Conditions I treat.
Here are some of the more Common Conditions I Treat
With thousands working days lost a year to back pain, this is one of the most common conditions I treat. There are many causes of back pain which commonly affect the lumbar spine or lower back. Common possible causes include;
- The poor posture of a desk/car based professionals.
- An inactive sedentary life style.
- Repetitive poor lifting technique.
- General misuse and abuse of the spine.
- Degeneration of "Flare and Repair" arthritic Changes.
- Acute trauma/injury following a fall, a road traffic accident or sports or work injury.
Treatment will depend upon what I find on examination and the symptoms you describe; but could include:
- manual therapy including mobilisation of stiff individual intervertebral joints.
- massage and fascial release of your soft tissue, including muscles in spasm.
- Taping or strapping to promote good posture.
- Exercises to help strengthen, mobilise and stretch the spinal soft tissue and joints.
- Postural re-education, back care and lifting advice.
- Electrotherapy, (shock wave, interferential, ultrasound and heat treatment with PSWD) to help decrease pain, resolve inflammation, break down scar tissue and reduce swelling
The overall aim of treatment is to analyse the problem, reduce the pain, inflammation and stiffness in order to enable normal movement, posture and function of the Spine and to educate the patient to be able to recognize the signs of re-occurrence and to be able to maintain good spinal health and normal pain free function going into the future.
Technically, true sciatica is irritation of sciatic nerve usually caused by compression of the nerve by a prolapsed intervertebral disc, (slipped disc) or compression of the nerve by abnormal biomechanics of the spine or the musculature in the pelvis. This can result in pain, numbness or tingling/pins and needles in the leg that can go as far as the foot and ankle. However, it has become common for Drs and GPs to describe any back pain leading to leg pain that goes below the knee as Sciatica even if the sciatic nerve is not involved. Leg pain can be as a result of problems with the sacroiliac joint for example.
Treatment is aimed at reducing pain and inflammation and gentle exercises to relieve pressure on the nerve to restore normal function and movement as quickly as possible. This combined with lots of advice on back care, posture and injury prevention makes the treatment plan complete.
I love getting stuck into treating neck pain! No matter what type?
Torticollis or Wry neck:
Torticollis is a descriptive term for a one sided acutely painful deformity of the neck. It usually occurs in the younger age group of patients, (15 to 30 yrs.) It comes on suddenly, usually after sleeping with the neck at an odd angle as when patients drop off on a sofa or sleep in their car or as your grandmother will tell you, “you’ve slept in a draft”. The pain is often off the scale, and patients are unable to move their head into a neutral position or turn into the pain. It can seem very frightening. But fear not: this condition is easily resolved by prompt treatment, usually manual therapy. So don’t delay in making an appointment.
This occurs when the body travelling forward at speed is suddenly stopped dead, resulting in the head being thrown forwards, blocked by the chest and then thrown backwards. Most of us recognize this mechanism of injury from what can happens in a rear end car collision or a riding or ski-ing injury. The speed of travel is usually high and the force at collision great. Symptoms are usually delayed until one or two days after the injury occurs and can range from a mild ache and stiffness in the back of the neck to raging burning nerve pain in the neck, pain into the arm/arms, pins and needles into the arms and hands and even pain in the thoracic and lumbar areas. Headaches are common whatever the area of the neck is affected. Clinically the damage is to the soft tissue including the facet joint capsules the complex ligaments of the neck and the muscles all sustaining a massive overstretching injury causing tears and hematomas within their microstructure. As a protective measure the uninjured superficial muscles go into spasm and as a result neck movement can be restricted. Most whiplash improves within a few weeks or months and it is worth remembering soft tissue healing time can take up to 6-8 weeks. Physiotherapy can help enormously with gentle exercises, heat and manual therapy techniques and its worth remembering the reassurance and advice on do’s and don’ts as well.
Cervical Spondylosis or Arthritic Neck Joints
This is usually an age related condition caused by degeneration of the intervertebral discs and the joints in the neck. It is worth remembering this is a Normal process caused by everyday use over many years and almost everyone will have a degree of spondylosis somewhere in their spine by the age of 65. The main features are, narrowing of the spaces between each vertebra and benign bony spurs, (osteophytes) that grow on the vertebrae edges causing a range of symptoms which can be as little mild stiffness or as much as severe pain and badly restricted movement. If the wear and tear of the discs and joint spaces continues, it can lead to increased pressure on the nerves which in turn causes symptoms such as pain, tingling or numbness that can refer into the shoulders and down the arms and even as far as the fingers.
