The most common neck problems seen in the clinic are:
- Disc : A bulging disc can impinge [put pressure] on a nerve in the neck causing local neck pain. However, the local pain can be accompanied with arm pain, numbness, pins and needles or muscle weakness. The severity of the symptoms will determine the treatment chosen, or if a specialist referral is required.
- Facet Joint Pain : These are small joints on either side of the vertebral column [spine]. They can become stiff or slightly shifted out of position. This then irritates the local soft tissues, often causing neck pain. Sometimes the irritation can be so severe that the symptoms can refer into the arm like a disc problem. This condition responds very well to physiotherapy.
- Acute Torticollis : This normally occurs in teenagers, but not exclusively. The patient often wakes up with a very painful neck, unable to hold the head upright because of the pain and muscle spasm. This condition, although very painful and sometimes frightening, improves very quickly with treatment.
- Post Whiplash : This normally occurs when someone’s neck and head go rapidly forward and then back again, usually in a car accident. This affects many tissues in the neck including muscles, ligaments, joints and even neural tissue [nerves]. The symptoms are varied, but usually involve stiffness and pain. All our physiotherapists are experienced in treating this condition.
- Osteoarthritis or cervical spondylosis : This is the wear and tear one gets in the neck joints from everyday living. Like most things some people get more severe symptoms than others. The symptoms include loss of movement, and some pain. Physiotherapy will not cure the condition but can ease the symptoms by reducing the pain and maximising the movement.
- Headaches : Physiotherapy can be a vital part of the treatment of headaches, particularly those of neck or spinal origin often referred to as cervicogenic headaches. Migraines and tension type headaches can still benefit although often to a lesser extent.
This occurs in the spine, between the neck and low back. The pain can be very acute and local, with referral into the chest region. At times it can be very painful to take a deep breath. If after assessment the physiotherapist diagnoses a mechanical problem, it normally reacts well to treatment.
The presentation of Low back pain can be extremely diverse from an ongoing ache over many years, to acute episodes where you feel unable to straighten up, to nerve referred pains such as sciatica. It is because of this variety that it is essential that a back specialist, such as your physiotherapist, fully assesses your condition to determine the appropriate course of treatment for your particular symptoms.
All of our physiotherapists are highly experienced in treating LBP as it is by far the most common condition that we encounter in our clinics. By undertaking a full physical examination your physiotherapist will be able to diagnose the likely cause of your back pain. Two of the most commonly encountered presentations are listed below :
- Disc related pain – Discs sit between each of the vertebrae throughout the spinal column, acting as shock absorbers and helping to maintain a balanced distribution of forces within the spine. Each disc consists of a gel like centre, called the nucleus, and is surrounded by an outer protective layer called the annulus (imagine a jam doughnut). Due to the often repetitive and sustained postural nature of many of our professions and hobbies the disc can be placed under repeated stress in certain positions. This can sometimes lead to a bulging of the disc, which can then press on some of the surrounding structures producing pain. If the disc happens to press on a nerve, you are likely to experience pins and needles, or numbness sometimes down to your toes.
- Facet joint pain – Each vertebra has two facet joints connecting to the level above and two to the level below. In a well conditioned back the facet joints slide and glide on each other to allow us to move normally and without pain. With LBP this can cease to be the case. One of the facets may become restricted in its ability to slide and glide, or following trauma may be impacted on the either the facet above or below, leading to LBP. The facet joints usually produce pain locally to one side,but if highly aggravated may refer pain into the leg.
Treatment for LBP : We strongly believe that a course of treatment must address not only the actual symptoms, but the cause of the problem. We frequently encounter patients who feel that their back has just ‘gone’ for no reason, but when delving into the requirements of their occupations, hobbies or family life, find clues as to why this may have happened. Initial treatment may involve manipulation or mobilisation, and exercises to restore the range of movement, and reduce the pain in your back. Following this, a consideration of lifestyle factors and a strengthening program to address the core muscles (e.g. Pilates) is often indicated. Every treatment program is individually designed to your symptoms and lifestyle demands.
