Education Division

Musculoskeletal Consumer Review is the on-line Healthcare Journal of the Core Concepts group. Musculoskeletal is the term used to define area of concerned with the skeleton, muscles, connective tissues like ligaments, tendons, and nervous system.Musculoskeletal Disorders such as sports injuries, spinal conditions are not simple. However, it does not have to be complicated. Musculoskeletal Consumer Review’s (MCR) purpose is to un-complicate things.

“When something can be read without effort, great effort has gone into its writing.”

– Enrique Jardiel Poncela

MCR articles, interviews and news summaries are prepared by MCR editorial team, combining clinical research and our clinical experience to deliver patient education materials. We believe that for knowledge to have impact, our readers and clients must be able to take specific concrete action on the concepts and advice. MCR is a non-profit effort by Core Concepts Group.

Read the journal here at Expert Articles

Peripheral Division

The Peripheral division is a focuses the peripheral joints of the body that is the arms and shoulder (upper limb) and the leg (lower limb). They may include parts of the body that overlaps with the sports injury division but is not a result of sporting activities and is aimed at getting better with less emphasis on maximising sports performance.

The areas of focus that falls under the Peripheral division include:

  • Shoulder conditions
  • Elbow and wrist
  • Legs and knees
  • Ankle and Foots conditions

The rehabilitation physiotherapy specialists under this division are:

SpecialistsLocation

Tian Li Feng

Raffles Place, George Street

Misako Okazaki

Novena Square, Orchard Road

Chew Pui Wan

Raffles Place, Novena Square

Naheed Ahmed

George Street, Parkway Parade

Chng Chye Tuan

Harbour Front, Parkway Parade

Lenia Teo

Orchard Road, Parkway Parade

Cheryl Ng

Novena Square

Women’s Health Division

Core Concepts’ Women’s Health division is focused on musculoskeletal conditions arising as a result of pregnancy, specifically in treating pelvic pains (low back and hip region) for pregnant women. Musculoskeletal care for pregnant women with such pains is a very narrow sub-speciality of spinal pain management.

Treating pregnant pains is quite different from treating the more commons forms of low back pain in two aspects.

First, the common forms of treatment such as ultrasound, the use electro-therapy machines such as TENS machines. short-wave, NSAIDs drugs, pain-killers and traction are not available due to the potential harm to the unborn child.

Second, pelvic pain for pregnant women is usually a result of the dysfunction of the pelvic and sacroilliac joint. The Sacroilliac Joint (SIJ) is the where the low back portion of the spine meets the pelvic bone This very complex area requires a high level of diagnostic skills and experience to determine the fault amongst the numerous interactions between the various components of this area. In contrast, pre-natal massages treat the end result of the dysfunctions e.g. muscle strain. Without treating the underlying cause, you can expect the pain increase both in frequency and intensity.

These two aspects limit the choice of physiotherapy treatments to sub-set of therapy known as advanced manual therapy, an area of speciality for the Core Concepts group. This combined with the exclusive focus of the spinal division uniquely positions Core Concepts for this sub-speciality.

Peri-Partum Pelvic Pain

Between 50% to 80% of all pregnant women will experience pain in the pelvic region and lower back sometime during their pregnancy. This Peri-Partum Pelvic Pain (PPPP)this pain is most prevalent in the fifth and sixth month of pregnancy, but can begin as early as eight to twelve weeks into pregnancy. Several studies also reported the evening hours seem to be the most difficult.

Approximately 67% of pregnant women suffer from night discomfort or backache. While 36% have night backache so severe it wakes them from sleep. Women with history of low back pain are at higher risk for recurrence, and their back pain can occur earlier into the pregnancy.

Generally, peri-partum pelvic pain presents in the following areas:

  • Lumbosacral joints (low back pain)
  • Sacroiliac joints (posterior pelvic pain)
  • Coccyx (pain in tailbone)
  • Symphysis Pubis (pain in the front of the pubis)
  • Groin area

PPPP tends to be influenced by posture and is associated with a waddling gait. Approximately 80% of these back pains are usually localized, but occasionally may vary. PPPP tend to increase in intensity towards the end of the 3rd trimesters and typically resolve 6 months after delivery.

