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Postural - The head is a heavy part of your body and if not balanced on top of the spine correctly results in the muscles working too hard to maintain an upright position. These muscles soon tire and give rise to pain. Many people who spend prolonged periods of time sat at a desk or driving, develop a 'poking chin' posture. Over time this is registered by the brain as normal but results in tight suboccipital muscles and stiffness/ bulkiness at the base of the neck, which can be painful. Treatment includes recognising the incorrect posture, loosening tight structures, strengthening the muscles around the spine, and re educating correct posture so it becomes easy and natural again.
Degenerative (spondylosis) - It is now thought that your genetic makeup has a large part to play here, hence spondylosis tends to run in families. Old injuries or persistent poor postures can also contribute. Cervical discs dehydrate with age and the facet joints become 'worn and torn'. A bulging disc can press onto a nerve and this gives rise to referred pain and/or pins and needles in the arm. Physiotherapy helps to maintain range of movement in degenerative joints, ensures muscles do not exert excessive compression on the sensitive structures and strengthens muscles to help protect the neck.
Whiplash - This is where the neck sustains an acceleration/deceleration force during, for example, a car accident or fall. The soft tissue structures around the neck region are potentially damaged, giving rise to a range of symptoms. It is important to reduce pain, restore range of movement, muscle control and strength following a whiplash injury, so that optimal tissue healing can occur. Physiotherapy is ideally placed to do this through a range of techniques, for example, joint mobilisations, soft tissue release, exercise, and acupuncture.
Torticollis (Wry neck) - This is where the neck becomes stuck in a tilted or rotated position due to either 'locked' facet joints or the muscles on one side of the neck going into spasm. Physiotherapy helps to ease this by manual therapy and the use of heat/ice. Symptoms usually ease over a period of a few days.
Post Operative Spinal Surgery - Physiotherapy following a cervical fusion or disc replacement is important to regain range of movement, mobilise soft tissues, including neural structures, and to strengthen the musculature in the neck and shoulder girdle. Nerve blocks or facet joint injections (cortisone injections) are sometimes used to temporarily relieve pain and inflammation. This gives a 'window' of opportunity to progress with rehabilitation. We liaise closely with orthopaedic consultants to optimise timing of physiotherapy post injections.
Frozen shoulder (capsulitis) - This is a common condition in the 40- 60 age group although we don't really know what causes it! The soft tissues around the shoulder joint (joint capsule) go through 3 distinct phases over a period of around two years if left untreated. The first phase is marked by significant pain, the second by pain and stiffness and the third by residual stiffness. Physiotherapy techniques utilised will depend on the stage of the capsulitis, but the aim of treatment is to restore function to the joint and reduce discomfort.
Impingement Syndrome of the Shoulder Joint - This condition usually presents as a painful arc of movement around shoulder height. It can occur for a variety of reasons, ranging from arthritic changes causing bony spurs, inflammation in the bursa (sack of fluid under the tip of the shoulder), or from injury to the rotator cuff (muscles supporting the shoulder joint), all of which can narrow the gap that the tendons have to pass through. It is often caused simply by muscle imbalance and poor posture. The shoulder joint is a shallow saucer and a ball, which relies on all of the muscles around it to work in a balanced way to keep it in the centre. Physiotherapy assessment can determine which muscles are overactive and tight, and which ones are long and weak. Re-training the muscles and correcting posture corrects the pattern of movement and relieves the impingement and ultimately pain.
Acromioclavicular Joint - The collar bone joint (ACJ) is prone to sprain, subluxation and even dislocation by falls onto the side of the shoulder. It is also common to develop arthritic symptoms in this joint, often felt when lying on one side. It is important that this joint moves freely to allow normal movement in the shoulder joint and mobilisations here can help.
Tendonitis/Tendonosis - Tennis and golfer's elbow are usually caused by excessive use or performing an unusual activity. As we age, tendons are prone to small tears that become inflamed and cause pain. A range of physiotherapy techniques can be used here including acupuncture, massage, mobilisations, strapping, bracing and ultrasound. It is important to load the tendon in a controlled way as it heals to maintain strength and stimulate healing.
Postural pain and stiffness - So many of our daily activities involving bending forwards or sitting in positions that are less than ideal. The thoracic spine is a common area to feel a burning ache in the muscles either side of the spine or around the shoulder blades, and this suggests postural problems and stiffness. It usually responds well to manual therapy and postural advice, with home exercises preventing it re-occurring.