The sciatic nerve is made up of a collection of nerves which merge together after exiting the spine and travel down the back of the leg and into the calf. True sciatica is due to an irritation of this nerve either mechanically (e.g. disc bulge) or chemically (inflammatory changes) and is often experienced as sudden shooting pains into the back of the leg or calf. Successful elimination of the pain is dependent on identifying the cause of the nerve irritation and looking to eliminate this.
The sacroiliac joint is formed by the sacrum connecting to the ilium (part of the pelvis). It is a controversial area with some schools of thought considering it a significant source of pain around the lower back and buttock area, whilst others feel it has little contribution to pain in this area. This difference of opinion is due to the SIJ being a very secure joint that has a very small amount of available movement. Pain is usually felt on one side and locally to the base of the spine and buttock area. It can commonly coexist with LBP or hip problems, and patients often complain of pain when getting in or out of the car, turning over in bed or standing on one leg. Pain attributable to the SIJ is often seen during pregnancy. SIJ pain is usually due to a directional stiffness at the joint, or instability due to poor muscle control. A thorough assessment by your physiotherapist will determine whether the SIJ, lumbar spine, hip joint or a combination of these are the reason for your symptoms.
The overuse injuries are often in the news, with RSI [repetitive stress injury ] often caused by the overuse, or poor postures adopted at computers, especially laptops. There were however many examples of RSI in the past with conditions such as Gamekeepers thumb.
- Post fracture stiffness and pain – This occurs due to the wrist having to be immobilised in plaster for up to six weeks. The patient is normally an elderly lady who has fallen onto her outstretched arm.
- Dislocation – This will often occur in sportsmen, especially racquet players who put their hand out to prevent a fall or when running into the court wall . This can result in a fracture of one of the small bones in the wrist or a dislocation.
- Tendonitis – It is usually a slow onset of pain in the wrist with increasing pain and disability. It is often seen in people with highly repetitive jobs working in a poor bio-mechanical position such as computer or checkout operators . Where possible it is important to have a workstation assessment to try to prevent re-occurrence of the condition once cured by physiotherapy.
This is a form of RSI as it is often an overuse injury. The pain is sited on the outside bony point of the elbow where the wrist and forearm muscles form the tendon that attaches to the bone.
- The common site of the pain is normally at this point but it can also be slightly lower down in the forearm.
- The symptoms are normally pain on the outside of the elbow aggravated by gripping and lifting, and early morning stiffness.
- It can be caused by tennis or other racquet sports, or a sudden increase in another activity such as pruning. If it is caused by increased tennis or increased practice particularly of a new stroke it should be mentioned to your coach. A change of racquet, one that is heavier or has a thicker grip can sometimes be the trigger of this condition.
Our physiotherapists are following the latest techniques to address this annoying condition. Taping, Soft tissue release, postural adjustment and exercise prescription are often used in treating tennis elbow
The symptoms are normally pain on the inside of the elbow, with early morning stiffness . The causes are normally from overuse or a change of equipment or technique. Our physiotherapists are following the latest techniques to address this annoying condition. Taping, Soft tissue release, postural adjustment and exercise prescription are often used in trating tennis elbow
The shoulder complex is a very mobile region of the body, which consequently may have compromised stability, and therefore shoulder injuries are commonly seen in the physiotherapy clinic. Different causes of shoulder pain include:
- Referral from the neck
- Rotator cuff pathology. The rotator cuff comprises of 4 muscles that work to maintain the position of the humerous in the shoulder joint. They are at risk of tendonopathy, impingement or possible tear.
- Shoulder joint dislocation
- AC joint dislocation/subluxation – commonly as a result of a fall onto a out-stretched hand or onto the shoulder e.g. during a rugby match
- Frozen Shoulder or Adhesive Capsulitis
- Post Surgery (eg subacromial decompression or arthroplasy)
- Subacromilal Bursitis – This one been very common and debilitating…..
