Arthritic and Joint Pain

There are more than 170 types of arthritis. Strictly speaking, the term “Arthritis” means inflammation of the joint, but is commonly used to refer to joint pain generally. There are two basic types of arthritis: that relating to wear and tear of the cartilage (osteoarthritis), and that involved with inflammation of the joint, resulting from an over-active immune system (such as rheumatoid arthritis). Approximately 350 million people worldwide suffer from Arthritis, and, surprisingly, over half of these sufferers are under 65 years of age.

Sources of the problem
Part of the problem in dealing with Arthritis is that it is extremely difficult to pinpoint the original cause of the disease. Often the first symptom of Arthritis is stiffness in the joints first thing in the morning or after sitting for a long time. Often, the joints causing pain can be warmer than other joints. However, early and accurate diagnosis is essential in preventing permanent damage and disability. How it can be treated, and what to expect at the physiotherapy clinic Living with arthritis can be a pain, quite literally. But apart from the medical treatment, there is much that can be done to make living with arthritis easier. The physiotherapist will be able to advise you on how to adapt your daily life to ease the symptoms. This will include:

  • How to use stronger joints to carry things, and what assistive devices are available for painful tasks.
  • A range of motion exercises and strengthening exercises that are good for Arthritis.
  • Diet advice on issues such as calcium and Vitamin C.

Prevention methods
Since it is difficult to pinpoint the causes of Arthritis, and also difficult to assess those with a higher than average risk of developing the disease, it can be difficult to prevent. Clearly, issues such as excessive and repetitive heavy lifting, or gym work, can exacerbate joint wear and tear, as can poor posture or excessive weight. Your physiotherapist will devise an individual programme for you, designed to tackle your weak areas, and restore normal movement and reduce pain as much as possible.

Back Pain

The Facts
Nearly two thirds of the population of the UK have experienced back pain which affects their ability to carry out daily tasks such as lifting or bending. 2.5 million people suffer back pain every day of the week. More working days are lost in this country through back pain than for any other reason.

Sources of the problem
It is not surprising that our backs cause most of the problems. Muscles in the back come into play during almost all movements we make, working against gravity to move us in the way we want to move. Back problems can be caused by acute and specific causes such as a fall or a road accident, but are more commonly caused by a gradual build-up of symptoms which increase over time. There is generally a fundamental difference in the treatment of back pain caused by injury than that caused by a condition such as rheumatoid arthritis or Ankylosing spondylitis.

How it can be treated, and what to expect at the physiotherapy clinic
Although there are a range of measures you can take to prevent back pain and to ease the symptoms, the Chartered Physiotherapist’s extensive training in anatomy and physiology means we are all experts in helping you understand what’s gone wrong, and how best to treat it. The most common causes of chronic pain are muscular or involve ligaments, joints, a trapped nerve or a disc. When you visit the Physiotherapist, they will carry out an extensive assessment before commencing treatment. This will include a discussion about your work, your leisure activities, and other aspects which could have caused the pain. You can expect a treatment which does not involve drugs, injections or complex machinery. Physiotherapy is still largely a hand-on profession. We will look at mobilisation of the joints of the spine, to see whether this causes or relieves the pain. We also look at manipulation, (often referred to as realigning a joint or “pulling it back”). Although this is the thing most people dread, since it can be a vigorous manoeuvre, the minimum amount of force is used, and often achieves very quick and noticeable results. Massage helps to relieve spasm, increase circulation to the injured areas and help speed up the healing process. To some extent it is also down to you, you will be asked to carry out specific exercises to strengthen muscles and improve muscle support. Pilates exercises are effective in toning up your deep stomach muscles. We hold these at the clinic led by a fully-trained fitness trainer. Our physiotherapists are trained in Pilates and can give you individual advice and exercises as well as offering treatment in small classes of four people.

Prevention methods

  • Don’t bend over for long periods of time, or bend when you could kneel or squat
  • Always warm up before you do any sport or exercise
  • Take time to improve your muscle tone, contract your stomach muscles for a few minutes each day
  • Always gently stretch backwards when you stand after having been bent over for some time
  • Whenever you sit, keep an eye on your posture to ensure your back is straight. Adjust your chair if necessary If lifting heavy or awkward objects, do bend your knees, not your back
Above all, call us! Whether it is to discuss your symptoms, or to discuss various aspects of your treatment, we will be happy to help.

