Month: June 2014
Musculoskeletal physiotherapy is the specialisation within physiotherapy that focuses on the diagnosis and management of problems of the musculoskeletal system i.e. muscles, tendons, joints, ligaments, nerves, connective tissue etc. Examples of such problems are mechanical spinal pain, whiplash associated disorders, arthritis and sports injuries, such as soft tissue injuries (ligament sprains and muscle injuries).
As Clinical Specialists in Musculoskeletal Physiotherapy, we are committed to evidence-based practice. This means that along with our combined 30 plus years of clinical experience, recent, good quality research findings continually inform our practice. This ensures that our patients receive the best physiotherapy treatment options available for musculoskeletal conditions, as well as appropriate referral onwards (for example to an orthopaedic surgeon or neurosurgeon) in the minority of cases where the desired treatment outcome is not achieved or physiotherapy is not the best treatment available for your particular problem.
There now exists a strong research base for a combination of manual therapy, exercise and education being effective for treating many musculoskeletal conditions, for example spinal pain.
Fracture at the Elbow
There are three bones involved in making up the elbow joint: the ulna, radius and humerus. Fracture of any one of these bones near or within the elbow joint causes problems in how the elbow joint functions.
Your orthopaedic surgeon will tell you when you need to commence physiotherapy, after your fracture has united.
This varies greatly depending on the location, type and management (surgery versus conservative) of the fracture at your elbow. Often people think of the elbow just in terms of bending (flexion) and straightening (extension), but in fact the elbow joint is also involved in allowing you to turn your forearm/ hand over and back. Physiotherapy is crucial to restoring this normal movement and function of the elbow joint.
At Iona Physiotherapy, you can expect a thorough assessment of not just your elbow, but the whole upper limb, including your shoulder and wrist/hand as these can sometimes be injured in the trauma or become stiff if you have been wearing a sling. Treatment may include massage, manual therapy and exercise to restore normal movement and function.
Top Tips for Fracture at the Elbow:
- While you are waiting to start physiotherapy for your elbow, it is very important that you move your hand/ fingers by making a full fist and then stretching your fingers out several times a day. It is not enough to just wiggle your fingers!
- The same applies to your shoulder; you need to move your shoulder through its full overhead range of motion every day.
- The above will really save you a lot of problems and reduce the amount of physiotherapy needed at a later stage. At Iona Physiotherapy we can give you the appropriate exercise programme, in the very first few days after your fracture in order to prevent such complications and allow your subsequent rehabilitation to be as straightforward as possible.
Wrist and Hand Injuries
The wrist and hand is a complex region of the body but is not as prone to injury as the shoulder, hip or knee. Injuries / conditions that occur in this part of the body can be acute, often from a fall on an outstretched hand (FOOSH) or overuse, from ongoing repetitive use of the wrist and hand. On occasion, pain in the wrist and hand can be due to causes higher up the limb, such as the shoulder and the neck.
At IONA Physiotherapy, you will receive a thorough musculoskeletal examination which should allow us to determine the actual source of the symptoms in your wrist and hand.
The most common wrist problems: wrist fractures, deQuervain’s tenosynovitis and carpal instabilities will be described in this section.
The shoulder complex is made up of 4 joints; the most well known of which is a ball and socket shaped joint. The anatomy of the complex allows it a great degree of movement. This is very useful to allow us to position the rest of the arm for specific tasks e.g. catch a ball, use a computer mouse, brush our hair, put on a seat belt etc. The downside of having so much movement available at the shoulder is that a more convoluted control system is required, made up of ligaments and muscles and this complexity of this system means that the shoulder is more vulnerable to injury than the other ball and socket joint in the body; the hip.
As Clinical Specialists in Musculoskeletal Physiotherapy, we specialise in the assessment and treatment of problems at the shoulder; such as rotator cuff injuries, frozen shoulder or overuse injuries. We can also design evidence-based rehabilitation programmes post shoulder fracture or dislocation.
Rotator cuff injuries
The rotator cuff is a group of 4 muscles and tendons in the shoulder that act to both stabilise and move the ball and socket joint of the shoulder. They can be injured due to a variety of reasons such as trauma, overuse, muscle imbalance around the shoulder complex, poor ergonomics, poor posture or stiffness of the upper spine etc.
