Treatments Available
A physiotherapist typically has a number of treatment techniques at their disposal, these may include:-
      Manipulation
      Mobilisation
      Massage
      Pilates Based Stabilisation Exercise
      Gym Based Strengthening Exercise
      Acupuncture
      Electrotherapy
      Referral on!
Physiotherapists will use these techniques to varying degrees depending on what they have found beneficial in the past, what the patient has found beneficial in the past if he/she has had physiotherapy previously, as well as depending on their 'school of thought'.
I rarely use Electrotherapy of any sort, and have found better outcomes with a more hands on approach. I do follow best practice, and where the evidence is strong for a particular intervention that technique will be adopted.
Manipulation / Mobilisation:-
Manipulation in terms of joint techniques is high velocity low amplitude thrusts (bone cracking sound) which you might associate more with Osteopaths or Chiropractors historically. The qualification leading to MMACP after a physiotherapist's name will indicate they are a Member of the Manipulative Association of Chartered Physiotherapists. Certificating they have undergone training in this specialist field.
These techniques are used to free up stiff or locked joints such as a 'crick' in the neck, or a locked low back.
These techniques would not be suitable on either very painful conditions with a lot of muscle spasm guarding the problem joint, or where there is any possibility of bone fragility, or chance of causing a greater problem. This is where Mobilisations can be safely and comfortably used.
A slow oscillatory mobilisation can ease up a stiff joint, return muscle tone to normal following spasm and promote the healing process.
Manipulation is nearly always aimed at spinal joints, where as mobilisation is used throughout the entire muscle and skeletal system.
Massage:-
Who doesn't feel better after a good deep muscular massage irrespective of what the ache or pain is? You would have to have some pathologically recognised aversion to touch not to feel slightly better after a massage. And maybe that is why it proves so helpful in promoting well being and injury recovery.
Okay, yes we all know it promotes fluid flow, stimulates receptors which can aid the reduction of muscle tension which in turn can remove 'knots' or 'trigger points' and there by reduce pain.
It also allows me as a practitioner a chance to feel the tissues to assess how they react, where they are stiff and if there is spasm. This information helps build a more informative picture as to the best way to treat the problem and ultimately 'fix you'.
But even this most basic form of treatment technique needs to be applied appropriately following an assessment to really get the most benefit. If it is applied too early or too strongly over a muscle injury it could lead to complications, similarly to massage over an irritated nerve can actually be pretty uncomfortable, and flare the situation up.
Pilates Based Exercise:-
More than just a passing trend, Pilates, or more generally Core Stabilisation exercises have gathered not just more popularity as a treatment tool in the management of spinal pain, and for that matter pain affecting other joints such as the shoulders and knees. But they have gathered an increasing body of good evidence to support their necessary use in treating back pain effectively.
The majority of spinal pain that I see and treat on a daily basis is derived from a spinal segment that moves too much. Most individuals come in to the clinic complaining of a stiff and painful back, but following examination, the problem is often uncontrolled movement, whilst the stiffness is muscle spasm to try and control this unwanted movement within the spine.
Pilates aims to get the right muscles working to allow Controlled Movement within and throughout the spine, allowing the bigger muscles to relax off.
This sounds all too very simple, but I have found this to really work in the majority of cases. I would however stress that the end result is dependent not just on receiving good Physiotherapy at the clinic, but on how much time 'you' (the client) put into doing the Core Stability work outside of the clinic!
Gym Based Strengthening:-
I am fortunate enough to have the backing of an excellent local fully equipped gym 'Base Fitness' set within the stunning grounds of the Ridge Golf Club.
This facility allows me to fully train a recovering athlete of any standard, taking the level of rehabilitation to one I could not replicate within the clinical setting.
Although I use the facility regularly not just for the younger athlete, but for all clients who see me having had Joint Replacements (even 80 years +), Ligament reconstructions primarily the Cruciate, but also as a progression of Pilates where greater resistance needs to be applied.
As with all treatment interventions, the use of the gym is based on findings following a detailed assessment, and taking into consideration where in the recovery process 'your' injury is at that precise time.
Acupuncture:-
The word means 'puncturing of bodily tissue for pain relief', derived from the Latin acus (the needle).
The exact mechanism of it's action is uncertain, although there is good understanding in the 'gate effect' for pain relief, simplistically put, this involves stimulating certain nerve pathways which have an inhibitory effect on the flow of pain from the spinal cord up to the brain, thus the perception of pain is reduced. In many ways we all do this without thinking. Every time we bang our head on a cupboard door, we immediately rub the painful area this rubbing dulls down the perception of pain by a similar mechanism to acupuncture.
In addition, acupuncture stimulates the release of the bodies natural endorphins from centers within the brain, where there is good evidence for their use as effective painkillers.
In the clinical setting I use both Meridians and local trigger point 'dry needling' techniques. And as for all treatment prescriptions, the use of this is dependent upon accurate assessment and suitability.
Electrotherapy:-
I mentioned earlier that I use very little electrotherapy, and it is safe to say that most electrotherapy use is based on clinical experience rather than good scientific evidence.
On the occasions that I have used Ultrasound for example, that decision has been based on the client having had an exceptionally good response to it previously at another clinic and now they have moved into an area near me.
I do believe Elctrotherapy has a place within the physiotherapy clinic, and even if it does work on a strong Placebo basis, a good outcome is a good outcome which ever way you look at it. I just choose not to offer Electrotherapy as my first line of attack (or second actually).
There are many types of electrotherapy modalities, others include TENS machines for pain relief which I do believe help to get through a crisis patch, but also Laser, Interferential and Magnetic therapy.
Referral On!!
Lets us not forget this. A good Physiotherapist in my eyes is one who knows when NOT to treat.
If I think you (the client) require a Cotisone (steroid) injection, an MRI scan for surgical opinion, or I suspect you have a torn Cartilage within your knee which quite frankly physiotherapy will do nothing for. I will not attempt to treat such conditions for 14 sessions before letting you know. I will let you know as soon as I have good clinical evidence this may be immediately, or following one or two sessions to test the water. Either way you will not waste your entire Private medical allowance on pointless intervention, when what you really need is a surgical opinion, or even a referral to a Podiatrist or a Chronic Pain Specialist.
A good practitioner knows their strong points, weak points and has a big address book of specialists who they can call upon for referral, or just to help trouble shoot!