Cervical or Neck Collars

Choosing Cervical Pillow, Collar for Neck pain

The use of supports like cervical pillow, cervical collars and neck braces is fairly common among people with neck pain. Such orthoses function by holding the wearer’s head in a particular position, while relieving the strain from the neck, thus playing a role in the conservative management of neck pain.

We have often seen neck pain patients (across different physiotherapy clinics), enquire about such cervical orthoses. Those dealing with cervical spondylosis, neck arthritis or cervical osteoarthritis may find immediate relief with neck collars and eventually become dependent on them. Sometime patients may have to use these in cases of acute or repetitive neck injuries like whiplash or chronic stresses and strains. However, the use of these is contested.

ReLiva Physiotherapists attempt at answering these frequently asked questions about neck supports (including cervical pillow and neck collars) with a comprehensive list of orthoses available, their usage and when and to what extent they can help.

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Workplace Ergonomics

Tips to Improve Workplace Ergonomics

Ergonomics and Workplace injuries  I   Tips to improve workplace ergonomics  I  Ergonomic principles for Office desk, space, height, movement, sitting posture, repetitive movements, friction and access

Ergonomics at workplace has become very important as maximum part of the day is spent at workplace.

Posture while sitting, standing or working can make all the difference to your physical wellbeing giving rise to back pain, neck pain, shoulder and finger issues. Injuries that result from poor ergonomics are some of the most common and frequent kinds of injuries, and they are found in all kinds of workplaces and occupations.

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De Quervain tenosynovitis

All About DeQuervain’s Tenosynovitis

There are two stages of the treatment for De Quervain’s syndrome or De Quervains tenosynovitis. It is a painful condition affecting the tendons on the thumb side of your wrist. In case of acute stage, when there is inflammation the goal is reduction in inflammation and preserving movements. Subsequently, once the inflammation subsides the goal is improvement in function.

Acute stage treatment

  • Splint to support the thumb and the wrist and which provides support and helps healing procedure.
  • Help identify aggravating activities and suggest alternative postures
  • Cryotherapy (e.g.: cold packs, ice massage) to reduce the inflammation and edema
  • Therapeutic Ultrasound (i.e. phonophoresis) or electrically charged ions (i.e. iontophoresis)-Ways in which a medication can be driven into the soft tissues through skin and promote faster healing.
  • Plan and suggest activity modifications to correct abnormal position of the hand in a particular activity.
  • Corrective exercises: Help in maintain the correct postures of the hand and thus enable better healing, promote faster rehab and aid in the prevention of further complications.

Second stage treatment (once inflammation subsides):

The goal is to work on the range of motion, Flexibility, Strengthening, Preventing recurrence

  • Thermal modalities to promote and aid in healing.
  • Transverse friction massage to break the adhesions.
  • Therapeutic exercises – starting with Range Of Motion (ROM) exercises, and as the patient progresses, adding strengthening exercises
  • Ergonomic workstation assessment as needed (Design work place to prevent further injuries after assessment of the same)
  • Educating the patient to either avoid or decrease repetitive hand motions, such as pinching, wringing, turning, twisting or grasping..
  • Rehabilitation exercises to prevent recurrence.
  • A home-exercise program for the maintenance of the goals achieved by the physical therapist and hence aid in faster recovery of function..

Physiotherapy treatment DeQuervains

Ultrasound therapy for wrist


Exercises for wrist and thumb rehabilitation

What is deQuervain’s Syndrome ?

It is the tenosynovitis (inflammation of the fluid-filled sheath called the synovium that surrounds a tendon and helps them glide easily) of the two tendons that control movement of the thumb. Inflammation results in pain, swelling and constricted movement of the tendons within the tunnel on the side of your wrist (Base of thumb). The swollen tendons and their coverings rub against the narrow tunnel through which they pass. The result is pain at the base of the thumb. At first, the only sign of trouble may be soreness on the thumb side of the forearm, near the wrist. If the problem isn’t treated, pain may spread up the forearm or further down into the wrist or both and thumb and limit your range of motion. As the friction increases, the two tendons may actually begin to squeak as they move through the constricted tunnel. This noise is called crepitus. It is pai nful especially when you turn your wrist, grasp anything or make fist..