Muscle Tightness, Spasm and Tension:
Most of the muscles in our bodies get a chance to relax completely when they’re not being used, but some groups of muscles, (the antigravity muscles) have to work all the time to keep the body upright. The neck muscles fall into this group and this coupled with the fact they have to hold your heavy head up, (a head can weigh N kg) makes them prone to tension and often painful muscle spasm. Despite our best efforts poor head and neck posture during prolonged sitting also contribute to muscle tension. Physiotherapy can help with correcting head and neck posture, and working to ease pain with manual therapy, heat and ultrasound.
Or as is more accurately described, a bulging or prolapsed disc, can vary in severity and presents with neck pain associated with pain radiating down one arm, pins and needles, and numbness. If the condition persists patients can describe weakness too. Often it will settle over time but can be greatly helped by physiotherapy intervention.
Stiffness in the upper cervical facet joints, C1, C2 and to a lesser extent C3 can sometimes cause headaches, either at the back of the skull, (occipital headaches) or frontal headaches. Patients complain of dull nagging headache especially after a night’s sleep or prolonged periods of sitting working at a computer. On the whole they respond very well to mobilisations, heat and as I have found, acupuncture. Symptoms can be diminished considerably even after a years of stiffness and pain. Prophylactic postural re-education and exercises are an essential part of a complete treatment program.
Pain and stiffness here becomes more common as we get older and as we spend more time in a chair, (be it at a desk, on a lap top or driving a car!) As we walk less and do more sedentary jobs we lose rotation in our thoracic spines and this along with spondylitic changes result in pain and loss of movement. Physiotherapy can help enormously be it with mobilisations, home exercise programs and/ or electrotherapy.
There are many causes Knee pain, but on the whole they can be put into 3 categories:
Osteoarthritis or OA is a disease that can affect any joint in the body. Osteo means bone and arthritis means inflammation, (causing swelling and joint damage) .The whole process, which is a normal function of the ageing joint, is rather like the way a road surface deteriorates over time. We start out with a brand new smoothly tarmacked surface giving us a lovely smooth ride and over the years the surface becomes rough, pitted and potholed making the ride rough and bumpy. Just as, in this way in our joints, the cartilage becomes dried out, rough and worn creating painful bone on bone rubbing and the formation of extra spikes of bone around the edge of the joint( osteophytes) causing stiffness. Symptoms include;
- Restriction of joint movement.
- Stiffness early in the morning until you get going.
- Dull achy pain worse after weight bearing activity and at the end of the day.
- The affected knee may look larger.
- The knee may become deformed, (bow legged or knock kneed)
- Hollowing and wasted muscles.
Whilst the risk of OA becomes more prevalent as we get older, it is not a problem in all old people! It often runs in families, the genetic factors being very important, the thinking being our genetic profile affects collagen, the main building block that form cartilage. OA is common in people who are overweight, especially middle aged women and it is true that after OA has developed, being overweight can make it much worse. But it is Untrue that normal use including exercise, (even running) causes arthritis unless it is excessive. Most people with OA knees carry on a normal life and for many who seek help, loose weight and strengthen up their quadriceps muscles it can even get better.
Whilst physiotherapy cannot cure osteoarthritis it can help a great deal by easing the symptoms, decreasing pain, managing swelling, and most importantly, strengthening weak muscles. In severe cases I can also advise on the correct use of walking aids.
Anterior Knee pain;
The knee cap or Patella can be the cause of pain in the front of the knee when it does not move or track properly. The patella is a unique bone on the front of the knee joint that is enclosed within the tendon of the quadriceps muscle and attaches via the patella tendon to the top of the shin bone. Its undersurface is shaped like the keel or bottom of a boat and covered in cartilage that glides in the groove on the upper surface of the lower end of the thigh bone or femur (the femoral groove). If the patella has roughened or diseased cartilage or is rubbing up against the surface of the groove it can cause pain on the front of the knee, i.e. anterior knee pain. A skilled physiotherapist can analyse the movement of the patella and work out if a muscle imbalance in the quadriceps is the cause of a painful mal-tracking problem.
