Many people who present to us in pain, with or without a ‘musculoskeletal diagnosis’, do not realise how the nervous system and pain system of the body can be a real obstacle to our recovery.
Pain science has shown that tissue injury is only one of the factors that determines how much pain we feel and how long it will last. Lifestyle factors can sensitise our pain system like poor sleep patterns, high levels of stress and diet. Our beliefs and perceptions (sometimes misconceptions) are other factors that can influence our pain system. They can lead to fear and anxiety about our painful conditions and can be major obstacles to full recovery.
Education about your specific condition, your pain system and what factors may be holding your recovery back is often an integral part of our management plan. Research shows that including this in the plan can improve your recovery outcomes.
2. Exercise prescription
Exercise prescription is the pillar behind our Physiotherapy treatment. Research has shown that exercise prescription is effective in the prevention of injury and illness. The prescription of exercise will be designed around your goals and how active you would like to be. These goals will be made with a Physiotherapist so a plan can then be made to help you reach your goals.
Throughout treatment you will be given an exercise program that suits your ability, pain levels and goals at that given time. These exercises will be assessed, adapted and progressed to suit you.
Exercise will include range of motion exercises, strengthening exercises, stretching, balance and conditioning. All of which will be prescribed with the aim of resolving your pain and correcting any deficiencies so that your pain will not return by giving specific repetitions, sets and dosage according to the needs of the patient.
3. Manual therapy
4. Soft tissue manipulation
Soft tissue manipulation can include myofascial release or sports massage/deep tissue massage.
Myofascial release is used when a patient has myofascial trigger points also known as muscle knots which are tight bands of muscle fibres that are tender to touch that can cause a patient a lot of pain. They can cause pain locally and they can also radiate away from that area causing pain referral to other body parts. These myofascial trigger points occur when muscles are either weak or over worked. Myofascial trigger points can cause severe pain and dysfunction and can happen anywhere in the body.
To treat a myofascial trigger point a Physiotherapist will use myofascial release by using sustained pressure to the trigger point. These trigger points can be easy to feel for Physiotherapists. The sustained pressure is held until the pain starts to ease and there are signs of the trigger point breaking down. Myofascial release helps to reduce pain and dysfunction so then we can help to strengthen or offload the area of the trigger points or pain.
Sports massage/deep tissue massage can help reduce aches, pains and injuries that are associated with recreational activities like running. It helps to manipulate the superficial and deeper layers of muscle and connective tissue using many techniques, to enhance performance, aid in the healing process and reduce pain
Massage can also help more globally by reducing heart rate and blood pressure..
5. Joint manipulation
6. Dry Needling
Dry needling is an invasive procedure in which a sterile thin filament needle is inserted into the skin and muscle directly at a myofascial trigger point. A myofascial trigger point is a focus of small muscle fibre contraction knots, which are related to pain and pain perception. They often occur as a result of neuromuscular dysfunction or weakness and in areas of musculoskeletal stress or tightness.
A key aspect of dry needling is to elicit local twitch responses, which are spinal chord reflexes. These twitch responses lead to favourable mechanical and biochemical effects which help to break down the pain cycle.
Dry needling can be a key modality to help get your pain under control so we can then aim to correct neuromuscular dysfunction or musculoskeletal stress which caused the pain cycle to begin so that we can prevent your pain experience from happening again.
Dry needling can be used for a variety of musculoskeletal problems. Conditions that can be treated include, but are not limited to neck, back and shoulder pain, arm pain (tennis elbow, carpal tunnel, golfer’s elbow), headache to include migraines and tension-type headaches, jaw pain, buttock pain and leg pain (sciatica, muscular strains/tightness/spasms).
Most people do not experience pain with the insertion of the needles but eliciting twitch response can briefly be painful. Soreness can be experienced after treatment but can be eased with use of ice, heat and stretching
7. Shockwave Therapy
Shockwave therapy is a fast and effective non-invasive method of treating many painful musculoskeletal conditions. It utilises energetic shockwaves (high energy sound waves and kinetic energy), not electrical, applied to the area that requires treatment. Shockwave treatment is completed by a Physiotherapist by holding the hand piece to the painful area. We can choose the appropriate settings for your presenting condition and it can be adjusted depending on the patients tolerance. Patients normally attend for between 4-6 sessions for Shockwave to have its full beneficial effect. The treatment can cause discomfort and pain but it is generally well tolerated as treatment time is short. Soreness may last for 24 hours after treatment but this can be a positive as shockwave is a pro-inflammatory treatment.
Shockwave works by creating a pro-inflammatory response. This means that we can accelerate the healing process by converting a chronic inflammatory condition into an acute inflammatory condition.
By doing this we can create beneficial effects like increasing blood circulation, breaking down calcium deposits (can be present in tendon injuries), stimulating tissue healing/growth, and reversing chronic inflammation. All of this can lead to the reduction in pain and in turn increased function.
