Musculoskeletal Physiotherapy – a holistic approach requires a broad range of skills
When you come to see us, we are looking to get you better in the easiest and most efficient way possible. By the end of your assessment we aim to give you a clinical evidence based diagnosis for your problem, a rational explanation as to why you have the ongoing symptoms (if this is not already obvious), and identify the different treatment options open to you to get yourself back to normal as quickly as you can. This process is not the same for everyone and will depend on the over-riding features that we identify in the examination and history taking, and the extent that you want us to be involved.
Treatments that we tend to use will generally fall into categories of ‘hands-on’ manual therapy, Exercise Rehabilitation, Behavioural modification, and advice and Education. We are all skilled in taping and strapping, and some of us will be able to use ‘dry needling’ which is a western-style of acupuncture, if this is deemed appropriate. If you require orthotic inserts for a biomechanical lower limb problem, we have the option to pass you to a podiatrist.
Depending on all these factors, we will then also be able to indicate to you how long the process of your recovery will take. Once better, we can offer advice on how to keep yourself fit, healthy and pain free!
‘Hands on’ Manual Therapy
At Physis, we believe in the power of touch. Whilst most conditions will get better without hands-on treatment, manual therapy can both alleviate pain in the short to medium term, making the recovery more tolerable, and give accelerated progress through certain stages of the healing process. Hands on treatments can be used to create windows of opportunity, during which time your pain eases to allow you to perform movements or exercises, which ultimately allows you to progress and move normally. Normal pain-free movement (performance / positioning) is the end game!
“Hands-on” treatments used by our physios would include; soft tissue massage, joint mobilisation, and joint manipulation, stretching, PNF (Proprioceptive Neuromuscular Facilitation) and Mulligan techniques.
In order to return you to a normal healthy state, you will often need to restore the loss of either muscular or joint range of motion, regain muscle strength lost through deconditioning and disuse, and even re-learn optimal ways to move, which allow your body to function with less pain. In order to regain these qualities, you need to perform specific movements. These movements will be selected based on your examination and your diagnosis. The frequency, duration and difficulty of the exercises will depend on the problems that you present with, and what you are able to commit to.
This is what we, as physios, are given a bad reputation for: nagging you about your posture! :) but what you do outside the clinic is often way more important than what we do inside the clinic! Trying to get you to reduce the stress on the injured site will help for a speedier recovery. This can involve looking at your posture, getting you to sit comfortably, which might be getting you to slouch more! Not all back problems benefit from an upright posture! Sometimes this can involve looking at your sleep hygiene, the way you breathe, your physical training loads and programmes or looking at your working routines. The relevance of your behaviours should become evident at your first assessment.
Advice and Education
This is often a huge part of what is required to progress someone, and is sometimes all that is needed to get someone better! If you understand your problem, you become more able to take an active part in your recovery. You can modify what you do more effectively, if you understand the stresses and strains that are being placed on the painful area. Often when you understand your problem better, you gain more control over the pain, being able to reduce it with certain movements or positions or actions. This in turn helps to reduce worry, and helps to motivate you to get even better! Understanding your problem would be considered a primary goal for us after day one. Once you crack this, you are half way there!
Identifying what kind of pain you have helps to direct you to the best pain management. Sometimes neuropathic pain requires some drug therapy. We might liaise with your GP to get your pain more under control. Chronic pain will often require some psychological support. As physios we are trained to identify neuroplastic pain and work with you to address unhelpful beliefs about your pain that often are the ongoing driver for the pain itself.
Other Treatments That Help Reduce Your Pain
Other treatment options would include taping / strapping, braces or orthotics to unload mechanical stresses on certain body tissues. Western style Acupuncture or ‘Dry Needling’ may help to alleviate some pain, and is offered by some of our therapists.
Cool ‘Techie’ Stuff
We are able to use certain technologies to determine loading patterns which might be contributing to the strain on tissues. These include the Biodex Isokinetic machine, video analysis, bike fit, running assessments, gait analysis to name a few. These novel approaches can give valuable information on the cause of a person’s pain.
Assessments and Measures of Improvement
There are clearly lots of things to consider on your road to recovery and there are lots of potential things to measure which help inform us and you as to how you are progressing. These assessments will range from self reported questionnaires, to measures of range of motion, or muscles strength, or function, or agility and dexterity. Your physio may look to perform these assessments at various stages of your rehab programme, or as an isolated assessment to to quantify any limitation. often these assessments can be quite simple to perform and can be good for you to perform to monitor your own progress (ask your physio for ideas if you are interested) or they may be a bit more technical, like the biodex.