Chest Conditions

As physiotherapists we are able to treat a variety of chest conditions such as emphysema, asthma, cystic fibrosis and chronic bronchitis.

How it can be treated

When you visit our clinic with an exacerbation of your symptoms we will be able to assist you by teaching breathing control and correct breathing exercises to practice at home. If you have any infection or excess secretions we will assist in removal of these with various techniques. Advice on posture and activity levels is also given.

Gynaecological Issues
The Facts
Gynaecological problems can affect any woman, particularly after childbirth or surgery.

Sources of the problem
Incontinence. This may be a problem post-childbirth, especially when the baby’s head has been pressing on the pudendal nerve before and during labour. It can also be general muscle weakness of the pelvic floor and the abdomen following pregnancy and gynaecological operations such as hysterectomy and Caesarian section. It can also be caused by vaginal prolapses related to childbirth.

Pubic Symphisis Pain
This can be caused by pregnancy, a road traffic accident, a fall or post pelvic fracture.

Problems associated with pregnancy
These can be problems such as low back pain and sacroiliac joint pain, with or without referred pain to the legs.

How it can be treated, and what to expect at the physiotherapy clinic
Internal examination may be performed if pelvic floor muscle strength needs to be assessed. The physiotherapist will use detailed questioning to determine the cause and nature of the problem. A physical examination of the associated joints and muscle of the pelvic area will be carried out. Treatment modalities include exercises, ergonomics and postural advice, dietary advice and advice on fluid intake, electrotherapy and manual therapy. Pelvic support belts can also be utilised, and TENS machines can be borrowed for use in labour.

Prevention methods
Postural and ergonomic advice is given to new mothers to help avoid any spinal or pelvic problems.

  • Pelvic floor exercises should be performed pre-and post-natally.
  • Early advice should be sought if you are aware of any pre- or post-natal problems.
  • Smoking and obesity are two contributory factors.
  • Make sure you treat any associated medical conditions, for example, repeated urinary tract infections such as cystitis.

Hand Injuries

The hand is a very complex part of the body, that is able to perform intricate and fine movements of precision and skill. It is therefore susceptible to many types of conditions and injuries. These can be related to trauma, overuse, or arthritis. Certain sports can be more prone to joint injuries eg. Rugby or cricket.

Types of Injuries
The conditions that may be causing pain are:
  • Ligament sprains of any of the hand/finger joints
  • Carpel Tunnel Syndrome
  • Wrist sprains
  • Tendon ruptures
  • Scaphoid fracture
  • Joint dislocation and fractures
  • Joint pain from arthritis
  • Dupuytrens contracture
  • Tendonitis
  • Repetitive Strain Injury from computer use or work

Physiotherapy can help to differentiate the possible underlying cause of the pain. Some conditions require the opinion of a hand surgeon but many can be helped with physiotherapy. This may be in the form of mobilizing the joints to improve mobility and reduce pain, or immobilizing the area by using splints to allow the area to rest. Appropriate advice will be given and exercises to strengthen and improve control of the hand/wrist.

Neck Pain
The Facts

Neck pain can cover anything from mild irritation to severe burning pain. Unlike many other conditions, neck pain can be caused by factors not immediately obvious such as poor sleeping positions, work-related positions including overuse of computers, stress and certain sports.

Sources of the problem

Pain in the neck can be due to injury, arthritic changes, a mechanical or muscular problem or a trapped nerve caused by a bulge in one the of discs between the vertebrae. Besides the small aches, neck troubles can bring on a host of other symptoms, including head aches, pains in the scalp, face or ears, dizziness, pressure behind the eyes and referred pain into the arm and hand.

Problems include radiculopathy, which is a pinched nerve, often from a disc protrusion. This causes pain down the arm, often described as an electrical feeling. Myofascial Pain – this is generally an aching pain in muscles that tends to be associated with poor posture of other job-related tasks. Patients often report they have difficulty sleeping. Although very rare, Spinal Stenosis is a narrowing of the nerve openings either around the spinal cord or nerve roots that can cause symptoms similar to a pinched nerve. Tendon, ligament and soft tissue pain is localised pain when an area is stretched or its muscles are overused. This results in tenderness in these structures.

