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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 Bencoolen 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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The shoulder is one of the most mobile joints in the body, allowing us to reach out and grab an object and place it almost anywhere. This is all possible because of our rotator cuff muscles, which are always active during arm movements to keep the ball of the shoulder in the socket. It is no surprise then that the rotator cuff is subject to overuse and injuries are commonplace in the physiotherapy clinic.
The rotator cuff is made up of 4 small but important muscles which play a key role in the stability of the shoulder. These are the supraspinatus, infraspinatus, subscapularis and teres minor muscles. More often than not, it is the supraspinatus that is at fault however any one of these muscles can be injured either in isolation or in conjunction with one another.
While injury can occur from an acute incident, such as falling onto an outstretched arm, it is more likely to be caused from repetitive overload of the shoulder musculature and come on gradually. Due to this fact, these conditions usually affect people over the age of 35, however they are also quite common in the sporting population, especially "overhead athletes" such as swimmers, throwers and those involved in racquet sports.
Common complaints are:
- Pain when moving the arm out to the side
- Difficulty sleeping on the injured side
- Difficulty doing overhead activities, such as hanging out the washing, putting things away on the top shelf
- Dull ache in shoulder after activity
Several things can predispose a person to a rotator cuff disorder, however the most common cause is impingement of the rotator cuff due to abnormal scapulo-humeral rhythm (the integrated movement of the shoulder blade and arm) and weak rotator cuff muscles. Poor scapulo-humeral rhythm is often the result of muscular tightness and strength imbalances and can be effectively treated by physiotherapy.
It is important to get your assessed early on. the longer you leave getting your shoulder treated the harder it becomes to treat and the more likely you are to get secondary problems.
Physiotherapists are well trained in assessing the shoulder and identifying the cause of rotator cuff disorders. A consult with one of these health professionals should involve a thorough examination of the shoulder biomechanics, the spine, and the muscles of both the rotator cuff and scapula. They will then go on to treat the problems that they find using evidence-based treatment techniques such as massage, mobilisation and dry needling. Furthermore, a rehabilitation program specific to you will be prescribed and should include a range of exercises and stretches to help correct the abnormalities and strengthen the rotator cuff.
Physiotherapists have the clinical skills to assess and treat posture and muscle imbalances, and overuse injuries of the shoulder muscles. The physiotherapist will develop a strengthening program to restore normal function of the shoulder and prevent recurrences.
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.