There are 3 types of peripartum pelvic pain generally:

References

  • Berg G, Hammar M, Moller-Nielsen J, Linden U, Thorblad J. Low back pain during pregnancy. Obstet Gynecol. 1988; 71:71-75.
  • Fast A, Shapiro D, Ducommun EJ, Friedmann LW, Bouklas T, Floman Y. Low-back pain in pregnancy. Spine. 1987; 12:368-371.
  • Fast A, Weiss L, Parikh S, Hertz G. Night backache in pregnancy. Hypothetical pathophysiological mechanisms. Am J Phys Med Rehabil.1989; 68:227-229.
  • Jain S, Eedarapalli P, Jamjute P, Sawdy R. : pubis : a practical approach to management. The Obstetrician & Gynaecologist 2006;8:153-158
  • Mantle MJ, Greenwood RM, Currey HL. Backache in pregnancy.Rheumatol Rehabil. 1977; 16:95-101.
  • Svensson HO, Andersson GB, Hagstad A, Jansson PO. The relationship of low-back pain to pregnancy and gynecologic factors. Spine. 1990; 15:371-375.
  • Wergeland E, Strand K. Work pace control and pregnancy health in a population-based sample of employed women in Norway. Scand J Work Environ Health. 1998; 24:206-212.

 

The pelvic girdle is made up of 3 bones, the sacrum flanked by 2 innominate bones. The symphysis pubis is a fibrocartilaginous structure that sits at the front of the pelvis, connecting and holding the 2 innominate bones of the pelvis together.

The joints at the back of the pelvis are called the sacroiliac joints. During pregnancy, hormones soften supporting ligaments in these joints to prepare for labour, hence decreasing stability in the pelvis. This instability may cause peripartum pelvic pains.

As your pregnancy progresses, there will be changes in your body to accommodate your baby. These changes sometimes can case stress and result in musculoskeletal dysfunction. These dysfunction often manifests as pain, especially in your pelvic girdle and back. Etonia’s approach to these symptoms involves analyzing the structure of the body to identify and correct these dysfunctions. Palpation, range of motion, and observation are used to reveal distortions of the pelvis, sacrum, and spine.

To reduce the stiffness, pain and discomfort brought about by these changes, Core Concepts’s physiotherapists apply various strategies in the restoration of spinal and pelvic girdle mobility and stability that often results in a reduction in the patient’s pain and spasm. Strategies include manual techniques, such as joint mobilization, muscle energy technique, myofascial release and pelvic girdle stabilization exercises.

Mobilisation

Mobilisation has always had its efficacy described in terms of improving mobility in areas of the spine that are restricted. Such restriction may be found in joints, connective tissues or muscles. By removing the restriction – by mobilisation – the source of pain is eliminated and the patient experiences symptomatic relief.

Muscle Energy Technique

Muscle Energy Technique (MET) uses precise positioning of the body in conjunction with very light muscle contractions to re-educate muscle whose dysfunctional tone distorts the body and causes asymmetry. Special emphasis is placed on the back and pelvic girdle, which control the functional core of the body. This technique is very gentle on the patient and can be very effective in relieving a variety of musculoskeletal dysfunctions, including symphysis pubis dysfunction (SPD).

Myofascial Release

Myofascial release uses manual, deep tissue release to lengthen shortened connective tissues. The release helps to induce a state of relaxation for the muscles that are tense due to the stresses of pregnancy. Manual stretching by the therapist and self stretching by the patient further this process. Lengthened and weakened muscles are then strengthened with gentle resistive exercises.

Pelvic girdle stabilization exercises will be incorporated in the management to help maintain stability and thus alleviate pains from pelvis, sacrum, and spine.

Manual Lymphatic Drainage

Manual Lymphatic Drainage (MLD) is an advanced therapy where a range of specialised and gentle rhythmic pumping techniques to move the skin in the direction of the lymph flow. This stimulates the lymphatic vessels and increase the rate of removal of waste products, toxins and excess fluid from the body’s tissues resulting in reduced fluid retention, swelling and puffiness such as of the ankles.

The rehabilitation specialists under this division are:

SpecialistsLocation

Chew Pui Wan

Raffles Place, Novena Square

Cheryl Ng

Novena Square

Sylvia Ho

Raffles Place, Parkway Parade

Sports Injuries Division

sports injuriesIn the broadest sense, the term sports injury refers to the kinds of injuries that most commonly occur during sports or exercise. Some sports injuries result from accidents; others are due to poor training practices, improper equipment, lack of conditioning, or insufficient warm-up and stretching.

However, there are also those that suffer from “golf or tennis elbow” but neither plays golf or tennis. In those cases, the root of the problem is repetitive strain rather injuries due to sports training.

Although virtually any part of your body can be injured during sports or exercise, the term is usually reserved for injuries that involve the musculoskeletal system, which includes the muscles, bones, and associated tissues like cartilage.

