuberant abdomen, etc. Prevention of neuropathy: 1. Avoid alcohol consumption and cigarette smoking. 2. Maintain ideal body weight/bmi (body mass index) 3. Lifestyle changes: daily exercises (>30 minutes per day) or brisk walking or swimming; avoid prolonged sitting or standing (>30 minutes). 4. Food/diet should have following components: •green vegetables e.g. Spinach, fenugreek leaves (methi), radish, etc •coloured vegetables e.g. Tomato, carrot, capsicum (green/red), ladies-finger (bhindi) •milk products e.g. Milk, buttermilk, curd, cheese (paneer) •protein-rich foods e.g. Fish, egg, chicken, pulses (daal) •fibre-rich foods e.g. Bran, oats, brown-rice •fruits e.g. Apple, orange, guava, papaya, pomegranate, berries 5. Blood sugar control (in diabetics) 6. Care of feet: •regular inspection of feet (with mirror) •comfortable, well-fitted shoes •regular consultation with a podiatrist •treatment of wounds, foot deformities 7. Adequate sleep 8. Warm water bath (increases blood flow to the affected area) treatment: •consult pain medicine specialist. •neuropathic painkillers e.g. Amitriptyline, pregabalin, gabapentin, capsaicin, duloxetine, etc. •vit. B12 supplements, anti-oxidants, multi-vitamins. •transcutaneous electrical nerve stimulation (tens) •acupuncture •relaxation and yoga •neural prolotherapy. 

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Dr. Julie Mercy J DavidErasmus Mundus Master in Adapted Physical Activity, MPT, BPTh/BPTPhysiotherapist

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Hand or wrist pain, numbness, weakness or tingling. Hand pain that wakes you at night. Pain, burning or tingling sensation in the forearm. Problems grasping items, writing or using a keyboard. Tenderness or pain in the elbow. Loss of muscle in the thumb (a rare symptom. N the case of chronic forearm compartment syndrome, the best treatment is to intermittently adjust the grip of the oar or the grip of the motorcycle to periodically change the stress on the forearm muscles. Sometimes increased grip strength is sufficient to allow them to continue participation in their sport. What happens if you don't treat compartment syndrome? Without treatment, acute compartment syndrome can permanently damage muscles. It can also lead to disability, paralysis or even death. Chronic compartment syndrome usually isn't an emergency. It's often caused by physical exertion, such as intense exercise. Your doctor may initially recommend pain medications, physical therapy, athletic shoe inserts (orthotics), massage or a break from exercise. Changing how you land on your feet when you jog or run also might be helpful.Wall calf stretchstand about two feet away from a wall. Place the ball of your right foot against the wall while your heel remains on the ground. Slowly and gently lean into the wall while keeping your knee straight. Hold this for the 10 sec with repetition of 3 times. 

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Dr. Julie Mercy J DavidErasmus Mundus Master in Adapted Physical Activity, MPT, BPTh/BPTPhysiotherapist