The very first aim of every treatment is always to increase Range of motion and reduce pain. This is achieved through mobilization and manipulation techniques and soft tissue release.. The treatment will also include strengthening exercises. In particular to restore the function of the rotator cuff and the shoulder blade stabilizers.
Temporomandibular joint disorders are problems affecting the jaw joint – usually pain or reduced movement of the joint. TemporoMandibular Joint (TMJ) problems are treated following a careful treatment of all possible elements affecting this problem. Problems in the TMJ area includes pain, clicking, occlusion problems affecting range of movement and poor alignment. Some of the techniques used to help TMJ problems include spinal and TMJ mobilisation techniques and postural adjustment.
Two main causes of hip pain are Osteoarthritis and trochanteric bursitis, although there are others.
- Osteoarthritis of the hip will normally show up as pain and stiffness in the hip. The pain can however refer into the groin and down the front of the thigh as far as the knee. The pain and stiffness often leads to a limp, and functional difficulties, such as getting dressed.
- Trochanteric Bursitis: This is inflammation of the main hip bursa and can cause pain directly on the hip bone especially if one tries to sleep on that side.
- Hip Replacement: Post operative physiotherapy is important to optimise recovery.
There are many causes of knee pain. The assessment as always is very important . The history and mechanics of the injury, and what affects it will help the physiotherapist make an accurate diagnosis. Below are some of the many knee problems the physiotherapist can help you with.
- Ligament Injuries – These vary on site and degree. They can be on the inside of the knee [medial] the outside [lateral] or occur internally [cruciate] . They can vary in degree from a strain to a complete rupture ,and the level of the injury will dictate if it is the physiotherapist or surgeon that carries out the first part of the treatment.
- Cartilage or Meniscal Tears – This injury is more common on the inside of the knee than the outside. Physiotherapy is normally post –operatively , unless there is a very minor tear, or if swelling reduction and muscle building is required pre-surgery.
- Tendonitis – This can be a primary cause of knee pain often at the front of the knee or as a secondary reason, normally because of a muscle imbalance and weakness caused by another often minor untreated injury.
- Osgood-Schlatters – Normally occurs in very sporty children going through growth spurts. The pain is just below the knee where the patella tendon attaches to the bone.
- Osteoarthritis – This can occur within the main weight-bearing part of the knee or behind the knee cap [patella]. Treatment will not cure the root of the problem but can provide pain relief and slow down the progression of the condition.
- Post-Surgery Knee – Whether the surgery is a fairly minor arthroscopic procedure or a total knee replacement physiotherapy will speed up and maximise your rehabilitation.
The first aim of every treamtment is always to increase Range of motion and reduce pain. This is achieved through mobilization and manipulation techniques and soft tissue release.. The treatment will also include strengthening exercises. Weakness of the major muscles surrounding the knee, either due to pain, swelling or non-use can lead to reduced control of the knee joint and the possibility of other structures becoming painful.
The most common injuries we see are:
- Tendonitis – overuse injury particularly of the peroneal tendons on the outside of the ankle. This may be caused by acute or chronic overloading of the tendons. Pain is often located around the outside of the ankle which is worse during or after exercise. A thorough assessment of the biomechanics of the lower limb may indicate the reason for this overuse.
- Lateral ligament sprains – pain on the outside of the ankle joint often following an incident of inversion or “going over the ankle” either recently or in the past.There may be swelling and significant bruising if acute. Physiotherapy can promote the healing of the ligament decreasing pain as well as addressing any muscle strength or gait problems.
- Post fracture – Ankles can be stiff and painful following fractures. Physiotherapy can help alleviate the pain as well as increase movement and help you on your return to full fitness.
- Sindesmosis Injury – pain is usually on the ‘neck’of the ankle, between tibia and fibula and the structure involved is the fascial tissue between tibia and fibula. A mobilization of the ankle mortice followed by specific exercises will restore the normal function
The most common conditions physiotherapists see in their clinics are:
- Plantarfascitis — this is acute pain and stiffness in the heel , especially when first putting the foot down in the morning.