Common conditions that can be treated using shockwave therapy include but are not limited to plantar fasciitis, Achilles and patellar tendinopathy, tennis and golfers elbow, shoulder calcification, jumpers knee, neck pain, back pain, ITB syndrome, greater trochanteric pain syndrome and muscle strains/tightness.
The benefits of shockwave therapy include that it is non-invasive, no anaesthesia or medication is needed, treatment is fast (15-30 minutes, 4-6 sessions) and has much less complications than other options. Possible side effects are rare but include redness in skin, discomfort after treatment and possible bruising.
If you are pregnant, taking antiplatelets or anticoagulants, have a blood clotting disorder, cancer or a cardiac pacemaker or other cardiac device, an infection in the injured area or had steroid injections in the area in previous 12 weeks you are not eligible for shockwave therapy treatment.
8. Laser Photobiomodulation Therapy (previously known as Low Level Laser Therapy LLLT)
Laser Therapy is a colloquial term for Photobiomodulation (PBM Therapy) previously known as Low Level Laser Therapy (LLLT).
It is a light therapy using lasers to improve tissue repair, reduce pain and inflammation. A Physiotherapist will apply the laser near to or in contact with the painful area normally for a period of 10-15 minutes and the intensity of the treatment will be specifically altered for your injury. Light energy penetrates tissue where it induces photophysical and photochemical changes that lead to alterations at the molecular, cellular and tissue levels of the body. These alterations lead to physiological reactions in the injured tissue to accelerate wound healing, tissue regeneration, increaseing circulation, reducing inflammation, reducing pain and helping to restore normal cellular function.
For inflammation, laser therapy vasodilation. Vasodilation allows inflammation, swelling, and edema to be cleared away from injury sites more effectively.
Vasodilation also promotes lymphatic drainage, which also aids in the healing process.
Pregnant women or people with visible skin lesions should avoid having laser therapy.
Laser therapy has been used for many years can be effective on sports injuries, arthritic joints, neuropathic pain syndromes, as well as back and neck pain.
9. Therapeutic Ultrasound
Ultrasound therapy is an electrotherapy which has been used in physiotherapy practices for many years. It is mainly used for its non-thermal effect where high frequency sound waves cause vibrations and movement of cellular fluids. Ultrasound is applied using the head of an ultrasound probe placed in direct contact with the affected area via a transmission coupling gel.
A piezoelectric effect caused by the vibration of crystals within the head of the probe generates the ultrasound waves. The ultrasound waves that pass through the skin cause a vibration of the local soft tissues. This vibration or cavitation can cause a deep heating locally though usually no sensation of heat will be felt by the patient. The frequency and power of the ultrasound can be changed by our Physiotherapist to suit your condition.
Ultrasound therapy can help to improve the healing rate of certain soft tissues, by increasing blood flow to an area in order to accelerate the resolution time of the inflammatory process.
It can also stimulate the production of collagen (the main protein in tendons and ligaments) during tissue healing.
Ultrasound can be used to promote healing in any soft tissue (muscle, ligament or tendon) condition/injury.
Ultrasound should be avoided over metal implants, local malignancies, infections or specific vascular abnormalities.
10. Orthotic prescription
Orthotics/Orthoses or orthopaedic insoles are footwear inserts that aim to modify or alter your foot biomechanics. The way we strike the ground when walking or running can often cause us pain or injury. Orthotics prescribed after a full assessment by a Physiotherapist can help the way we function during these tasks allowing us to accept load optimally through our body. Orthotics can allow us to offload the painful areas, decreasing our pain and allowing us to then strengthen any weaknesses that could be found in the assessment.
Orthotics can be simple off the shelf insoles which can be modified by a Physiotherapist if needed or they can be more complex custom made insoles which can be made after a thorough foot assessment, biomechanical assessment or after casting.
Off the shelf insoles can be perfect for a general case of mild acute pain but more complex cases may need custom built orthotics which can last a number of years.
Prescription of orthotics can help a wide range of different issues like plantar fasciitis, shin splints, foot pain, knee pain, toe pain, low back, knee or ankle pain and heel pain.
11. Ergonomic expertise and advice
Ergonomics is the relationship between a worker and the job and focuses on work areas or tasks to improve job productivity and performance.
The goal of ergonomics is to provide maximum productivity with the least physiological or health cost to the worker. There are many factors that play a role in ergonomics including body posture and movement and environmental.
Physiotherapists can help have a major effect on body posture and movement. This includes the way we sit, stand, lift, pull or push at work. We can help with your office/desk set up and provide advice and education about how to work optimally without developing any pain.
Poor body posture and movement can lead to musculoskeletal disorders also known as work related upper limb disorders or repetitive strain injuries. These are soft tissue injuries affecting our bodies.
Physiotherapists can help to provide assessments of work areas or desks and then provide expert recommendations of how to avoid these injuries by either altering the workers body posture and movement while working or advise regarding the buying of certain equipment.