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Knee pain: resisted terminal knee extension: make a loop with a piece of elastic tubing by tying a knot in both ends. Close the knot in a door at knee height. Step into the loop with your injured leg so the tubing is around the back of your knee. Lift the other foot off the ground and hold onto a chair for balance, if needed. Bend the knee with tubing about 45 degrees. Slowly straighten your leg, keeping your thigh muscle tight as you do this. Repeat 15 times. Do 2 sets of 15. If you need an easier way to do this, stand on both legs for better support while you do the exercise. •standing calf stretch: stand facing a wall with your hands on the wall at about eye level. Keep as arthritis is very common that you get generally bilaterally. Ice therapy would definitely help to reduce the inflammation. We also advise you to use knee cap which would help to prevent the knee from damaging further and also to maintain the quadriceps muscle tone •stretching exercises. Regular, steady stretching exercises can reduce muscle spasm and help lengthen the muscle-tendon unit. Don't bounce during your stretch. •strengthening exercises. Weak thigh muscles contribute to the strain on your patellar tendon. Exercises that involve lowering your leg very slowly after extending it can be particularly helpful, as can exercises that strengthen all of the leg muscles in combination, such as a leg press.•this is a general knee pain and for this you can follow these measures: one keep a pillow right under the knee while sleeping, next is you can keep ice in the painful area for about 5--10 minutes, it looks like you are is important to check that. Anaemia always leads to the symptoms of being tired and also having body pain though there may not be any pathological reasons for knee pain. With knee exercises you will definitely feel better and muscles must be strengthened. Right hand pain it might be due to carpal tunnel syndrome, where the pain will be felt in the wrist. You can do hot water fermentation/ wax therapy for shouldtreat carpal tunnel syndrome as early as possible after symptoms start. Take more frequent breaks to rest your hands. Avoiding activities that worsen symptoms and applying cold packs to reduce swelling also may help. Other treatment options include wrist splinting, medications and surgery. Splinting and other conservative treatments are more likely to help if you've had only mild to moderate symptoms for less than 10 months. Lifestyle and home remedies these steps may provide temporary symptom relief: •take short breaks from repetitive activities involving the use of your hands. •lose weight if you are overweight or obese. •rotate your wrists and stretch your palms and fingers. •take a pain reliever, such as aspirin, ibuprofen (advil, motrin ib, others) or naproxen sodium (aleve). •wear a snug, not tight, wrist splint at night. You can find these over-the-counter at most drugstores or pharmacies. •avoid sleeping on your hands. If pain, numbness or weakness recurs and persists, see your doctor. Alternative medicine integrate alternative therapies into your treatment plan to help you cope with carpal tunnel syndrome. You may have to experiment to find a treatment that works for you. Always check with your doctor before trying any complementary or alternative treatment. •yoga. Yoga postures designed for strengthening, stretching and balancing the upper body and joints may help reduce pain and improve grip strength. •hand therapy. Early research suggests that certain physical and occupational hand therapy techniques may reduce symptoms of carpal tunnel syndrome. •ultrasound therapy. High-intensity ultrasound can be used to raise the temperature of a targeted •area of body tissue to reduce pain and promote healing. Research shows inconsistent results with this therapy, but a course of ultrasound therapy over several weeks may help reduce symptoms. 

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Dr. Julie Mercy J DavidErasmus Mundus Master in Adapted Physical Activity, MPT, BPTh/BPTPhysiotherapist

