Physiotherapists typically have a number of treatment techniques at their disposal.
These techniques will be used to varying degrees depending upon what the physiotherapists have found beneficial in the past, as well as whatever treatment the patient has found to be the most successful. Patients’ feelings and opinions about their previous problems and treatment experiences are a very important consideration when choosing the way forward for new treatment. With this in mind we always encourage patients to share their thoughts on this subject with us.
We rarely use electrotherapy of any sort, and have found better outcomes with a more hands on approach. We 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.
The letters MMACP appearing after a physiotherapist’s name denote that he or she is a Member of the Manipulative Association of Chartered Physiotherapists and has 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. However, they are not suitable either for very painful conditions with a lot of muscle spasm guarding the problem joint, where there is any possibility of bone fragility or a chance of causing a greater problem. In any of these cases the techniques of mobilisation can be safely and comfortably employed.
A slow oscillatory mobilisation can ease up a stiff joint, return muscle tone to normality following spasm and thereby promote the healing process.
Manipulation is nearly always aimed at spinal joints, whereas mobilisation is used throughout the muscular and skeletal system.
Who doesn’t feel better after a good, deep muscular massage irrespective of what the ache or pain may be? Most people seem to derive palpable benefit from massage, which may be the reason why it proves to be so helpful in promoting injury, recovery and feelings of well-being. We also know that it aids fluid flow, and stimulates receptors which can aid the reduction of muscle tension, which in turn can remove ‘knots’ or ‘trigger points’ and thereby reduce pain.
The use of massage also allows us as practictioners an opportunity to feel the tissues and assess how they react, finding out where they are stiff and if there is a spasm. This information helps us to build a more comprehensive picture enabling us to decide the best way to treat the patient and ultimately fix the problem!
However, even this most basic form of treatment technique needs to be applied appropriately following a careful assessment in order for the patient to obtain the maximum benefit. If it is applied too early or too vigorously over a muscle injury it could lead to complications. Similarly, to massage over an irritated nerve can actually result in considerable patient discomfort and cause the problem to flare up.
Pilates Based Exercise
Not only has Pilates gained increasing popularity as an effective and sometimes necessary treatment tool in cases of spinal pain management, it has also been successful in the treatment of pain in other joints such as shoulders and knees. Interestingly, over time there has emerged considerable hard evidence to support this trend.
The majority of spinal pain cases that we see and treat derive from a spinal segment that moves too much. A lot of patients come into the Clinic complaining of a stiff and painful back but examination often reveals the problem to be uncontrolled movement, whilst the stiffness is muscle spasm trying to 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.
This approach may seem all too simple but we have found it to be remarkably effective in the majority of cases of this type. We would stress, however, that the end result is dependent not just upon the patient receiving good physiotherapy while with us here but also on the amount of time and effort the client can devote to doing the core stability work while away from the Clinic!
We are fortunate enough to have our own gymnasium. This facility allows us to give full training to a recovering athlete at any standard, taking rehabilitation to a higher level than could possibly be achieved within the clinical setting alone.
Although we use the gymnasium regularly for the younger athletes, who may have had ligament reconstruction or meniscal repair, we have several older clients using the gym facility who have had joint ‘tidy-ups’ or replacement.
As with all treatment interventions, recommendations to use the gym facilities are based on findings following a detailed assessment of the condition of the current problem, which also includes a decision as to exactly what point the patient’s recovery has reached. This is vitally important because it is upon the accuracy of these decisions at this stage that an entirely successful outcome of the patient’s treatment may well depend.
The word means ‘puncturing of body tissue for pain relief’, derived from the Latin acus (the needle).
The exact mechanism of acupuncture is uncertain, although there is good understanding of the ‘gate effect’ for pain relief. Put simply, this involves the stimulation of certain nerve pathways that have an inhibitory effect on the flow of pain from the spinal cord to the brain, the perception of pain thus being reduced. We all do this involuntarily in many ways. For instance, every time we bang our head we immediately rub the painful area. This act of rubbing, dulls our perception of pain through a mechanism similar to that of acupuncture.
In addition, acupuncture stimulates the release of the body’s natural endorphins from centres within the brain, where there is good evidence for their effective use as painkillers.
In the clinical setting we use both meridians and local trigger point ‘dry needling’ techniques. As with all treatment prescriptions, the use of this method of treatment is dependent upon accurate assessment to confirm suitability.
This resource must not be forgotten. In our eyes a good physiotherapist is one who knows when NOT to treat. For instance, if after careful examination and assessment we think that a client requires a cortisone (steroid) injection, an MRI scan or a surgical opinion, that is the time for referral. Again, if we suspect a client has a torn knee cartilage, for which physiotherapy can do nothing at all, referral is the obvious answer. In this kind of situation we let the client know at once what our findings are so that suitable decisions and/or arrangements may be made for the necessary further expert opinions to be sought. What we do not do is embark upon a programme of what we would know only too well to be useless physiotherapy treatment. This means that clients will not waste their entire private medical allowance on pointless intervention when what they really need is either a surgical opinion or in other cases perhaps a referral to a podiatrist or a chronic pain specialist.
Good practitioners know both their strong and their weak points. One of the best weapons in their armoury, however, is their ready access to an address book full of names of the specialists on whom they can call when needing help or advice.
We believe that most electrotherapy use is based on clinical experience rather than proven scientific evidence. For example, on the majority of occasions that we have used ultrasound, the decision to employ this particular treatment has been based on the fact that the client had experienced a particularly good response to it at another clinic before attending our premises. We are of the opinion that electrotherapy has its rightful place within the physiotherapy clinic, even if it may sometimes work on a strong placebo basis. However, a good outcome is a good outcome whichever way you look at it but as a rule we just choose not to go down that route very often.
There are many other types of electrotherapy modalitiies including laser, interferential and magnetic therapy. TENS machines also have a place in the treatment of pain – a useful resource, we believe, in helping to get a patient through a temporary crisis.