Scoliosis - This is an abnormal curvature in the spine. It can be present at birth or develop in adolescent years or later in life. The curvature places abnormal forces on the spinal joints and muscles which can lead to pain. If structural, these curves can not be corrected, however, understanding which way your curve goes and regularly performing specific stretches and strengthening can minimise the curve progression and reduce symptoms.
Costochondritis - This is inflammation of the rib cartilage. It can respond well to acupuncture which relieves the inflammation and pain.
There are many causes of low back pain. Most people present with simple mechanical back pain caused by poor postures, weak core strength and/or stiffness.
A thorough physiotherapy assessment will ask about the history of your back pain, look at how you move/use your spine, and determine which structures are giving rise to the pain. Depending on what we find, a treatment plan is devised to enable you to return to full activity as soon as possible. This may include: manipulation, mobilisation, soft tissue work (myofascial techniques), neural mobilisation, specific back exercises and advice R.E. general exercise, acupuncture and advice/education.
Sciatica - Pressure on one of the nerves in the low back can result in pain being referred into the leg. The pattern of the pain indicates which nerve is being irritated or compressed. It can also be accompanied by tingling/pins and needles, numbness and weakness. Physiotherapy can be helpful here but if symptoms persist we can request an MRI scan to determine what structures are at fault and this is where we liaise closely with Spinal Consultants.
Other causes of back pain include - Degenerative changes in discs and facet joints, prolapsed intervertebral discs, spondylolithesis, stress or osteoporotic fractures, sacroiliac joint problems, stenosis.
The key to successful treatment and management is an accurate diagnosis from a thorough physiotherapy assessment.
Osteoarthritis (degenerative changes) - This tends to result in pain in the groin, front of the thigh or knee. Range of movement is limited and walking distance reduced. In the earlier stages, physiotherapy can help by mobilising the joint and strengthening the muscles around it.
Impingement - This results in a pinching pain in certain positions and responds well to muscle balance work; stretching and strengthening specific muscles.
Bursitis - Bursae are thin sacs of fluid that buffer muscles from bony prominences. If they become irritated they become swollen and give rise to pain. They are painful to compress, for example, by lying on or contracting a muscle over them. They often respond well to acupuncture and correction of the movement pattern.
Ligament injuries - These can be acute due to sudden injury resulting in tears or chronic due to abnormal repetitive strain put through the knee joint.
Meniscal cartilage tears - Often caused by twisting the knee whilst weight bearing through it. Both ligament and meniscal injuries can be managed conservatively, through a progressive exercise programme, under the supervision of a physiotherapist, depending on the severity and type of injury, and how long since it happened. A thorough assessment will determine this. Severe injuries may need assessing and investigating by an Orthopaedic Consultant, and we would liaise with them accordingly.
Tendonitis - Large forces are transferred across the knee, particularly during weight bearing sports, often the equivalent of many times our body weight, and so the tendons can become overloaded and painful. Recent research shows that controlled loading of the tendon encourages healing and promotes strength. Advice and guidance through a rehabilitation programme maximises this.
Osteoarthritis (degenerative changes) - The articular cartilage on the bone ends can break down with age, previous injury, and heavy use. This results in low grade inflammation giving rise to pain, swelling, giving way and weakness. It is important here to maintain range of movement and strengthen the surrounding muscles to help off load the joint. Acupuncture can also be helpful in reducing pain and inflammation, allowing more movement and improving the ability to exercise.
Patellofemoral joint pain - This is where the back of the knee cap becomes irritated against the knee joint. It is a floating bone, sitting in the quadriceps tendon, and so depends on good muscle balance and control in order to move smoothly in its groove. It is a fairly common problem in adolescents going through growth spurts, or in older people where the cartilage becomes worn. The main stay of treatment here is a rehabilitation exercise programme, with possibly the addition of taping to facilitate and correct alignment of the lower limb.
Ligament sprains - 'Twisted ankle' injuries are very common. They usually heal well over a period of a few weeks but can easily recur if the ankle remains weak and balance reactions poor. Rehabilitation ensures restoration of full movement, muscular strength and balance control.
Foot posture - The most common problem here is 'fallen arches'. The foot acts as a lever to propel the body along as we walk or run. It has to cope with our whole body weight and over the years the supporting ligaments and muscles can become chronically stretched and weak. This can result in conditions such as Plantarfasciitis, or affect further up the limb giving symptoms in the knee or hip. Physiotherapy consists of stretching, strengthening and off-loading the region with taping or orthotics, advice and education.
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