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Kindly do these exercises standing extension how it helps – this standing extension helps reverse what you do on a daily basis (hunching)… since most bulging discs and herniated discs are caused by poor posture and repeated flexion of the spine (esp bending fwd in bad posture), this stretch helps push the disc back to neutral position. How to do it – begin this exercise by standing up with good posture. Now take both hands and place them on both sides of your lower back. Now with the help of your hands push your pelvis forward and extend your spine back. Follow the extension with your neck so that you end up facing the ceiling. – start with 10 repetitions and do 2-3 sets. – this one is particularly great to do when you need a break from sitting at your desk. ** this should not cause any pain. If you feel pain during it is not a good one for you. In that case, stop and try some of the other exercises below instead. 3. Half cobra pose (prone lumbar extension) how it helps – the half cobra stretch helps to push the disc material back towards the center of the inter-vertebral disc to allow for improved healing. The goal of repeated lower back extension is the “centralization of symptoms”, which basically means pain that travels down the affected leg to the foot should come back up closer to the low back – which will in turn alleviate the pain. How to do it – begin this exercise by lying on your stomach (prone position) and slowly prop yourself up on your elbows while keeping your hips in contact with the floor. – hold the prop-up position for 10-15 seconds before returning to the prone position (lying face down). – gradually increase to holding the end position for 30 seconds. Aim for 10 repetitions of this stretch. ** initially, you may not be able to tolerate this position very well, so make sure you start slowly and carefully. If there’s any pain, try a different exercise instead. 4. Full cobra pose (advanced extension) how it helps – this stretch is based on the same principle as the half cobra pose above. This advanced extension helps to push disc material back towards the center of the intervertebral disc, with the goal of alleviating pain symptoms. How to do it – once you’ve mastered the half cobra pose, you can increase the difficulty by moving to the advanced version of this stretch. Begin this exercise by lying on your stomach in the prone position (lying facing down) and slowly press up on your hands while keeping your pelvis in contact with the floor and lower back relaxed. – hold the prop-up position for 10 seconds. Aim for 10 repetitions of this stretch. – eventually try to hold this pose for longer if it feels good (20-30 seconds). ** if you feel pain during this exercise, it is not a good one for you. In that case, stop and try some of the other exercises instead. 5. Cat-cow how it helps – this is one of the most popular herniated disc exercises. By combining two yoga poses, the cat-cow stretch can help to relieve pressure on the herniated disc by opening the intervertebral disc space. It also improves mobility of the spine, which may help to relieve disc herniation pain and speed recovery. How to do it – begin this stretch on your hands and knees. Inhale and let your stomach “drop” towards the floor as you look up towards the ceiling. – follow this by exhaling and slowly rounding your spine while pressing into the floor with your hands and slightly curving your neck to look at your feet. – aim for 10 repetitions of this stretch and do 2-3 sets. How it helps – this exercise will help strengthen and stabilize your lower back and deep spine muscles. This will help you to maintain a good posture and avoid future episodes of herniated discs. How to do it: – begin on your hands and knees with your hands positioned under your shoulders and knees positioned under your hips. – raise your left arm and reach it forwards until it is aligned with your torso; at the same time, kick your right leg backwards until is it aligned with your torso. – hold this position for 2-3 seconds before slowly returning to the starting position. – repeat with your right arm and left leg. – alternate sides for 10 repetitions and do 2-3 sets. ** ensure that your head, neck, and back maintain a neutral alignment to minimize stress on your neck. Plank: how it helps – just like the bird dog, this “core” exercise will help bring your pelvis into right position by strengthening the deep spinal muscles and glutes (butt muscles). How to do it – begin lying on your stomach with your forearms against the mat. – engage your core and lift your body so that you are resting on your forearms and toes. – start with 10 second holds and work up to 30 second holds, do 2-3 sets. ** ensure to keep your back straight throughout the entire exercise – spine in neutral position. Thoracic expansion if you’re using a chair, sit facing forward and allow your upper body to fall over the back of the chair. Extend your arms above your head for a deeper stretch. Hold either position for 10 seconds and release. Repeat 3 times. Pelvic tilts lying on back with knees bent and feet flat on the floor. Flatten back by tightening stomach muscles and buttocks. Hold for 5 seconds, breathing normally. Repeat ten (10) times per set. Do two (2) sets per session. Do one (1) session per day 3. Double-leg abdominal press lying on back with knees bent and feet flat on the floor (photo 1), keeping your back in a neutral position. Raise your legs off the floor one at a time so that your knees and hips are bent at 90° angles (photo 2, 3). Push your hands against your knees while pulling your knees toward your hands, which will engage your abdominal muscles (photo 4). Keep your arms straight! hold for three deep breaths. Repeat ten (10) times per set. Do two (2) sets per session. Do one (1) session per day. 5.Single leg balance (if possible, perform in front of a mirror for self monitoring) with your eyes open, bend one knee up and balance on one foot. At first you may use your hands, like holding the back of a chair, table, or the wall. As balancing gets easier, take your hand (s) away and place them out to the side. Challenge yourself by bringing your arms across your chest. Close your eyes for an even greater challenge. Repeat five (5) times per set. Do one (1) set per session. Do one (1) session per day. 6.Plank exercise you can hold it for 10-15 seconds. •the plank is similar to a push-up position, but instead of resting on your hands, you rest on your elbows and bring them directly underneath your chest. •after kneeling, lean forward and place your elbows on the ground directly below your shoulders. •lift your knees off of the floor and push your feet back. Ensure your back is straight and keep your neck aligned with the rest of your spine. •hold the position and tighten your core muscles for the desired time. 2. Side plank just like the original plank, but only balancing on one side. •lie on the floor on your side, facing sideways with your feet together. •lift up your body until you are supporting yourself with your elbow, directly below your shoulder. •raise your hips until your body is in a straight line and tighten your core muscles; your body should create a slant from your shoulders to your feet. •hold this position without dropping your hips. •repeat on the opposite side. 7.arm and leg raises lie on your front with your forehead to the ground. Extend your arms out over your head, with the palms positioned flat on the ground. Keep your legs straight. Raise one arm off of the ground. Hold for one or two full breaths, then lower the arm back down. Repeat with each arm and each leg. Aim for 15 repetitions on each limb. Latissimusdorsi stretch stand with good posture in a neutral position. Keep the feet shoulder-width apart and the knees very slightly bent. Reaching over your head with both hands, grab your right wrist with your left hand. Bend slightly toward the right side until you feel a stretch in the left side of the body. Hold for one to two breaths, then push with the left foot to return to the original position. Repeat on the opposite side. Do 5–10 repetitions on each side. 