Spinal instability is a problem caused by increased motion between vertebra, usually resulting from an injury. The pain typically feels like tingling in the neck or arms.

How it can be treated, and what to expect at the physiotherapy clinic

Ease of symptoms may involve weekly treatment of the acute phase, in order to reduce inflammation and pain. Then, if symptoms persist, treatment sessions may be more intermittent (once per month). Our solutions range from mobilisations, manipulation, the use of electrical equipment (ultrasound, interferential therapy, laser), acupuncture, deep soft tissue massage, neural mobilisations and lifestyle advice.

Prevention methods

Factors such as sitting position, exercise regime and posture, all contribute to the problem. Your physiotherapist will be able to advise on your own set of symptoms, and ways of preventing recurrence and lifestyle adjustments. Ergonomic advice from your physio can reduce further problems.

The Facts

Osteoporosis is the weakening of bone mass so that bones become fragile to the point where a simple everyday movement, such as picking up a bag of shopping can cause a broken bone. Often it is a broken bone that is the first symptoms of the problem. Osteoporosis is widely regarded as a Woman’s disease and indeed, one in three women will develop osteoporosis during their lives. However, osteoporosis also affects one in twelve men in their lifetimes, and accounts for around 20% of vertebral fractures and 30% of hip fractures.

All of this adds up to around 3 million sufferers in the UK, 70,000 hip fractures, 50,000 wrist fractures and 40,000 spinal fractures per year, at a cost to the NHS of over £1.5 billion.

Sources of the problem

We are all potentially at risk from Osteoporosis as we live longer, and our bones have more time to degenerate. However, a lack of oestrogen in women and low levels of testosterone in men have been proven to lead to higher instances of the disease, and heavy smoking and drinking coupled with low body weight are also shown to add to the risk. Early signs include loss of height, and curvature of the spine (known as kyphosis).

How it can be treated, and what to expect at the physiotherapy clinic

We can assist in the prevention of osteoporosis in young people prior to the menopause, and exercises for post-menopausal women. We can also aid in the recovery following a bone fracture. Treatments consist of pain relief, balance exercises and strengthening programmes. Unfortunately, many people suffering from Osteoporosis have to deal with chronic and long-term pain. Also, some patients become depressed about their pain. Our clinic offers help and advice for all these patients. They may respond to TENS (Trans Cutaneous muscle stimulator) which can aid in pain relief, general exercises, acupuncture and advice regarding activity and home management, and how to increase you tolerance to pain.

Prevention methods

The good news is that, to a large extent, Osteoporosis is preventable. Calcium intake in childhood and adult life can increase bone mass in all ages, and in bone health in general. Vitamin D is another good preventative product to help reduce the fracture risk. Unfortunately, both calcium and Vitamin D deficiencies are common in Europe. A “bone friendly” diet helps keep you bones strong and healthy.

The contains some very useful advice on the best diet to prevent osteoporosis.

The Facts

Anyone can break a bone ­ children, adults and the elderly, whether they are playing sport or simply walking down the street. A break or fracture (these terms are the same) can be simple or complicated but always requires some treatment. Most commonly this will be with a plaster cast, although more complicated fractures may be treated with internal fixation. This means an operation to hold the parts of the bone together with plates or screws.

Sources of problems

Holding limbs still to allow bones to heal can lead to problems of stiffness and weakness while immobilised and afterwards. Swelling after injury or operation can also lead to pain and stiffness. Suitable advice and exercises can help prevent long-term problems.

Physiotherapy treatment

Usually begins once the plaster cast has been removed, or after any necessary operation. The aim of physiotherapy is to restore normal movement, strength and function in the injured limb. So if you break your arm at the wrist, this might include treatment for the elbow, shoulder hand and wrist, depending on how the arm was injured and the type of treatment you have had. Typically this will be in the form of massage, exercises ­ at home and in the clinic, and advice. For leg fractures it will include regaining a normal walking pattern, balance re-education and improving posture and strength.

