PHYSIOTHERAPY - WE OFFER A HOLISTIC APPROACH IN THE ASSESSMENT AND CARE OF YOUR CONDITIONS
Conditions / injuries treated at our practice
Any and all joints/nerves/muscles/connective tissue structures in the body can be assessed and treated by a qualified physiotherapist, such as Fransien. The following list highlights some more well-known conditions that Fransien can treat:
1. Neuro-musculo-skeletal conditions
Disc herniation: A herniated disc, commonly known as a ‘slipped’ or ‘popped’ disc, can be a debilitating injury. A disc injury can occur anywhere in the spine, but most commonly occurs in the neck and lower back. There are a lot of misconceptions surrounding what a disc herniation actually is. Let me explain it in a simplified way:
Your spine is made up of vertebrae (bones) that are stacked on top of one another. Between the vertebrae, there are intervertebral discs (cushions) which enables the spine to move (bend, extend, rotate). The back part of each vertebra has an arch. Put together, it forms one long continuous column, wherein the spinal cord runs. The spinal cord originates from the brain, and gives off branches (nerve roots) at each vertebral level. These nerve roots run to every organ and limb, enabling it to move, feel, react and function according to your body’s needs.
The intervertebral discs consists of a gel-like centre (nucleus pulposus) with a strong fibrous capsule (annulus fibrosis) surrounding it. If the disc is exposed to repetitive over-stretching in a certain direction, the capsule may weaken or wear out over time. Eventually a small tear may develop. If the tear goes all the way through the width of the capsule (annulus fibrosis), the gel centre (nucleus pulposus) may start leaking out, which may cause a chemical irritation of the nerve root and other surrounding structures, as the nucleus pulposus is very acidic/a strong irritant. Whether the disc is injured acutely or slowly through repetitive strain, there will be a significant level of inflammation present that not only causes discogenic pain (pain originating from the disc itself), but also causes irritation of the structures surrounding it (facet joint, muscles, nerve root). The paravertebral muscles typically go into a protective spasm to ‘splint’ or ‘brace’ the spine, which may unfortunately cause added discomfort and impairment, but is normal for that phase of the injury.
A person with a disc injury where the nerve root is involved may experience referred symptoms in the limbs – pain, pins and needles, numbness, weakness, burning etc. Please note that pain in a limb is not necessarily only an indication of a nerve irritation, certain muscles and joints can also cause referred pain.
The physiotherapist will thoroughly assess whether there are any red flags, such as a nerve compromise. If the condition seems stable, conservative treatment will commence. If there is reason for concern, the physiotherapist will refer you to a neurosurgeon for further investigation. In the latter case, an MRI scan is usually done to determine the amount of spinal cord/nerve irritation. If the specialist deems it within safe limits, he may advise the patient to continue with conservative treatment through physiotherapy and prescribe appropriate medication. If there is definite nerve compromise that may cause permanent damage, the neurosurgeon may choose to operate. After the operation the patient will need specific physiotherapy rehabilitation for a few months. This involves a progressive rehabilitation program – focussing on spinal stability and mobility. Ultimately the goal is to re-educate normal healthy movement patterns and for the patient to return to their normal activities of daily living.
It is important to realise that a disc injury is serious – but it does heal with time. All tissues heal! It may take anything from two months to two years to heal. If a person seeks the help of a physiotherapist, follows their advice, takes their prescribed medication, addresses the relevant lifestyle factors, complies with their exercise program and avoids aggravating activities (as stipulated by the therapist), they will stand the best chance of full recovery.
d. Inflammatory conditions: These conditions include rheumatoid arthritis, osteoarthritis, ankylosing spondylitis and fibromyalgia.