Patients report a variety of symptoms including pain, retro patella swelling, and restriction in knee movements that are often accompanied by grinding or clunking sensations, (crepitus) that commonly occurs when squatting, kneeling or going up and down stairs.
Physiotherapy treatment comprises local reduction of pain and swelling and correction of the muscle imbalance with training the patient in specific exercises. Commonly strapping can be used to facilitate normal tracking and stretch any tight soft tissue so relieving pain.
This condition usually affects younger age groups of patients, in particular growing adolescents and can be caused by a combination of factors including;
- weak or imbalanced thigh or buttock muscles.
- tight hamstrings.
- short tight ligaments around the patella.
- Problems with weight bearing and the alignment of the feet
There are many ligaments that help stabilize the knee joint and effectively hold it together whatever combination of movements and positions we throw at it. Ligament injuries are common and can range in severity from a mild sprain to a complete rupture. Sports like football (where the studded boot is fixed in the ground and the player bends and twists at speed) and ski-ing ( where the speed and twisting forces through the knee are great) can often produce more serious sprains , but anyone of any age can injure a knee ligament in any way. The usual symptoms of pain over the site of injury, swelling and a limp occur.
However, if the patient describes their knee as locking up or giving way, this may indicate damage of the specialized knee cartilage or Meniscus. These symptoms are common when doing stairs of after a long period of sitting with a bent knee. Whilst physiotherapy cannot cure these injuries per say it can diagnose the problem, manage many of the symptoms and advise when further investigations may be indicated. Strengthening exercises are essential to restore stability whist the ligaments are going through healing and local ice and ultrasound can help reduce pain and swelling.
The shoulder is a complicated joint. Functionally it offers almost 360 degrees of movement but this comes at a price . . . . . its stability. Technically a ball and socket joint the head or ball of the humerus is large in comparison to the rather small shallow pear shaped socket which offers little congruity. In order to secure some stability the shoulder has a group of four small deep muscles that grip the head of the humerus into the glenoid cavity. These are called the Rotator Cuff; Supraspinatus, Infraspinatus; Subscapularis and Teres Minor.
Shoulder Impingement Syndrome;
Impingement is one of the most common causes of pain in the adult shoulder but it is not to be confused with frozen shoulder.
It results from pressure or pinching on the tendons of the rotator cuff muscles as they travel under the bony arch of the acromion process, (part of the shoulder blade). Overuse or injury can cause inflammation in the tendons which then swell and thicken. It doesn’t take much thickening to cause more pinching and so yet more pain, which in turn causes more inflammation, and so a vicious circle of impingement and pain is set up. The sub acromial bursa, (a friction absorbing fluid filled sack) is also prone to impingement and hence inflammation as it also is situated in the tight sub-acromial space. All in all it’s no wonder this area is such a common cause of shoulder pain. Despite the site of the pain being clearly defined, patients often describe pain that moves all around the shoulder and upper arm, even as far down as the elbow. However, nearly All describe pain doing the same movements and activities; reaching out to the side, putting their arm into the sleeve of a jacket, doing their bra up, washing their hair and reaching behind them are all common aggravating factors.as the problem progresses there may be pain at night and loss of range of movement and strength resulting in visible wasting of supraspinatus and infraspinatus on the back of the shoulder blade.
Treatment of Shoulder impingement Syndromes:
- Initially relative rest and avoidance of repetitive aggravating activities. But, absolute rest should be avoided.
- Cold packs may help reduce the pain and inflammation and settle irritation especially after exercises.
- Steroid injections can help in the short term but in view of the associated risks they should only be used as needed to aid in rehabilitation only to aid rehabilitation.
- Your GP may send you for an X-ray but this will only give information about your bone, not the condition of the tendons or bursa and so will not necessarily help in the initial management. MRI scan or in severe cases shoulder arthroscopy (key hole camera exploration of the joint) are the only sure way to assess the level of structural damage of soft tissue.
- Kinesio tapping can be applied to help off load the painful shoulder in the acute painful stage
- Postural correction is vital as a forward head or poking chin posture is known to be associated with shoulder pain. Physiotherapy can help reeducate pts to sit or stand with shoulders back, chest lifted, head in line with your spine.
- Rotator Cuff strengthening exercises should be painless, carried out in the correct postural position and progressed as they get easier by increasing resistance not number of repetitions.