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Dr. Julie Mercy J DavidErasmus Mundus Master in Adapted Physical Activity, MPT, BPTh/BPTPhysiotherapist

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Symptoms of osteoarthritis may include joint pain and progressive stiffness that develops gradually. Symptoms of may include painful swelling, inflammation, and stiffness in the fingers, arms, legs, and wrists occurring in the same joints on both sides of the body, especially upon waking up in the morning. •rest. Avoid activities that aggravate your elbow pain. •pain relievers. Try over-the-counter pain relievers, such as ibuprofen (advil, motrin ib) or naproxen (aleve). •ice. Apply ice or a cold pack for 15 minutes three to four times a day. •technique. Make sure that you are using proper technique for your activities and avoiding repetitive wrist motions. Physical therapy. Specific exercises are helpful for strengthening the muscles of the forearm. Your therapist may also perform ultrasound, ice massage, or muscle-stimulating techniques to improve muscle healing. Brace. Using a brace centered over the back of your forearm may also help relieve symptoms of tennis elbow. This can reduce symptoms by resting the muscles and tendons. Fist clench 1.Sit at a table with your forearm resting on the table. 2.Hold a rolled up towel or small ball in your hand. 3.Squeeze the towel in your hand and hold for 10 seconds. 4.Release and repeat 10 times. Switch and do the other arm. Supination with a dumbbell 1.Sit in a chair holding a 2-pound dumbbell vertically in your hand with your elbow resting on your knee. 2.Let the weight of the dumbbell help rotate the arm outward, turning the palm up. 3.Rotate the hand back the other direction until your palm is facing downward. 4.Repeat 20 times on each side. 5.Try to isolate the movement to your lower arm, keeping your upper arm and elbow still. Wrist extension 1.Sit in a chair holding a 2-pound dumbbell in your hand with your palm facing down, resting your elbow comfortably on your knee. 2.Keeping your palm facing down, extend your wrist by curling it towards your body. If this is too challenging, do the movement with no weight. 3.Return to starting position and repeat 10 times on each side. 4.Try to isolate the movement to the wrist, keeping the rest of the arm still. Wrist flexion 1.Sit in a chair holding a 2-pound dumbbell in your hand with your palm facing up and elbow resting comfortably on your knee. 2.Keeping your palm facing up, flex your wrist by curling it towards your body. 3.Return to starting position and repeat 10 times on each side. 4.Try to isolate the movement to the wrist, keeping the rest of the arm still. Towel twist 1.Sit in a chair holding a towel with both hands, shoulders relaxed. 2.Twist the towel with both hands in opposite directions as if you are wringing out water. 3.Repeat 10 times then repeat another 10 times in the other direction. 

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Dr. Julie Mercy J DavidErasmus Mundus Master in Adapted Physical Activity, MPT, BPTh/BPTPhysiotherapist

