As physiotherapists, we are trained to managed a range of different injuries and complaints. In our treatment we aim to use a combination of techniques which will include exercise prescription, various mobilisation techniques for individual joints, massage, and education. As the saying goes, knowledge is power. By providing you with information about your condition, you are better able to manage your symptoms, which then aids with your recovery.
There are a number of causes of neck pain and unsurprisingly, posture can play a major role in neck complaints. The neck consists a number of joints, muscles and between the bones or vertebrae, discs which act to cushion and assist with movement. From a detailed description of symptoms along with examining how your neck responds to movement, we are able to diagnose the underlying cause of the complaint. Neck pain is typically related to either the joints and/or the disc. It can refer symptoms as far as the hand and cause pain, pins and needles and/or numbness. Depending on the underlying cause of the symptoms, physio aims to reduce pain, restore any movement loss and restore function. We are able to achieve this through postural and positioning advice, soft tissue massage to assist with any muscle spasm, joint mobilisation which works to restore movement, and nearly always we provide exercises which aims to centralise the pain from the arm and towards the neck, where it can then be resolved.
This area houses your ribs. Again, issues here can be related to posture, and like the neck, there are a number of joints, muscles and discs. It is more rare for discs to cause a problem in this part of the spine. An issue in the thoracic spine is more likely to be related to a joint. Here, physio can assist by correcting posture, strengthening the postural muscles responsible for holding you upright and mobilise the joints to free up movement. This is the part of the spine that protects the autonomic nervous system, responsible for acting mostly unconsciously and regulates bodily functions such as heart rate, digestion, and respiratory rate. For this reason, the thoracic spine has less movement than the neck or lower back, but it should still allow you to move freely, without pain and is very important for rotation of the spine.
The shoulder is an incredibly complex joint and is one of the most mobile joints in the body. The shoulder joint can be thought of as a golf ball sitting on a tee and as a result relies on a number of surrounding structures to provide it with stability. This includes the shoulder capsule, ligaments and the rotator cuff (RC) muscles. The shoulder joint works dynamically with the Acromioclavicular (AC) joint. There are a number of causes of pain and decreased movement within the shoulder, which we are able to diagnose through testing range of movement, strength testing as well as via special orthopaedic tests. Most commonly shoulder complaints will be related to impingement of the bursa, calcification of a tendon, a tear of a rotator cuff muscle, or a frozen shoulder. In treating the shoulder, the first objective is to manage the pain first and foremost, followed by restoring movement loss. Exercise is a major component of rehabilitation of all shoulder complaints. As the shoulder joint is so reliant on the RC for stability and the muscles surrounding the shoulder blade, or scapula for correct alignment, a combined strengthening program aims to achieve a correct scapulohumeral rhythm, or in other words a well synchronised movement of the shoulder blade in relation to the shoulder. Other techniques include mobilisation of the shoulder joint to achieve the correct positioning of the head of the shoulder within the golf tee or glenoid fossa. Taping the shoulder can also be very effective in offloading the ligaments and muscles, providing support while the shoulder recovers.
There are two common complaints in the elbow joint—tennis elbow which affects the outside of the elbow and golfers elbow which affects the inside of the elbow joint. Although their names make them sound specific to a particular sport, these injuries typically occur as a result of overuse, incorrect technique or trauma. Physiotherapy aims to decrease pain and restore the normal movement of the elbow and most importantly restore grip strength as appropriate. This is done via education around how to avoid what aggravates symptoms and gripping technique. We also use a technique developed here in New Zealand, known as Mulligan’s mobilisations with movement as these can be very effective in restoring pain free range of movement. After restoring pain free movement/grip strength, we then focus on improving functional strength.
The hip joint has a number of structures that can be a source of symptoms and the type of presentation can be influenced by a number of different factors. Symptoms from the hip can be as a result of osteoarthritis or trochanteric pain syndrome, however these complaints are more age related. For sporting and active individuals sources of pain can include femoral acetabular impingement, where there is a bit of a mismatch between the hip ‘ball’ and ‘socket’ or less commonly, a labral tear. The labrum is a ridge of cartilage around the rim of the hip socket, assisting in making the hip joint deeper and therefore more stable. A labral tear can result from a fall, repetitive trauma such as sports that require regular rotation of the hip, such as golf, soccer, ballet, or hockey. Hip pain that is felt on the outside of the hip can include wear and tear or straining a tendon of the gluteal muscles that surround the hip and buttock. This occurs as a result of repetitive overloading of a gluteal tendon. Physiotherapy aims to accurately diagnose the underlying cause of the symptoms and appropriately manage this with joint mobilisation, strengthening exercises and self management advice.
The knee joint consists of cartilage pads or menisci and is surrounded by ligaments to provide stability. The most common knee injuries we see are injuries to the ligament on the inner side of the knee, the medial collateral ligament or MCL; injuries to the menisci, which is most commonly the medial meniscus; and patella-femoral pain syndrome or pain around the knee cap. Our aim here is to assist with settling pain, improving pain free range of movement within the knee joint as this can become restricted in both bending and straightening. We use a combination of techniques and again get good results using the Mulligans Concept to mobilise the knee joint. Strengthening of the surrounding muscles assist with recovery and is crucial for patella-femoral pain syndrome.
The ankle joint again is a joint that relies on the balance of muscle strength and the ligaments to provide stability. Although injury to the ligaments on the inside of the ankle can occur, sprain injuries are far more common on the outside of the ankle as a result of rolling the ankle. There are a number of ligaments on the outside of the ankle, however it is usually the Anterior Talofibular and Calcaneofibular ligaments that will be injured with a rolling type injury. Two other common complaints around the ankle can include issues with the Achilles tendon, the large tendon from your calf muscle down to your heel, or the plantar fascia, which is a tough fibrous band that runs along the sole of the foot. These complaints can be managed with changes to foot alignment with supports, taping, strengthening exercises and stretches. It may surprise you, but one of the most common important factors, whether it be an issue with a shoulder or an ankle, is calf strength. This creates a stable basis for other joints to function in the kinetic chain.