Q: Last year I had pain in my neck and shoulders. I used to have severe pain in neck movements. After MRI I was diagnosed for Koch in C1 and C2. There was minimal erosion in C1 and C2. However, there was no pressure on spinal cord. I was advised rest to spine for 5 weeks along with the following medicines: Inj Streptomycin (0.75 mg), first 30 injections daily and balance 30 injections alternate day; Tap Rcinex (600) empty stomach daily; Tab Combutol (600) 2 daily; Tab Oflox (400) 2 daily; Tab Pyzina (750) 2 daily; Tab Oflox (400) 1 1/2 daily and Cap Becosules 1 daily. I took the above treatment for 3 months. Now I have been advised as below for the next 3 months and then the doctors will review and advise: Tap Rcinex (600) empty stomach daily; Tab Combutol (1000) 1 daily; Tab Oflox (400) 1 1/2 daily and Cap Becosules 1 daily. My Uric Acid is 6.9 and all CBC and LFT tests are normal. MRI shows no pressure on spinal cord. I am using cervical collar to protect the neck from unforeseen jerks. Hope my treatment is in the right direction? How much neck movements I can start now?

A:You should start your physical therapy only after your pain and inflammation has been controlled to a comparatively harmless stage to start any movements. Your doctor will guide you on this. Basically you should aim to restore full range of motion (ROM) of joints and flexibility of the neck and shoulder girdle muscles. Start with small turning movements in bed with the help of your therapist. You can take modalities such as electrical stimulation but should be used only to control pain in the initial stages of exercises. Later, as ROM improves, cervical muscle strengthening exercises can be started in a single plane involving flexion, extension, lateral bending and rotation. In addition, scapular stabilising muscles including trapezius, rhomboids, serratus anterior and latissimus dorsi should be strengthened with progressive isotonic activity. Gradually, you can learn turning in bed and sitting up and standing and related postural advice which should become a daily habit for you. Breathing exercises are very important for you at this stage and later too.