Symptoms include pain on specific shoulder movements (often overhead) and with specific tests that target these muscles. The pain may be as a result of pinching of one of the rotator cuff tendons or even a tendon tear.
Your physiotherapy treatment will depend on your specific problem but may include: manual therapy, an exercise programme, analysis and modification of your training regime/ ergonomics/ activities of daily living. Sometimes an MRI or surgery is required, and onward referral to a shoulder specialist will be carried out where appropriate.
Also known as Adhesive Capsulitis, this is a painful condition whereby all shoulder movements become increasingly restricted. Thankfully, the natural course of a frozen shoulder is that it does get better with time but often it can take up to 2 years to resolve.
However, physiotherapy is a crucial part of the recovery process- in regaining normal movement and function of the shoulder. An injection in the shoulder can be helpful in the early stages of a frozen shoulder along with a physiotherapy programme.
A fracture is the medical term for a broken bone. Trauma to the shoulder (like a fall on an outstretched hand) may cause a fracture, which may or may not require surgery. Either way, as soon as your orthopaedic consultant deems that you are ready, you will need to start physiotherapy for your shoulder to restore normal movement, strength and function with a progressive programme of rehabilitation.
This may occur in the shoulder due to significant trauma or more easily, if hypermobility (too much movement) is present as a result of congenital laxity. Physiotherapy is crucial to restoring normal strength and stability in your shoulder to prevent recurrence.
Sometimes surgery is required in cases of repeat dislocation, after which you will need post operative physiotherapy to restore normal movement, strength and function with a progressive rehabilitation programme.
Pregnancy related back pain
Pregnancy related back pain is very common. More than two-thirds of pregnant women experience lower back pain (LBP) and almost one-fifth experience pelvic girdle pain. These are two distinct although related problems. Such pain can interfere with work, daily activities and sleep.
Lower back pain is felt in the region of the lower spine, between the lower ribs and the buttocks, it may refer pain down into the buttocks or legs. Pregnancy related lower back pain can be aggravated by a variety of activities, such as sitting, standing or certain spinal movements Pelvic girdle pain (PGP), may be felt at the back and/or the front of the pelvis and is often made worse by rolling in bed, climbing stairs and standing on one leg and walking.
Pain comes from the pelvic joints or ligaments in pregnancy related pelvic girdle pain. Symphysis pubic dysfunction (SPD) is one type of PGP whereby the pain is felt at the front of the pelvis, where both halves of the pelvis join together.
It is thought that lower back pain in pregnancy is related to altered posture with the increased lumbar lordosis (exaggerated curvature of the lower spine) necessary to balance the increasing anterior weight of the womb, and inadequate muscle control of the stretched core muscles that support the lower back.
Pelvic girdle pain in pregnancy is linked to a variety of factors including a change in hormone levels which affect the ligaments that support the pelvis and/or a previous history of lower back pain or pelvic trauma. See below for what you can do to help.
What can I do?
Firstly it is important to identify the reason for the pregnancy related back pain- whether the pain originates from the spine, pelvic girdle or both. As chartered physiotherapists, specialising in musculoskeletal physiotherapy, you will receive a thorough assessment to identify your problem(s) and formulate an appropriate treatment plan.
Treatment may include: manual therapy for pain relief, specific exercises depending on your problem, advice regarding aggravating activities and in some instances use of a belt to support the pelvis. We also have antenatal clinical pilates classes commencing on 31st of October 2015- which can be a great way to keep your muscles strong and alleviate the aches and pains associated with pregnancy.
Neck pain is the second most common complaint (after low back pain) of people presenting for physiotherapy in private practice. The World Health Organisation’s Taskforce on Neck Pain concluded that neck pain is so common that we should expect it to occur at some point in our adult lives). About 15-30% of people will have recurrent or ongoing neck pain that proves more troublesome in the longer term.
Neck pain can be caused by many factors e.g. poor posture at work, study or during hobbies like reading or guitar playing; degeneration (joint wear and tear) or trauma e.g. a road traffic accident.
