Many people will experience joint pain to some extent at some stage during their lifetimes. Symptoms can occur without any obvious predisposing factors or history of injury or trauma. Such symptoms are often due to degenerative joint disease or osteoarthritis, OA. OA refers to mechanical abnormalities involving the degradation or degeneration of joints, including the articular (joint) capsule and the subchondral (underlying) bone.

In addition to pain, other symptoms may include joint tenderness, swelling, stiffness, locking and clicking. The mechanical loading of joints that occurs in everyday activities such as jogging or lifting can cause what is often referred to as ‘wear and tear’ of the joint cartilage. Other processes may also contribute to cartilage loss, such as hereditary, metabolic or developmental factors.

When the boney surfaces of a joint become less well protected by cartilage, the underlying bone may become exposed and damaged. These degenerative changes usually result in bone and joint inflammation and the development of the associated symptoms already mentioned.

While it is not possible to reverse the degeneration and erosion of the joint cartilage and underlying bone, Physiotherapy can help reduce the symptoms caused by these processes. Stiffness and loss of joint movement can be minimised by joint mobilisation techniques. Pain, tenderness, inflammation and swelling can be reduced by manual therapy and the application of electrotherapy modalities, heat and ice.

Weakness and wasting of the muscles adjacent to and surrounding the affected joints can be addressed by the prescription of specific strengthening exercises. Supportive splints, braces and orthoses may also be of benefit. For example prescription insoles can provide support and shock absorption to reduce pain associated with OA of the joints of the foot.

Appropriate and practical advice is also an essential component of effective management of OA especially in terms of lifestyle and activities. Many patients find that with good adherence with their home exercise programmes and advice that they can self manage their condition very effectively with minimal impact on their daily lives, and that they only need to attend for treatment when they experience a flare-up, in other words on an as-required basis.

Others prefer to adopt a maintenance approach to their treatment, and present at regular infrequent intervals of once every 2 to 3 months, even when they are asymptomatic. This allows us to evaluate their progress with their home exercise regime, but also to pre-empt and ‘trouble-shoot’ problems and thus prevent severe exacerbations from developing. We are happy to advise regarding the post appropriate approach to management and treatment following a thorough assessment.

Whiplash associated disorder describes the injuries sustained to the neck from a hyperflexion/hyperextension injury caused by a collision in a road traffic accident. Primarily the injuries are to the cervical (neck) ligaments and muscles, but can also involve strain of the joints between the cervical vertebrae and/or lesions of the cervical discs.

It is common for a patient to report feeling relatively asymptomatic in the immediate aftermath of an accident but for symptoms to develop some time later. Symptoms usually include pain and stiffness, often severe, often radiating up into the head, or downwards across the shoulders and into the arms. Headaches and muscle spasms are common.

Rib and sternal pain is also a common feature secondary to the restraining forces applied by the seat-belt. Neurological symptoms such as altered sensation, numbness and weakness are not common but may be present and are tested for on examination.

Unfortunately with these injuries, it is usual that complete resolution of symptoms is unlikely for a considerable length of time. However, it is widely accepted that early mobilisation encourages a more rapid recovery and may avoid the development of chronic problems. In the acute stages, the emphasis is on the recovery of good active movements of the neck and upper back in all directions.

Manual therapy in the early intervention stage consists of gentle joint mobilisations to regain movement, the application of heat, massage and soft tissue techniques including trigger point release and the instruction of a home exercise programme that is aimed at maintaining good joint movement and soft tissue flexibility. When good active movement is returning and pain is more controlled, improving the strength and stability of the cervical musculature and developing good postural awareness become the main focus of treatment.

In addition to the effective treatment and management of these injuries, the physiotherapists at our clinic are frequently requested to provide comprehensive and detailed medico legal reports and expert witness evidence to the Courts on behalf of our patients.

Cervicogenic headaches are those that originate from the cervical spine (neck) and the adjacent areas. The term refers to the tension-type headaches and chronic daily headaches experienced by migraine sufferers and are the type of headaches that can respond to effective physiotherapy treatment.

Cervicogenic headaches can occur as an isolated symptom of spontaneous onset, as part of another condition such as a prolapsed cervical intervertebral disc and chronic neck pain or post trauma such as a Whiplash Associated Disorder. Physiotherapy management includes improving the mobility of the joints of the neck, the upper back and the interscapular area (between the shoulder blades).

Techniques to reduce muscle tension for example soft tissue massage, stretching, myofascial release, trigger point dry needling and heat application are typically used. In the sub-acute phase when pain is subsiding, rehabilitation of the deep stabilising muscles of the neck, shoulders and upper back needs to be undertaken to help improve posture patterns and prevent the recurrence of headache episodes.

While some patients may present with a mixed headache pattern attributable to certain specific triggers such as stress, hormone imbalances and dietary irritants, it is important to note that an element of postural dysfunction may also be a significant contributory factor which therefore also needs to be addressed to achieve resolution of symptoms.