- Stretching can also be introduced to help regain any lost range of mobility if a shoulder is stiff.
Frozen shoulder is an extremely painful and movement constricted condition that just comes on out of the blue, (sometimes triggered by a mild injury or following surgery). It is not an arthritic condition but has been associated with diabetes, high cholesterol, heart disease and patient with the scar tissue condition in their hands called Dupuytrens contracture.
In this condition the lining of the shoulder joint known as the Joint Capsule is affected. Usually a flexible elastic structure it becomes inflamed, swollen, contracted and tight. Resulting in pain in the upper arm that can radiate as far down as the wrist and globally reduced range of movement in ALL directions. There is no quick fix cure, although treatment can ease symptoms until the condition resolves of its own accord.
Typically the condition follows three phases;
- Phase 1- The “Freezing”, painful phase can last 2-9 months. Stiffness and limitation of movement gradually build up. Pain is worse at night usually when lying on the affected side.
- Phase 2-The” Frozen” phase- This typically lasts 4 -12 months. Pain gradually eases but the stiffness and movement limitation really kicks in. The movement most severely affected is rotation outward.
- Phase 3-The “Thawing”; recovery phase. This typically lasts 5-24 months. The stiffness gradually goes and movement slowly starts to return to normal.
Treatment strategies aim to ease pain and keep the range of movement as good as possible whilst waiting for the condition to run its course include; Ice Packs as safely advised by your Physiotherapist, either with do it yourself frozen peas or proper ice packs.
Heat can help have a sedative effect on pain especially on aching muscles.Sleeping with pillows to support under the shoulder blade and under the length of the arm or sleeping on the opposite side hugging a pillow to your chest or just placing a pillow under the elbow.
Shoulder exercises to try and stop the shoulder from stiffening up and keep movement as full as possible. Most benefit comes if patients do them regularly as instructed by their physio and build up slowly as movement returns. Although difficult at first gentle perseverance and increasing confidence will enable sufferers to push the movement further in all directions.
Acromio- Clavicular Pain;
Sometimes as a result of a sports injury or other trauma, the ligaments in the small joint at the shoulder end of the collar bone, (acromioclavicular joint) gets sprained. Patients complain of intermittent pain usually on pushing up or weight bearing on the arm or reaching across the body. Physiotherapy with ice, ultra sound and tapping can really help here and the problem resolves quickly usually within a few weeks.
Elbow pain is common but not usually caused by osteoarthritis (Rheumatoid Arthritis however does affect the elbow) There are several soft tissue conditions that occur more frequently.
This was long thought to be an inflammatory condition of the common extensor origin, the tendon by which the extensor muscles of the forearm attach to the lateral epicondyle of the humerus. Recent clinical studies have shown that in fact it is not true inflammation but irritation of the cells and re distribution of the nuclei causing structural changes and pain.
Pain, swelling and debilitation from this common injury is often underestimated and symptoms can go on for months if early appropriate treatment is not sought and advice heeded. Reduction of swelling is essential, usually with the application of ice, along with compression and elevation, and on occasion with chronic swelling, padded compression strapping can be helpful. Exercises are also vital in restoring lost range of movement and increasing circulation and promotion lost strength. But most importantly and often forgotten is proprioceptive re-education. That is to say, re-education the joint’s balance sense; so preventing repeated injuries- due to a weak wobbly ankle. I use ultrasound to expedite good ligament recovery.
Hip Pain- Trochanteric Pain Syndrome/ Trochanteric Bursitis:
Deep dull aching in the hip joint and often into the groin is associated with degenerative wear and tear in cartilage and bony margins of the ball and socket joint. Physiotherapy can help enormously in the early stages to work to increase range of movement and decrease stiffness, as well as condition weakened hip muscles inhibited by pain. Re-education of poor gait pattern and advice on walking aides is also part of what I can offer.
Trochanteric Pain Syndrome (Bursitis)
This is characterised by pain in the outer aspect, or widest part of the hip. Patients commonly complain of pain when rising from a low chair or after a long drive when getting out of the car. They also describe sleep disturbance when sleeping on the affected side from pressure on the painful hip. Treatment is dependent upon my findings on examination but can involve stretching and releasing tight soft tissue(ligaments or muscles), building up weak muscles, and the use of electrotherapy be it ultrasound or shock wave treatment depending upon the chronicity of the condition to help with the state of the irritated tissue.