Neck pain that results from trauma is known as Whiplash Associated Disorders (WAD) and can include other symptoms such as stiffness, dizziness, arm pain and tingling, heavy headedness etc. There has been a huge amount of research in the last few decades regarding WAD and this has led us to be able to predict in the early days following injury, who will have a speedy recovery and who is more likely to have long term problems. Primarily, we know that you must take an active approach to your own recovery.
More details about assessment and treatment of neck pain can be found in this section, as well as links to useful research-based consumer websites.
Lower Back Pain
Lower back pain (LBP) is very common with a lifetime prevalence rate of 60-80%, meaning that most of us will experience back pain at some point in our lives. There may not always have been an identifiable incident or injury but triggers include twisting, lifting, falling, vibration, impact, poor/ altered posture, poor work practices and muscle imbalance around the spine. The source of the pain can include the muscles, discs, joints and nerves. Sometimes lower back pain can refer pain down into the buttocks and into the legs. This pain down the back of your thigh or leg is also referred to as “sciatica.”
Musculoskeletal physiotherapists are experts at treating lower back pain and referred leg pain. Evidence based research supports the effectiveness of physiotherapy in treating both acute and chronic lower back pain. Aims of treatment include reducing pain, improving spinal mobility, improving postural control of your muscles, return to your normal activity/sport and prevention of recurrence. Manual therapy (“hands on treatment”) helps to reduce pain, which allows for earlier return to activity and improved clinical outcomes. Good exercise prescription is an integral part of this rehabilitation programme as it allows for earlier return to activity, significantly improves outcomes for chronic lower back pain and is the only effective treatment for preventing recurrence (see below).
The bigger problem you may have is that when it resolves there is a very high chance (80%) of it recurring again in the future. Exercise is the only form of treatment that can prevent recurrence of lower back pain. A specific type of exercise, for the deep muscles in your lower back that have become inhibited by pain have been shown in research to significantly reduce recurrence rates. Both Ciara and Louise undertook Masters Degrees in the University of Queensland in Australia, where there is exciting research ongoing into the role these muscles play in injury prevention and in reducing recurrence rates.
Top tips for Lower Back Pain: what you can do before seeing your physiotherapist:
- Keep active
- Seek advice from your G.P. or pharmacist regarding painkillers to help control your pain while allowing you to stay active
- Watch your posture (see blog regarding tips on posture)
- Avoid bed rest – we now know that bed rest for more than a day or two is the worst treatment and in fact delays recovery.
- Stay positive – how you psychologically cope with pain can help affect your recovery
Contact us now to seek an expert assessment, a tailored treatment plan and start the road to recovery.
Have you taken our back pain quiz? https://iona.webdemo.ie/back-pain-quiz/
The knee is a complex hinge type joint that is comprises of four bones: the femur (thigh bone), the tibia (shin bone), the fibula (thin bone that runs alongside the shin bone) and the patella (knee cap).
The knee also consists of ligaments (connect bone to bone), tendons (connect muscle to bone), a medial and lateral meniscus (tough cartilage that act as shock absorbers), a capsule (leathery type structure that surrounds the knee joint) and synovial fluid (the type of fluid present in the normal knee joint). Some examples of injuries/problems that may occur at the knee are: fracture, injury to the ligaments, meniscal injury, patellofemoral pain syndrome (PFPS), patellar tendonitis, patellar tendinopathy and osteoarthritis.
Symptoms of injury or a problem at the knee may include: pain, swelling, stiffness, loss of movement, locking or giving way (feeling of instability).
Hip and groin
Problems of the hip and groin affect a wide range of people; from the GAA footballer who is at risk of groin strain to the over 55’s who are at risk of osteoarthritis of the hip joint that could ultimately lead to a total hip replacement.
On occasion, pain in the hip / groin can be referred from a source in the low back or pelvic joints. It’s also possible to have simultaneous problems in both low back and hip and in fact a problem in one region makes an adjacent region more likely to become problematic, over time.
At IONA Physiotherapy, you will receive a thorough musculoskeletal examination which should allow us to determine the actual source of the symptoms in your hip and groin and ultimately tailor an evidence-based treatment plan.