Do you need help ?
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 Joo Chiat 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.
What’s the right price to pay for a physiotherapists help in Joo Chiat?
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.
"I've Busted my Knee..."
What have I done?...
Acute Knee injuries are one of the most common injuries that are experienced on the sporting field. There are many structures that can be damaged, including the ligaments (both collateral and cruciate), the meniscus and the patella. Normally the knee will be injured by forcibly twisting when the foot is kept planted. The amount of force required to cause injury sometimes does not have to be very large. Usually the knee will swell considerably, become very painful, and range of motion will become restricted.'Clicking', 'giving way' and 'locking' are common symptoms. To determine the exact area of damage, your Physiotherapist will perform a number of specific special tests on your knee. However, for an accurate diagnosis, the swelling and pain may have to subside somewhat first, as too many false positives (where everything hurts!) may occur early on. If severe, it may be appropriate to undergo an MRI scan to determine the exact cause of the injury and the most appropriate action. A referral by your doctor to an orthopaedic surgeon is necessary prior to having an MRI scan.
So what does my Diagnosis actually mean?
The Cruciates: Anterior & Posterior Cruciate Ligaments The basis for treatment depends mainly upon what structure has been damaged. If the Anterior Cruciate Ligament (or ACL) is torn, as many footballers and netballers suffer, then surgical reconstruction of the ligament will likely result in the best outcome. This to some extent depends on your goals for recovery, your age and how physically active you are now and intend on being in the future. The Posterior Cruciate Ligament (or PCL) is less of a concern as the quadriceps muscle is perfectly positioned to compensate for any injury to the PCL. Rarely is surgery required and with 6 weeks of progressive rehabilitation, an athlete can expect to be back to near full fitness. The Meniscus Meniscal Injuries involving the cartilage discs within your knee are the most common injury and their treatment depends on how severe the injury is. If not severe, then there is a good chance that your symptoms will respond to conservative management under the guidance of your Physiotherapist. Strengthening and dynamic control work is essential.
What Do I Need to Do?
STAGE 1: ACUTE MANAGEMENT (1- 3 DAYS)
Rest: Try not to take too much weight through the knee initially. For severe cases, crutches may be required.
Ice: Early & Often for 24 hours; 15-20 minutes every 2-4 hours. Compression: Bandage or taping to control swelling for 48 hours.
Elevation: Above waist height to assist in oedema control. Seek treatment. Correct diagnosis and EARLY management will often be the difference between an optimum and a poor recovery. Avoid alcohol, heat or heavy massage.
STAGE 2: SUB-ACUTE MANAGEMENT (3-14 DAYS)
Where range of motion begins to return, strength training begins and walking becomes easier. Progress off crutches as advised by your Physiotherapist. This stage will see the Physiotherapist use their manual therapy skills, with a primary goal to return Range of Motion. The Physiotherapist will prescribe exercises aimed at maintaining the strength of your muscles in different areas - and if appropriate, begin strength training about the knee.
STAGE 3: RETURN TO FUNCTION (14 DAYS - 21 DAYS)
Range of motion is restored, strength training progresses, walking returns to normal. The patient now becomes more of a driver of the treatment, with a strong emphasis on exercise rehabilitation to ensure optimal return to function. However, it will be important to ensure that the rehabilitation program is closely monitored, so as not to aggravate the knee. At this stage, it is also important to ensure that muscle balance of the lower limb is maintained to ensure that secondary complications are avoided.
STAGE 4: RETURN TO SPORT (3-6 WEEKS)
A return to sport will be partly dictated by the extent and nature of the injury. Your knee will be required to pass certain 'fitness' tests, much the same as what footballers do, before being allowed to resume training. Your Physiotherapist will guide you through this process and specify when and what you can do at training. Returning before your knee is capable of withstanding the demands of sport can be disastrous.
A Final Word...
Remember, each individual is different. Almost all patients will progress at different paces, and will have different end goals, meaning that rehabilitation programmes will differ substantially between individuals. Each stage will have certain goals that your Physiotherapist will look for you to achieve before moving onto the next stage. Working together with your Physiotherapist, you will achieve the best outcome for your injury. If you have any queries about the rehabilitation programme that you are given, please discuss this with your treating Physiotherapist.