Osteoarthritis: Osteoarthritis (OA) is a common condition in middle-aged to older people where the cartilage in a joint becomes uneven/brittle due to long term inflammation and over-use. Sometimes, a joint injury that was sustained when the person was younger can contribute to the development of OA. Other times it can be the slightest muscle imbalance or weakness that, over the years, cause uneven strain on a joint. Once there is OA in a joint, you can’t necessarily heal it, but a lot can be done to lessen the pain and dysfunction associated with it, as well as slow down progression of the condition. Treatment may involve strengthening of stabilising muscles, changing movement patterns, gentle capsular stretching, ergonomic education, weight loss, adopting an eating plan that lessens systemic inflammation and aqua-aerobics or swimming. A treatment plan may also involve anti-inflammatory medication prescribed by the patient’s general practitioner, be it herbal or pharmaceutical medication.
e. Postural and ergonomic problems: The way you sit at your desk, on the couch, at your dining room table, in a meeting, in your car, the mattress you sleep on and how you are positioned while sleeping, how you pick up your baby or your heavy luggage bag - all these factors have a major influence on your body, and if done poorly, can predispose you to injury.
People who work on a laptop often adopt a slouched posture, poking their chin forward and rounding the shoulders. It might not necessarily be a major problem in your younger years (although many people do suffer from back pain from a young age due to poor posture), but as you become older you might develop chronic conditions that are more challenging to treat and eliminate.
It is important to position your spine in a neutral position if you are going to be in one position for a while. Consider these check-points if sitting at a desk:
f. Cervicogenic headaches: This condition is related to: whiplash, sinusitis, jaw tension, stress, poor posture and neck/shoulder tension.
A Cervicogenic headache or ‘tension headache’ is a type of headache that is caused by dysfunction of structures in and around the neck, skull, face and jaw (tempero-manibular joint). This is NOT a migraine type headache, although a cervicogenic headache can sometimes trigger a migraine indirectly.
Tension and trigger points in the muscles running from the neck to the shoulder blades and collar bones can cause tension type headaches. This may be associated with mal-alignment and compression of the joints in the upper part of the neck (upper cervical spine), which can also worsen headache pain.
The jaw / tempero-mandibular joint (TMJ) and its associated muscles may also be involved in tension type headaches. This is often the case in people who grind their teeth at night or who have recently undergone a lengthy procedure at the dentist (keeping the jaw wide open for an extended period of time may cause strain on the TMJ and lead to joint inflammation and stiffness).
Sinusitis (inflammation and congestion within the sinus cavities) can cause intense
headaches. It may also trigger the muscles below the base of the skull (occiput) and
those on the side of the neck to go into spasm.
Poor posture (typically the ‘poke chin’ slouching posture) while sitting at a desk is a common cause of chronic headaches. Once again this posture causes abnormal load on the neck extensor muscles that runs at the back of the neck and attaches to the base of the skull. It may also cause compression on some of the joints in the neck.
Whiplash is an uncontrolled high velocity jerking movement of the head causing the structures in the neck to be overstretched and injured. This commonly occurs during car accidents, falling incidents like fainting, impact sports and even when flying in extreme turbulence. Think of a person accelerating forward in a car and suddenly hits a still-standing car- the person’s head is still moving forward due to forward momentum, but because he is wearing a safety belt, he is bound to the suddenly decelerating car. This would cause high amounts of strain on the ligaments, joint capsules and muscles in the back of the neck. It is advised to have an X-ray after a severe whiplash injury to rule out instability of the upper cervical spine. The initial symptoms of neck stiffness, spasm, inflammation, headaches and fatigue normally subsides after a few weeks, depending on the severity of the incident. Unfortunately some people struggle with headaches years after a whiplash accident. This may be due to laxity of certain ligaments and joints in the neck, and the fact that the supportive stabilising muscles were never adequately re-educated. Other muscles may then become over-active in the attempt to try and provide some form of stability, but this may cause further pain and disability.
Clearly cervicogenic headaches comprises of many contributing factors. It is important that the physiotherapist investigates all of the above-mentioned areas as to determine the root cause of a headache.
g. Neural Dynamic Dysfunction: This includes conditions such as sciatica, carpal tunnel syndrome, thoracic outlet syndrome, neural sensitisation, etc.