Unfortunately, for a variety of reasons, some patients may develop chronic pain as a result of injury or trauma such as Whiplash Associated Disorder or a fracture, degenerative disorders such as Osteoarthritis, post surgery, inflammatory or rheumatological disorders such as Rheumatoid Arthritis, and neurological disorders such as Multiple Sclerosis or Stroke. For this group of patients, resolution of symptoms may not be possible or realistic. However, physiotherapy intervention can make a significant contribution to effective pain management strategies.

The objectives for physiotherapy treatment become focused on the individual needs of the patient and the specific nature of their complaint. Overall, the primary goal is to minimise the effects of the symptoms to such an extent as to allow for maximum independence in the activities of daily living, active participation in leisure, recreation and occupation activities and optimal quality of life. Goal setting needs to be realistic and attainable.

All too often, patients embark on protracted and expensive courses of treatment in the hope of achieving symptom resolution, which proves to be elusive. We, at Neasa Long Partnership Physiotherapy Clinic, promote a self directed approach to the management of chronic pain conditions. We aim to equip our patients with the skills and advice they need to keep symptoms at a manageable level for them and to avoid situations in which over-dependency on treatment can develop. Once effective self management strategies are in place, physiotherapy treatments are then only required periodically for maintenance purposes and to prevent/minimise exacerbations.

Because of the multiplicity of predisposing and contributory factors to chronic pain syndromes and conditions, effective management is multi-disciplinary and is very much a team approach. Therefore, regular and appropriate liaison between the physiotherapists and other health care professionals including GPs, pain management consultants and other specialist consultants is crucial. We recognise this fact and view good communication as an integral component of our duty of care.

An orthotic device is an orthopaedic appliance that is used to support and align the joints of the foot, to prevent or correct deformities and to improve function. Optimal alignment of the feet is important for a number of reasons. They include the prevention of postural deformities, the prevention of musculoskeletal pain, the reduction of mechanical stress on joints and thus the prevention of joint dysfunction.

Corrective orthoses can vary from ‘off-the-shelf’ heel raises, wedges and arch supports, to clinic-made temporary devices, to prefabricated devices and then to prescription insoles and custom made orthoses designed from an impression of the foot at the upper end of the scale. Bespoke devices incur a considerable expense which is prohibitive for many patients.  However, only a limited percentage of patients require these casted orthoses.

The type of orthotic that our Physiotherapists recommend for individual patients is determined by many factors, including the findings on biomechanical assessment, the type of injury sustained or presenting condition, footwear, budget and lifestyle. Chartered Physiotherapists at Neasa Long Partnership Physiotherapy and Sports Injury Clinic have completed postgraduate education in biomechanical assessments and orthotic prescriptions and participate regularly in in-service training and workshops to ensure that we are familiar with the latest developments in the pre-fabricated device market.

This allows us to recommend non-customised but nonetheless very sophisticated devices to our patients if these devices meet their biomechanical requirements. We firmly believe that the best device is not necessarily the most expensive!

For those patients who require a custom-made device, we conduct a detailed assessment of the foot in the neutral position, which we then send to a reputable laboratory.

Prior to orthotic prescription, a detailed biomechanical assessment is undertaken. This includes the following:

Often, the prescription of a corrective device is recommended as part of the overall physiotherapy management of a condition or treatment. Conditions such as heel spurs, plantar fasciitis, Achilles tendonopathy and recurrent injuries such as ankle ligament sprains may be attributable in part to faulty biomechanics. However, these types of problems require physiotherapy treatment in the first instance to settle symptoms prior to the introduction of a device if one is indicated.

In these cases, it is important to be aware that an insole or orthotic is not a substitute for physiotherapy treatment but rather one important facet of overall management.

Physiotherapy can play a vital role in the effectiveness of orthopaedic surgery and in many cases can influence the outcome. Whilst the repair of damaged structures is accomplished during surgery, the rehabilitation process is extremely important to ensure that healing is complete and that full function is recovered. The most common surgical procedures that we provide treatment and rehabilitation programmes for include the following:

In many cases a patient may require specialised assistance and guidance with regard to recovery after other types of surgery. We often receive referrals requesting the implementation and supervision of rehabilitation following general surgery (abdominal, mastectomy), gynaecological surgery (Caesarian section, hysterectomy), cardiac surgery (coronary artery bypass grafting) and vascular surgery (varicose vein surgery).

Physiotherapy intervention can include the use of manual therapy techniques to reduce pain and promote early return of movement. Post surgical rehabilitation also involves the prescription of appropriate exercise therapy to assist with regaining strength and stamina and ensuring that the return to normal activities is a smooth transition.

These injuries may involve soft tissues, joints and neural tissues to varying degrees. They occur often without the presence of structural damage.

A thorough assessment is required to identify the involved structures and the source of irritability.

Physiotherapy treatment is implemented to reduce the symptoms caused by the affected tissue often in conjunction with medication and pain management procedures if indicated.

As the underlying cause of these injuries is often multi-factorial, the physiotherapist treating these problems needs a wide range of skills at their disposal.

Physiotherapy treatment includes:

These conditions are often slow to resolve and need a systematic management by an experienced physiotherapist to adopt a multi-faceted approach in conjunction with other members of the multidisciplinary team.

These are injuries leading to impairment and dysfunction in muscles, ligaments and tendons.