Wrist Pain

Wrist Pain on movement



What causes deQuervains ?

de Quervain’s tenosynovitis is basically a combination of overuse, repetitive movements e.g.; racket sports, hammering and poor hand on wrist posture. It can be idiopathic (has no specific cause).

Common causes include:

  • Repeated hand and thumb motions such as grasping, pinching, squeezing, or wringing may lead to the inflammation of tenosynovium.
  • Holding your hand at an angle to your wrist creates a compression point that excessively rubs the tendon.
  • This inflammation can lead to swelling, which restricts the smooth gliding action of the tendons within the tunnel.
  • Scar tissue from a previous injury can make it difficult for the tendons to slide easily through the tunnel.
  • Arthritic diseases that affect the whole body, such as rheumatoid arthritis, can also cause tenosynovitis in the thumb.
  • Arthritic diseases that affect the whole body, such as rheumatoid arthritis, can also cause tenosynovitis in the thumb.


Wrist injury

Text Thumb

Benefits of physiotherapy:

  • Physiotherapy treatment reduces inflammation and accelerates healing.
  • improve strength, range of motion and endurance and correct postural and muscle imbalance which in turn prevents recurrence of condition.
  • Ergonomic corrections and activity modifications prevent various other injuries of hand and wrist along with deQuervains.
  • Physiotherapy rehabilitation exercises helps to restart all activities early.
  • Recovery is rapid if you start treatment in early stages. Chronic condition takes time as lot of changes like adhesion formations, Muscle weakness take place. But one can expect full recovery with the rehabilitation program completion.


Pregnant ladies and post-delivery mothers are affected more often. Contributory factors may include hormonal changes, fluid retention and – more debatably – lifting (baby).


Related Reading:

Working long on Computer : Carpal Tunnel Syndrome

Ergonomics: Does it matter in your workplace

Ergonomics Programme for Corporate Employees

5 minute Office Stretch exercises: Back, Neck pain

Neck Pain : Managing at Home

Physiotherapy, a sustainable solution for workplace Health & Wellness


Carpal Tunnel Syndrome

Carpal Tunnel Syndrome

Home Treatment  I  Physiotherapy treatment  I Understanding  I  Prevention  I  Symptoms  I Causes

Carpal tunnel syndrome is a type of repetitive stress injury characterized by pain, paralysis, or weakness in the wrist area. It is caused by compression of a nerve that passes through the carpal tunnel in the wrist

CTS is a common condition that occurs in 2.7% of the general population. Studies report that It is more common in women than men, and the average age of people with CTS is 40–50 years.

At an early stage, Carpal tunnel syndrome may cause you more inconvenience than pain owing to trouble in movement and use of your wrist. You could ease these early symptoms yourself.

Here are five ways you can treat your carpal tunnel syndrome at home:

  1. Discontinue the repetitive movement that is causing pain
  2. Heat/cold packs
  3. Wear a wrist splint to support your wrist in a neutral position. Splinting works the best when done within three months of having pain.
  4. Sleep with your hand in a neutral position on or alongside the bed.
  5. Shaking or massage the wrist to relieve burning sensation at night.




When is the time to see doctor for Carpal Tunnel Syndrome?

carpal tunnel syndrome

Early diagnosis and treatment is important in order to avoid any kind of permanent damage to the wrist nerve. If these home treatments don’t ease your pain in one or two weeks, it might be time to see a doctor. Physiotherapy is often recommended as part of your treatment plan to reduce the pain, swelling and help in stretching the muscles and retinaculum around and strengthening them.

Generally, surgery is only an option for severe cases of CTS and if the other treatments have failed for a period of at least six months.


How will physiotherapy help in the treatment of Carpal Tunnel Syndrome?

A good physiotherapy program would include:

  • Carpal bone mobilization and flexor retinaculum stretching to open the carpal tunnel
  • Nerve and tendon gliding exercises to ensure full unrestricted nerve motion is available.
  • Muscle and soft tissue extensibility.
  • Comprehensive upper limb, wrist and hand ROM strengthening and endurance exercises.
  • Grip and pinch, thumb and forearm muscle strengthening in later phases.