Nerves run in between and around various other structures in the body. It should be able to move and glide freely as a person moves. If any one of those structures along its path causes increased pressure or friction on the nerve, the nerve becomes sensitive to movement and stretching and may become inflamed. Other muscles may even sense that the nerve is under strain and also go into spasm, causing more restriction. A person with neural tension may unknowingly adopt an antalgic posture or movement pattern in order to lessen the stretching of the sensitive nerve. Treatment involves identifying which interfaces are causing friction or restriction on the nerve/nerve plexus, and will gradually work to release these structures (muscles, fascia, and joints), where after graded neural gliding exercises will help to mobilise the nerve itself. Here follows some well-known conditions that involves neural tension:
Sciatica is a condition characterised by altered sensation and pain along the distribution of the sciatic nerve. It may be caused by mechanical irritation anywhere along the path of the sciatic nerve, typically in the pelvis and upper thigh. Spasms of the piriformis and hamstring muscles are often the cause of this condition: Nerve roots branch out of the spinal cord and exit the spinal column through small holes formed by the vertebrae called neural foramina. The sciatic nerve is formed by five nerve roots: L4, L5, S1, S2 and S3. These nerve roots converge to form the large sciatic nerve that runs through an opening in the pelvis. It runs past the piriformis muscle, along the hamstring muscle and close to the knee, where it separates into two branches (peroneal and tibial nerves). These nerves run down either side of the lower leg, down to the ankle and foot and continues to separate into smaller nerve branches.
Carpal tunnel syndrome:
Carpal tunnel syndrome is a condition where a person may experience pain, pins and needles, numbness, and weakness in the hand and arm due to nerve irritation. The carpal tunnel is an anatomical tunnel formed by the wrist bones and ligaments. Many structures, such as muscle tendons, arteries and veins, and the median nerve must pass through this tunnel. If the muscle tendons become slightly swollen, it causes increased pressure on the median nerve, as there is limited space in the tunnel. This causes irritation and sensitisation of the median nerve, which leads to the above-mentioned symptoms.
Thoracic outlet syndrome:
Thoracic outlet syndrome includes a group of disorders where nerves and blood vessels running through a space formed by the muscles along the side of the neck, the collar bone and the first rib, become compressed. There may be different reasons for the compression and irritation of the nerves and/or blood vessels, and it is the responsibility of the physiotherapist to determine these factors. Symptoms includes pain, pins and needles, numbness, weakness, tightening and altered sensation in the neck, arm and/or hand.
h. Post-operative rehabilitation: Following an operation, a patient needs education, reassurance, specific hands-on treatments and mobilisation, and most importantly a progressive rehabilitation program. Patients are not always referred for rehabilitation and often end up coming to the physiotherapist weeks or months after the surgery with severe stiffness, weakness and incorrect movement patterns. It is then much more difficult to treat, but can usually still be treated successfully if the patient complies with the prescribed exercises. It is best to start with physiotherapy rehabilitation soon after an operation to avoid pain and frustration. The physiotherapist will communicate with the surgeon to confirm the guidelines for that specific operation in order to stay within safe limits
Post-operative rehabilitation is necessary after the following:
Women with breast cancer often have to have a mastectomy. Some may choose to have breast reconstruction at a later stage. These are both major surgeries. As the skin and all the deeper connective tissue layers heals, it tends to contract/stiffen and cause adhesions. This can cause restriction of shoulder elevation, which if not treated, can become very debilitating over time. It is therefore very important to start gentle mobilisation exercises at an appropriate time, as guided by the physiotherapist. Manual therapy is usually necessary at a later stage to loosen scar tissue that is still causing restriction.
2. Respiratory conditions
Many respiratory conditions can be treated by a physiotherapist with the use of nebulisation, percussions, postural drainage, breathing exercises, coughing techniques and ribcage mobilisation. These techniques help to loosen the phlegm/mucus, helping the patient to cough it out successfully.
Babies often also need suctioning as they cannot be commanded to cough and are sometimes just too lazy to cough, even when a cough is stimulated. Suctioning involves using a small sterile catheter (that is attached to a suction machine) and gently guiding it into the nostril and down to the bronchus where the mucus is then suctioned out quickly and effectively. The baby is usually not very happy with this procedure, as one can imagine, but it is over within 10 – 20 seconds. They tend to forget about it quickly and can then breathe with ease – all worth it!