Introduction:Musculoskeletal rehabilitation is one of the frontline domains in physical therapy practice. In most countries, physical therapists prefer independent practice with referrals from general practitioners and orthopedic surgeons. Under these circumstances, the physical therapist may be the first contact professional handling these individuals who may not have adequate medical records with their personal medical history. Cryotherapy for pain relief could be the first choice of pain management opted by a musculoskeletal therapist. That is when both the therapist and the patient have to be aware of the undesirable effects of cryotherapy application and its potential local and systemic complications. The outcome of this paper could be an initiative for a standardized screening process to be incorporated into physical therapy practice. Clinical Findings:A 30-year-old man with left knee pain who underwent exercise therapy in the physiotherapy unit of a tertiary care center developed erythematous rashes around the knee following ice application. It was noted that the patient was not aware of the same in the past. The patient was attended by a dermatologist, and a diagnosis of cold urticaria was made following confirmation with cold stimulation test. Conclusion:From this study, it may be concluded that the awareness of cold-induced urticaria has to be emphasized on both patients and health care professionals. A simple screening protocol should be made mandatory in orthopedic physical therapy practice, which would suffice this purpose. Keywords: Urticaria, cryotherapy, Physical therapy

Introduction: Quadriceps weakness and extension deficit of the knee following anterior cruciate ligament (ACL) reconstruction (ACLR) can threaten rehabilitation, and isometric quadriceps exercise is the usual prescription. However, the outcome depends more on the individual's re-learning process. Identification of this lacuna and focussed attention to the isometric strength of quadriceps are lacking in the current practice, and developing a tool can lead to optimal outcomes in ACLR. The objective of this study was to assess the role of 'isometric quadriceps pressure difference' (IQPD) in regaining quadriceps strength following the ACLR using a simple tool. Patients and Methods: Eight patients who underwent post-operative ACL rehabilitation between March 2016 and May 2018 were analysed retrospectively. A 'progressive isometric training protocol (PITP)' based on IQPD was prescribed along with the standard protocol. Data were collected from the case records of the patients. IQPD, thigh muscle girth and heel height difference (HHD) were noted pre-operatively, immediately following surgery and 3 months post-operatively. A non-parametric test was used to compare the outcomes before and after surgery. Results: Based on the analysis, the inclusion of IQPD-based PITP in regaining the terminal extension had a significant statistical difference in the IQPD, HHD and girth (p < 0.007, p < 0.005 and p = 0.027, respectively). Conclusion: IQPD can be a simple, cost-effective strategy to identify subtle quadriceps weakness. Further, PITP can improve the isometric quadriceps strength in the acute post-operative period and reduce the incidence of knee extension deficit in post-ACLR.

Introduction Patients with spinal cord injury (SCI) and concomitant lower limb fractures are a challenge to rehabilitate. Conventionally, postural orientation is an important milestone in the rehabilitative process. We propose an alternative strategy in achieving goals in individuals with an SCI with concomitant injuries that preclude weight bearing below the knee. Case presentation A 16-year-old girl sustained a burst fracture of L1 in conjunction with bilateral ankle fractures. During rehabilitation, the calcaneal fracture on the left and tibial plafond fracture on the right prevented her progression in conventional rehabilitation. An alternative strategy "K-ing" (Kneel Standing/Kneel Walking) was adopted to facilitate truncal activation without loading the ankle joints. This was found to be helpful in obtaining upright posture stability without hampering her recovery of associated ankle injuries. Discussion "K-ing" strategy can be useful and presents a simple alternative in the presence of associated ankle injuries. It also avoids complications associated with bedrest when there is delay in initiation of ambulation.

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