ReLiva physiotherapist will help you with:

  • Quickly relieve pain and swelling
  • Nerve gliding exercises
  • Loosen stiff muscles and ligaments
  • Strengthen your wrist and hand muscles
  • Improve your everyday living

In line with ReLiva’s 3 step Recovery Process, we also spend time in educating you about your condition, home exercises and dos and dont's, so that you can continue to remain healthy at your home even after the treatment is complete.

How can CTS be prevented?

As they say, prevention is better than cure. One can take care of the following things to prevent onset of CTS:


  • The positions of wrist while working.
  • Take frequent breaks from repetitive activities.
  • Stretch your wrists / arms periodically between activities.
  • A therapist may be helpful in reviewing ergonomic tips or performing a work place evaluation.



What Are the Symptoms of Carpal Tunnel Syndrome (CTS)?

Carpal Tunnel Syndrome (CTS) is usually associated with complaints in the hand, wrist and forearm, of:

  • numbness
  • tingling
  • pain, especially at night
  • decreased grip strength

A lot of patients report this as pins and needles in the hand / wrist and forearm. A person with CTS may also experience clumsiness in handling objects, usually caused by decreased grip strength.

What is Carpel Tunnel Syndrome?

Our wrist is made up of eight small bones. A ligament (also called retinaculum) lies across the front of the wrist. Between this ligament and the carpal bones is a space called the carpal tunnel. This carpel tunnel is a cramped up space, crowded with the muscle tendons attaching the forearm and the fingers and a median nerve.

The median nerve gives sensation to the thumb, index and middle fingers, and half of the ring finger. It also controls the movement of the small muscles at the base of the thumb.

Any tension in this canal due to various reasons can compress the median nerve giving rise to the symptoms. This is known as Carpal tunnel syndrome (CTS).

The main symptoms are pain, burning sensation, numbness and tingling in the thumb, index finger, middle finger, and the thumb side of the ring finger. Pain may extend up the arm. Weak grip strength may occur and after a long period of time the muscles at the base of the thumb may waste away.

Typically, burning, acing, tingling sensations in the hand are present in the night. It is relieved by shaking or massaging the wrist.

What causes Carpal Tunnel Syndrome?

As stated above, the symptoms occurring in carpel tunnel is due to the nerve compression leading to inflammation. This in turn produces pain, swelling and at times obstructed blood flow. Causes of carpal tunnel syndrome are:

  • Congenital: the carpal tunnel is simply smaller in some people than in others
  • Obesity
  • Rheumatoid
  • Repetitive movements: repeated use of vibrating hand tools; poor positioning of the wrists while using keyboards, mouse; repeated movements at the wrist such as playing piano, typing
  • Development of a cyst or tumor in the canal
  • Diabetes 
  • Thyroid dysfunction
  • Fluid retention from pregnancy or menopause
  • High blood pressure (high BP)
  • Fractures or trauma to the wrist

Something you may not know about CTS:

Women are three times more likely to have CTS than men. It may be that the wrist bones are naturally smaller in most women, creating a tighter space through which the nerve passes. Women also deal with strong hormonal changes during pregnancy and menopause that makes them more likely to suffer from CTS.


How is CTS treated?

Treatment of carpal tunnel syndrome should begin as early as possible, under a doctor's direction.  Underlying causes such as diabetes or arthritis should be treated first.

Overall the treatment for CTS will include some or all of the following:

A. Non- surgical treatment

  1. Care at home(see above for things to do at home)
  2. Splinting: Initial treatment is usually a splint worn at night.
  3. Avoiding daytime activities that may provoke symptoms. Some people with slight discomfort may wish to take frequent breaks from tasks, to rest the hand.  If the wrist is red, warm and swollen, applying cool packs can help.
  4. Medicines: In special circumstances, your doctor may prescribe you some medication to ease the pain and swelling associated with carpal tunnel syndrome.
  5. Physiotherapy: Physiotherapy is often recommended as part of your treatment plan to reduce the pain, swelling and help in stretching the muscles and retinaculum around and strengthening them. Physiotherapy at Reliva involves three main components -:
  1. Passive treatments,
  2. Active treatments and
  3. Education and self management.