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Physiotherapy and exercise - psoriatic arthritis therapeutic exercises therapeutic exercises are activities based on your exact needs. They are designed to reach a certain goal, eg to increase muscle strength. There are two types used for arthritis: range of motion and strengthening. Range of motion exercises help to maintain joint movement, relieve stiffness and restore flexibility. To increase or maintain range and flexibility you need to take your joints and muscles to their limits. Range of movement exercises should be carried out daily. Strengthening exercises help maintain or increase muscle strength. To strengthen a muscle you need to apply resistance to the movement. This can be done using your own body weight, weights or resistance bands. Strengthening exercises should be performed on alternate days and not when a joint is hot (feels warm when touched) and painful unless you are supervised by a physiotherapist. The following exercises are just some examples to get you started. A health professional can design a programme for your specific needs. Fingers and hands 1. Forearm supported on a table, hand relaxed over the edge. Extend the wrist and clench your fist - relax and let your hand relax. Repeat ten times. 2. Clasp your hands together and support your forearms on a table with your hands over the edge. Bend your wrist up and down. Repeat five times. 3. Forearm on a table, elbow tucked in to your side and palm turned down. Alternately, turn your palm to face up, then down, keeping elbow still. Repeat ten times. 4. Elbow on table with hand up. Straighten your fingers out then bend them to touch your fingertips to the base of your fingers. Repeat ten times. 5. Palm on table. Lift each finger individually off the table. Repeat five times. 6. Elbow on table with hand up. Bring the tip of the thumb to the tip of the little finger, repeat to other fingers in sequence. Repeat five times. Neck and back for the first three exercises sit up straight in a supportive chair, ie one with back support. 1. Tilt your head towards one shoulder until you feel the stretch on the opposite side. Hold for approximately five seconds. Repeat to the other side. 2. Turn your head to one side until you feel the stretch. Hold for approximately five seconds. Repeat to the other side. Repeat five times to each side. 3. Pull your chin in, keeping your neck and back straight (not tipping your head forwards). Hold at the end position and feel the stretch in your neck. Repeat five times. 4. Lie on your back with your hands on your stomach, legs bent at the knee, feet flat on the bed or floor. Tighten your stomach muscles to flatten your lower back against the bed. Hold for five seconds, repeat ten times. 5. Lie on your back as with the previous exercise. Keeping your shoulders down flat, slowly roll your knees from side to side. Hold for five seconds, repeat ten times. 6. Lie on your back as before. Push down through your heels to lift your bottom and lower back off the bed. Hold for five seconds, repeat ten times. Feet and toes 1. Press your toes down and shorten your foot by pulling up the arch on the inside of the foot. Repeat on the other foot. 2. Lie with your legs out straight and pull your feet up, then push your feet down. Repeat ten times. 3. Wiggle your toes. Repeat ten times. 4. Circle your feet around one way, then the other way. Repeat ten times. Hips and knees 1. Lie face down with both legs outstretched for five minutes. Then gently bend each knee to its limit, then relax with your legs straight. Repeat five times with a 30-second break. 2. Sit with your legs outstretched on a firm bed. Press each knee down onto the bed to straighten it. Hold for five seconds. Relax. Repeat five times. 3. Lie on your back with your knees bent up and feet flat on bed. Bend each knee in turn up to meet your stomach, straighten and lower to the bed. Repeat five times. Jaw gently open the mouth to its full width. Stretch a little and hold for five seconds. Then close your mouth completely. Repeat five times. Recreational exercise this type of exercise includes any form of movement or relaxation that refreshes the body and mind. Recreational exercises or activities improve your fitness and help maintain or improve joint range of motion and muscle strength. They add to a therapeutic programme but do not replace it. •swimming is a good all-round exercise that does not stress your joints. Psoriasis is not generally affected by the chlorine in swimming pool water, but if you find it becomes itchy when dry, apply some barrier cream before you swim and after your shower at the end. •walking is another good way of exercising. If your arthritis affects your feet make sure you wear a wellfitting pair of shoes, and insoles if they have been prescribed for you. •cycling can be an alternative to walking and is often more comfortable on the feet. •activities such as yoga, pilates and other complementary therapies may be beneficial for people with arthritis. Contact your local council offices or community centres for further information and details of classes or events. 

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Dr. Julie Mercy J DavidErasmus Mundus Master in Adapted Physical Activity, MPT, BPTh/BPTPhysiotherapist

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Right hand pain it might be due to carpal tunnel syndrome, where the pain will be felt in the wrist. You can do hot water fermentation/ wax therapy for shouldtreat carpal tunnel syndrome as early as possible after symptoms start. Take more frequent breaks to rest your hands. Avoiding activities that worsen symptoms and applying cold packs to reduce swelling also may help. Other treatment options include wrist splinting, medications and surgery. Splinting and other conservative treatments are more likely to help if you've had only mild to moderate symptoms for less than 10 months. Lifestyle and home remedies these steps may provide temporary symptom relief: •take short breaks from repetitive activities involving the use of your hands. •lose weight if you are overweight or obese. •rotate your wrists and stretch your palms and fingers. •take a pain reliever, such as aspirin, ibuprofen (advil, motrin ib, others) or naproxen sodium (aleve). •wear a snug, not tight, wrist splint at night. You can find these over-the-counter at most drugstores or pharmacies. •avoid sleeping on your hands. If pain, numbness or weakness recurs and persists, see your doctor. Alternative medicine integrate alternative therapies into your treatment plan to help you cope with carpal tunnel syndrome. You may have to experiment to find a treatment that works for you. Always check with your doctor before trying any complementary or alternative treatment. •yoga. Yoga postures designed for strengthening, stretching and balancing the upper body and joints may help reduce pain and improve grip strength. •hand therapy. Early research suggests that certain physical and occupational hand therapy techniques may reduce symptoms of carpal tunnel syndrome. •ultrasound therapy. High-intensity ultrasound can be used to raise the temperature of a targeted •area of body tissue to reduce pain and promote healing. Research shows inconsistent results with this therapy, but a course of ultrasound therapy over several weeks may help reduce symptoms. 

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