Physiotherapists can help you to understand what exercise is safe, how much you should use the limb, how much weight to carry on it or lean through it, and advice when to stop using a sling or crutches. Graded, specific exercise helps you to get movement and strength back quickly and to use the limb in a normal way in every day activities.

Some people may need help while still in a plaster cast ­ maybe to keep fingers or shoulders moving in a wrist fracture, or to assist walking and maintaining knee movement in an ankle fracture. We can also advise on controlling swelling, and on exercise for un-injured limbs to maintain strength.

Further information

For other issues relating to bone injury and fracture see: “osteoporosis” and “joint replacement.”

Repetitive Strain Injury
The Facts

Symptoms of work-related disorders and RSI include tenderness and pain in the neck, shoulders, upper back, upper arm, elbows, forearms, wrists or fingers. This may extend to numbness and tingling in the wrists and fingers.

Sources of the problem

There are two distinct types of RSI: “Distinct” RSI, which covers conditions such as tennis elbow and tendonitis; and “Diffuse” RSI, where multiple areas of diffuse pain occurs in various muscles and soft tissues, caused by nerve compression and other trigger points. As part of their training, physiotherapists cover the whole area of ergonomics and work-related disorders. Working postures can be the cause of these types of problem and treatment may be essential, but in combination with this we are able to give advice and practical training on work situations. Also, these issues relate not only to the workplace, but to a person’s whole lifestyle. We also discuss exercises and changes to postural habits at home.

How it can be treated, and what to expect at the physiotherapy clinic

When you visit the clinic with what seems to be a work-related disorder, we will check for back and neck problems, neural tension, muscle tightness and trigger point tenderness. Treatment may be any of the following techniques:

  • Neural mobilisation
  • Joint mobilisation
  • Muscle and trigger point relaxation with appropriate stretching
  • Splints or strapping
  • Ultrasound
  • TENS for home use
Prevention methods

Once you have RSI, the healing process can be long and slow to progress. However, there is a lot you can do to prevent the onset of RSI and work-related disorders. Correct typing technique, posture and good work habits with appropriate chairs, desks, wrist rests and document holders are all likely to prevent problems. While you are actually typing your wrists should not rest on anything, and should not be bent up, down or to the side. Sit straight, and do not slouch (how many times have you been told this!). Use a light touch on the keys and don’t tuck the telephone between your shoulder and your ear.

These are some examples of our advice. It might seem simple, but it can work.

Sports Injuries
The Facts

The average athlete in the UK who takes sport seriously will suffer from some sort of sport-related injury at one time or another. These may not render the person unable to do sport, but will affect in some way their ability to give it their best shot. The average British sports enthusiast will suffer from two specific instances each year which result in sport injury.

Sources of the problem

Sports injuries can be broadly broken down into two categories, those associated with trauma, or a specific incident resulting in an acute injury, and those associated with overuse or poor technique. Acute injuries typically include: fractures, internal injuries, sprains, dislocations, contusions and strains. Overuse injuries typically include: stress fracture, shin splints, runners’ knee, etc. Muscle imbalance in adolescents is a particular problem. In these cases, the muscle tissues grow more slowly than the bones, and often take time to catch up. This results in tight muscles, hamstring problems, problems with pectorals and neck muscles. Young people who do a lot of sports are particularly prone to these problems.

How it can be treated, and what to expect at the physiotherapy clinic

Whatever happens, trying to exercise away, or “run off” a sports injury is the last thing you should do. Aside from the first aid treatment you might require if an injury comes on very suddenly, clearly the next step is to receive an accurate diagnosis of the problem. We treat soft tissues and joint-related sports injuries from any sports. Typically, this will be from the initial, acute phase, through to final rehabilitation and full return to fitness. Aside from treating the injury itself, we can advise on warming up techniques, muscle imbalance and so on. We can correct these problems with a series of stretching and postural advice.

Prevention methods

Working back to the notion of the two types of sports injuries, prevention revolves around reducing the risk of trauma injury by assessing the condition of the pitch and the playing surface, the condition of any safety equipment and the qualifications of any staff on hand. Prevention or limitation of overuse injuries requires looking at any external factors such as type of footwear used and running surface. Warming up before any sports can also lessen the impact of a traumatic injury.

