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Physios are able to help with a wide range of ailments and physical problems. There are four main areas that they work on: musculoskeletal, neuromuscular, cardiovascular, respiratory. Musculoskeletal refers to the bones, joints and soft tissue in the body. Neuromuscular is the brain and the nervous system, cardiovascular is the heart and blood circulation, and respiratory refers to any part of the body which are used to help you to breathe, such as the windpipe and lungs. Some physio clinics in Jurong East are able to help in these areas:
• Mental health
• Intensive care
• Long-term conditions
• Orthopaedics and trauma
• Workplace health
• Elderly care
• Education and health care promotion
• Womens problems
Once the physiotherapist has seen the effects of repeated movements on your pain picture and tested the neurological status of your affected body part they will have a more detailed idea of which structures need more detailed examination to clarify the exact nature of the problem. It is time for the individual muscles, joints and ligaments to be stressed to assess their reaction and add to the understanding of what is going on. The physio may just feel and grip the area firmly first to get an idea of the state of the tissues. Are they very sensitive? Is there muscle spasm, thickened tissues, or pain?
During your physiotherapy session the therapist will often put you on your side and move your spine backwards and forwards as they feel the movement occurring between the individual spinal levels. After this you may be placed on your front as the physiotherapist palpates (prods and pokes) your spinal levels with varying degrees of force but often quite firmly to see if any particular level reacts by bringing on the pain you normally complain of. All the tests for pain in your neck, back, elbow, knee or ankles will help diagnose the issue.
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Cervical spine pain and disability is one of the commonest problems for which people consult a physiotherapist. The first part of the examination is to find out the cause of onset of the pain and how it has behaved since then. The cause of the pain is clear in about half of all cases but the rest can give no good idea why the pain came on. Where the pain is and how it behaves gives indications to the physio about where the underlying pathology might be found and what treatment approach might be
The first investigation of the physiotherapist will be into the location and kind of pain. It is vital to understand if the pain is specific to one spot or whether it also affects other parts of the body. For example, if the pain is intense and specific the physiotherapist would surmise that the cause may be poor posture or a kind of degenerative problem; on the other hand, a referred pain may suggest a pinched nerve or a problem elsewhere.
Because neck pain could be an indicator of various pathologies the physio will ask all the special questions such as general health, past medical history, weight loss, bladder and bowel control, quality of appetite and sleep and medication usage. The objective examination begins by getting the patient to take their upper body clothes off and looking at the posture of the trunk, neck, shoulders and arms. A humped thoracic spine with rounded shoulders and a poking chin are a common postural abnormality which can lead to pain.
Cervical ranges of movement are tested to elicit important information about what is going on in the neck. The response to movement testing will help the physio understand the kind of neck pain problem and how to start treating it. Cervical rotation, flexion, extension, side flexion and retraction are all assessed to try to pinpoint the problem. Muscle strength, sensation and reflexes are tested to ascertain that the nerve conduction to the arms is working well.
Manual therapists such as physiotherapists learn mobilization techniques and to assess the spinal joints manual palpation of the cervical spine is used. Using their thumbs or the heel of the hand, the physio presses down on the spinal processes or side joints of the cervical spine. This allows some specific conclusions to be drawn when the pain symptoms come on at one particular spinal level and not another. Treatment will be aimed at these levels.
Mobilization techniques are a core manual skill for physiotherapists and abnormal joint mechanics, known as dysfunctions, can be identified by palpation of the main spinal and facet joints by the physio. Treatment can use repetitive small movements to relieve pain an encourage normal motion, to more forceful manipulations which take the joints beyond their typical ranges and restore movement. Any increases in movement gained by treatment is maintained by home exercises.
Typical physio treatments are exercise programmes, nerve mobilizing techniques, correction of poor posture, pacing technique, trunk segmental mobilization and strengthening of the deep flexor muscles of the cervical spine. Nerve root compression of a cervical nerve root can cause severe arm pain, loss of sleep and distress from a cervical slipped disc. Cervical traction can decrease the pressure on the affected segment and reduce pain enough to allow recovery to start, either by physio treatment or autotraction from a home traction kit.
Golfer's elbow, more technically called medial epicondylitis, is a similar type of condition to tennis elbow or lateral epicondylitis, but is less common. Since there is little or no inflammation present in these syndromes, they are known as tendinopathies, where degeneration of the tendon occurs and gives symptoms. Typical aggravating factors are racquet sports, golf and sports which involve throwing, although other sports people may be affected such as weight lifters, archers and cricket bowlers.
The muscles which flex and rotate the forearm originate over the medial epicondyle, the bony prominence on the inside of the elbow, with the tendon anchored into the bone by the tendinous insertion. The pain occurs close to this and may be due to a degenerative process occurring in the tendon, as little inflammation has been noted in these cases.
High stresses occur in the cocking phase of a throw and during the subsequent acceleration, and in the golf swing from high backswing down to near the ball strike. Golfers are more likely to have their dominant hand affected and tennis players who use heavy topspin in their forehands are also more at risk.
Golfer's elbow is not as common as tennis elbow but is the commonest cause of medial elbow pain with about half as many women affected as men. The third to fifth decades of life are the commonest periods for pain onset and 60% of golfer's elbow occurs in the dominant hand. An acute onset of pain is reported in a third of patients, with the other two-thirds developing over a period of time.
Patients complain of aching pain over the front of the inner epicondyle, worse with repeated wrist flexion and better with rest. Pain can occur in the shoulder, elbow, forearm or hand, with weakness in the lower arm and hand also. The physiotherapist will examine the bony areas and joints of the elbow, check the muscles and their tendinous insertions. The physio palpates the ulnar nerve in the groove behind the elbow, called the "funny bone" when it's hit. The nerve can give pins and needles or weakness in the forearm and a neurological examination excludes other causes of pain or weakness.
The main treatment of golfer's elbow is conservative, including anti-inflammatories, wrist and forearm splinting, corticosteroid injection and physiotherapy. Modifying the provoking activity is a first line of management, making patient education about the condition and the eliciting factors vital. An example is modifying the golf swing mechanics to avoid setting the problem off continually. The patient is taught to avoid aggravating positions and activities, such as leaning on the elbow if there is nerve involvement.
Non-steroidal anti-inflammatory drugs are used in the initial acute phase to reduce pain and inflammation along with avoiding painful movements, use of ice, gentle stretches, friction massage and ultrasound. As the problem settles and becomes sub acute the aims change to improving flexibility by stretching, increasing strength and normal activities. A forearm brace may also be used or a wrist brace to rest the wrist muscles. Once the problem is chronic the programme continues with reduced use of the splint and re-introduction of sporting activities.
Scientific work shows that steroid injections can be useful in the early stages of golfer's elbow to reduce pain and the time to recovery, but they are also used in chronic situations. There is no evidence that shockwave or laser therapy has any effectiveness and surgery is contemplated when a significant period of physiotherapy has been attempted without success. The surgeon removes the abnormal tendinous tissue and if the ulnar nerve is involved may move it around to the front of the elbow from its posterior groove.
Correction of sporting technique, such as the golf swing, is best achieved by engaging a professional instructor who can also advise on stretches, fitness work and muscle strengthening. Athletes should warm up well before sport and stretch effectively afterwards, choosing good technique and selection of appropriate equipment. Doctors and therapists may need to monitor patients, especially athletes, very carefully as they tend to continue to perform through the pain.