- Metartarsalgia – this is pain underneath the foot, normally between the second and third toes.
- Tendonitis — this is inflammation of a tendon, of which there are many in the foot.
Foot problems are often of a biomechanical origin and might require made to measure insoles. If the physiotherapist believes insoles are required he/she will refer you to a podiatrist to help prevent a reoccurrence of the condition.
Bursitis is inflammation of a bursa. Bursae are small fluid-filled sacs located between two adjoining structures, usually muscles, tendons and bones. They reduce friction and assist movement of the tendon over the bony surface. Bursitis does not cause joint deformity, but can cause significant pain and restrict movement. Bursae are located outside the joint itself. Since both tendons and bursae are located near joints, inflammation in these soft tissues may be mistaken for arthritis. However, arthritis involves inflammation within joints, whereas bursitis involves inflammation outside the joint.
The symptoms of bursitis may include:
- localised pain
- a warm feeling in or around the affected area
- increased pain at night
- pain worsened by movement
- reddening of the skin.
The shoulder, elbow, hip, knee and heel are the most common sites of bursitis. Injury, repeated pressure and overuse are common causes of bursitis. Certain disorders (such as rheumatoid arthritis, gout and diabetes) can also contribute to its development. A common cause of bursitis is also overuse of a particular body part, especially if that activity is performed awkwardly or with considerable pressure. Examples of work-related activities that may trigger bursitis include production-line packing and typing. Sports that can cause bursitis include jogging, tennis and squash. Bursitis is generally detected as a tender, warm swelling at the site of a bursa. A diagnosis may include investigating and ruling out any other possible causes.
Tests performed to confirm or rule out bursitis may include:
- physical examination
- medical history
- x-rays, to rule out the possibility of any other condition
Treatment will depend on the cause of the bursitis. Treatment aims to alleviate the symptoms as much as possible while the healing process takes place. A thorough assessment is fundamental to obtain a positive outcome. Treatment options may include pain-relieving mobilization techniques, cold packs, gentle mobilizing exercises and rest. Anti-inflammatory medications are usually not effective as there is no blood supply to the bursa. Injections of corticosteroids may be used in cases of severe pain.
MUSCLE STRAINS & JOINT SPRAINS
A MUSCLE strain usually means a stretching or tearing of muscle fibers. Most muscle strains occur either because the muscle has been stretched beyond its limits or it has been forced to contract too strongly. The severity of a muscle strain is graded into:
- First-degree strain – a mild strain when only a few muscle fibres are stretched or torn. The injured muscle is tender and painful, but has normal strength.
- Second-degree strain – a moderate strain with a greater number of injured fibres. There is more severe muscle pain and tenderness. There is also mild swelling, some loss of strength, and a bruise may develop.
- Third-degree strain – this strain tears the muscle all the way through. There is a total loss of muscle function.
A JOINT sprain is an injury to a ligament. Ligaments are strong tissues around joints which attach bones together. They give support to joints. A ligament can be injured, usually by being stretched during a sudden pull. The ligaments around the ankle are the ones most commonly sprained. The severity of a sprain is graded into:
- Grade I – mild stretching of the ligament without joint instability.
- Grade II – partial rupture (tear) of the ligament but without causing joint instability.
- Grade III – complete rupture (tear) of the ligament with instability of the joint.
A damaged ligament causes inflammation, swelling, and bleeding (bruising) around the affected joint. Movement of the joint is painful.
Usually, the damaged ligament or muscle heals by itself over time. Some scar tissue is produced where there has been a tearing of tissues. The main aims of treatment are to keep inflammation, swelling, and pain to a minimum, and to be able to use the joint or muscle normally again as quickly as possible.
Physiotherapy helps in both type of injuries, helping the healing of the tissue damaged and restoring the normal function of the tissue/joint involved.