The Facts

Whiplash has had a mixed press, due to the wealth of litigation surrounding whiplash and car accidents. However, whiplash is a real condition. A study in 1994, which reviewed all of the litigation cases on this issue in that year reported that “the unavoidable conclusion is that the majority of whiplash injuries result in real, organic lesions in genuine patients.”

Sources of the problem

Technically, such injuries are termed hyperextension and hyperflexion injuries. Recent research by a car crash safety division of Chalmers University, Sweden, reported that in a car crash, it is an tenth of a second that the damage is done, as the neck moves too fast and the fluid is trapped and squeezed. The affected part of the neck therefore exerts extra pressure on everything it touches, including the nerves. This effect is called Vertebral subluxation, and in severe cases, its effect are immediate. In other cases, as the body tries to compensate for the changed circumstances, the effects may not become apparent until hours afterwards.

How it can be treated, and what to expect at the physiotherapy clinic

We at the clinic, specialise in the treatment of whiplash injuries. We aim to educate the patient and guide them through the acute stage of their injury therefore preventing chronic pain states later. Patients need a holistic approach looking at all aspects of their life to help improve their painful states after these injuries. Treatment modalities include mobilisations, massage, treatment of irritable nerves, postural and ergonomic advice, and advice on the management of pain.

Prevention methods

Since whiplash is generally caused by a traumatic injury rather than a disease, there is little that can be done to prevent whiplash injuries. However, driving and headrest positions and other safety-related driving matters will help to minimise damage should you be involved in a car crash. Directly after the event it is imperative to have the injury diagnosed and treated as early as possible to prevent possible complications later.

Joint Replacement
The Facts

Joint replacement is an increasingly common operation. Most frequently knees and hips are replaced, but shoulders, finger joints and ankles may also be replaced.

Sources of the problem

Arthritis and injuries to joints can wear away the smooth cartilage that allows painfree movement. Replacing one or both parts of a joint can restore movement and reduce pain. However, all joint replacements retain your own ligaments and muscles which often require exercise or other treatment to recover after replacement surgery.

What to expect

Exercises often begin while still in hospital, and you may have a routine to follow at home. At our clinic you can get advice on how to change these exercises as you progress, or to target specific movement problems. Often help is required with correct walking pattern, perhaps with crutches or sticks, and regaining good posture is also important. In knee replacements, controlling swelling and regaining movement and strength are vital for success. Even if you are doing well it is good to get advice and encouragement in your exercise regime. Adding variety can make progress quicker and keep up your enthusiasm.

Prevention/Pre-op treatment

Maybe you are waiting for a replacement or have been told your joints require treatment in a few years time. Don’t wait for the operation date! Exercising and using your limbs now can make post-op recovery quicker and less painful, and knowing what to expect after surgery is very reassuring. We can provide treatment and advice before surgery to help you prepare and maintain strength and function.

Neurological Conditions

Neurological Physiotherapy is specialised physiotherapy used to treat people who have suffered damage to the central nervous system caused by neurological conditions such as Multiple Sclerosis, Parkinson’s Disease, Motor Neurone Disease and Cerebral Palsy. Lucy treats people who have sustained a stroke, a head injury, spinal cord injuries and any other neurological conditions.

Damage to your central nervous system, including your brain and your spinal cord, means that the messages from your brain are not reaching the affected parts of your body. This can result in loss of movement and sensation, uncoordinated movement, weak and floppy muscles, spasm and tremor.

Neurological Physiotherapy is able to kick-start the message pathways that your brain is struggling to use, to make new pathways through repetitive actions and exercises.

Many clients who undergo specialised Physiotherapy can improve some of their symptoms such as difficulties with loss of balance, loss of hand function, walking, spasticity and pain.

Our Neurological Physiotherapist will assess your symptoms and work with you to achieve your goals, whether that is to walk to the shops, drive your car again, relearn to open and close your hand, or to help you return to work or sport.

Regardless of your condition, each person is different, has individual goals and requires a treatment plan that is unique to them. An assessment by our Neurological Physiotherapist is the first stepping stone to identifying your difficulties and impairments, setting your goals and working together to enable you to explore your potential and maximise your independence.