B. Surgery:

Generally, surgery involves severing a ligament around the wrist to reduce pressure on the median nerve. You may choose to have one of the following:

a. Open Release surgery

b. Endoscopic surgery: This may allow somewhat faster functional recovery and less post-operative discomfort than traditional open release surgery but it may also have a higher risk of complications and the need for additional surgery. Your surgeon is best equipped to decide.

Following surgery, the ligaments usually grow back together and allow more space than before.  Although symptoms may be relieved immediately after surgery, full recovery from carpal tunnel surgery can take months.  Almost always there is a decrease in grip strength, which improves over time.

How is CTS treated during Pregnancy?

CTS is common in pregnancy. If you have tingling, numb and painful hands during pregnancy, it's likely to be caused by carpal tunnel syndrome (CTS). It happens when there is a build-up of fluid (oedema) in the tissues in your wrist.

A lot of pain medications are not safe during pregnancy, hence it may be best to consult a prenatal pain specialist like those at FabMoms or a physiotherapist to find relief from the symptoms.


What will happen if carpal tunnel syndrome is not treated?

If left untreated, carpal tunnel syndrome can lead to weakness and lack of coordination in your fingers and


Pain may radiate up the arm all the way to the shoulder. Over time, if untreated, carpal tunnel syndrome can cause the muscles on the thumb side of your hand to waste away (atrophy). Even with surgical treatment, strength and sensation may never be completely restored.

How long does it take to recover from carpal tunnel syndrome?

Early diagnosis and compliance of treatment suggestions (see above) may mean early relief from pain. However, numbness may take longer to be relieved, even up to 3 months. ReLiva physiotherapist will also spend time in educating you about your condition, home exercises and dos and dont's, so that you can continue to maintain your recovery and avoid recurrence of CTS.

Surgery won't help if carpal tunnel syndrome is the wrong diagnosis. When the carpal tunnel syndrome has become severe, relief may not be complete. There may be some pain in the palm around the incisions that can last up to a few months.

Can Carpal tunnel happen all of a sudden?

In most cases, one can sense pain in the wrist which grows to include numbness and tingling at night. This can continue to aggravate over a prolonged period of time. In the case of acute CTS, symptoms may be sudden and severe. The may appear over a matter of hours rather than weeks or months and may be triggered by specific causes ( see causes of CTS above). Whether acute or chronic, pain associated with carpal tunnel syndrome may even spread up the arm to the shoulder.

Occupations with High Risks of Carpal Tunnel Syndrome:

Statistically it is reported that profession has a large role in incidence of CTS. Here are few occupations with High risk (greatest risk to lowest):

  • Cooks and other cafeteria workers
  • Installers and repairers of electrical power lines
  • Construction and maintenance personnel (including painters)
  • Painters, construction and maintenance
  • Highway workers
  • Metal workers, and mechanics
  • Housekeepers and maids
  • Industrial machine mechanics

Last Updated on 6 August, 2018

This post is based on the inputs from Dr Carol Johnson (PT). Dr Carol is an expert with musculoskeletal issues pertaining to office ergonomics, sports injury and women’s health.


Related Reading:

All about DeQuervains Syndrome

Ergonomics Programme for Corporate Employees

5 minute Office Stretch exercises: Back, Neck pain

Ergonomics: Does it matter in your workplace

Neck Pain : Managing at Home

Physiotherapy, a sustainable solution for workplace Health & Wellness


workplace health and wellness

Physiotherapy, a sustainable solution for workplace Health & Wellness

Author: Subodh Gupta
As India grows increasingly important in the World economy, more and more Indians are getting into white collared jobs. Information Technology or IT/ITES sector, alone forms the largest employer in the organized private sector of our country. And when over 50 % of these IT professionals in India report musculoskeletal problems like back pain, neck pain etc, one cannot ignore the mounting size of the issue.

A high prevalence of musculoskeletal (orthopedic) problems has been seen amongst IT workforce. Studies have found that over 50% of the IT professionals in India report these issues. Office for National Statistics in UK has found that back, neck and muscle pain accounted for more absences than any other ailment.

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