 

Shoulder Injuries

Shoulder injuries are among the most common and complex orthopaedic injuries because the shoulder has the greatest range of motion of any joint in the human body. The difficultly arise from the “ball and socket joint” design which allows the arm to move in a multi-planar direction and the fine control over a large set of individual muscles to stabilise the joint. Ask anyone who has dislocated this major joint, and he or she may also argue that shoulder injuries are also the most painful. For many years, people who severely injured their shoulders and needed surgery had long hospital stays and considerable postoperative pain and stiffness. And for many athletes, amateur or professional, the limited range of motion they experienced after surgery slowed or even ended their careers.

Some of the more common shoulder injuries are:

  • Rotator Cuff tears
  • Shoulder Subluxation
  • SLAP Tears or Bankart Lesions
  • Acromio-Clavicular(AC) Joint / Sterno-Clavicular(SC) Joint Strain

Knee Injuries

Some of the more common knee injuries are:

Achilles Tendon

The achilles tendon, the tough band extending from the calf muscles to the heel. The calf muscles and tendon work together to lower the front of your foot when your heel touches the ground and to raise the heel when your toes push off the ground.

Achilles tendinitis is where this tendon becomes inflamed or swollen. This usually happens then the tendon is placed under great stress such when running downhill or uphill. Other various functional and structural abnormalities may also predispose the Achilles tendon to injury. These include rolling the feet onto the outside (pronation) excessively, the habit of landing too far back on the heel (checking the sole of the running shoe can show where the heel is most worn), bowed legs, tight hamstring and calf muscles, high arches, tight Achilles tendons, and heel deformities. Achilles tendonitis can lead to small tears within the tendon, and make it susceptible to rupture.

Plantar Fasciitis or Heel Pain

Plantar fasciitis is the most common cause of heel pain. The plantar fascia is the flat band of ligament connecting your heel bone to your toes. It supports the arch of your foot. When strained, it gets weak, swollen, and irritated causing your heel or the bottom of your foot hurts when you stand or walk. It can happen in one foot or both feet.

People with plantar fasciitis usually have pain when they take their first steps after they get out of bed or sit for a long time. You may have less stiffness and pain after you take a few steps, but your foot may hurt more as the day goes on. It may hurt the most when you climb stairs or after you stand for a long time.

Though more common in older adults, it also occurs in younger people who are on their feet a lot like athletes.

Repeated strain on the plantar fascia ligament can cause tiny tears leading to pain and swelling. Some common causes are:

  • Your feet roll inward too much when you walk (excessive pronation).
  • You have high arches or flat feet.
  • You walk, stand, or run for long periods of time, especially on hard surfaces.
  • You wear shoes that don’t fit well or are worn out.
  • You have tight Achilles tendons or calf muscles.

In addition to the treatment of the sports injuries, Core Concepts also provides the following specialised services

The rehabilitation specialists under this division are:

SpecialistsLocation

Chng Chye Tuan

Harbour Front, Parkway Parade

 

Scoliosis Division

The Spinal Scoliosis division is a distinct area of focus. While it part of the spine, the scoliosis condition requires more specialised training and approach than regular physiotherapy. We use the SpineCor approach for idiopathic scoliosis.

Core Concepts is the first private centre in Singapore to be an accredited SpineCor® Physiotherapy Training Centre.

If you have a child or an adult with scoliosis who is considering non-surgical approaches to idiopathic scoliosis, SpineCor® bracing may be the solution for you. Aside from surgery, bracing is considered the next most viable form of treatment for scoliosis.

Compared to traditional rigid braces that can be uncomfortable to wear, SpineCor® is a flexible dynamic brace is softer to touch and more comfortable to wear. SpineCor also aims to do more that simply stop the progression of scoliosis. It aims to reduce the severity of the curve.

To learn more and better the understand the condition and the treatments options available, read:

Complimentary Assessment and Advisory

If you suspect or think that your child or teenager has a scoliosis, a curved or crooked spine, do drop by for a complimentary assessment if it is indeed scoliosis, and advisory on what can be done.

Are you confused about what you should do for scoliosis? If these are some of the questions that are troubling you, a complimentary assessment will help put your mind on the right path.

  • Does my child have scoliosis or not?
  • Will the curve worsens?
  • Is there a chance my child’s spine straighten?
  • It is too early to wear a brace? It is too late to wear a brace?
  • Are spinal manipulation useful to straighten the spine?
  • How often should my child wear the brace and for how long?
  • Is surgery necessary?
  • Is waiting and monitoring the best option?

  1. SpineCor – a non-rigid brace for the treatment of idiopathic scoliosis: post-treatment results Eur Spine J (2003) 12 :141–148
  2. SpineCor treatment for Juvenile Idiopathic Scoliosis: SOSORT award 2010 winner Coillard et al. Scoliosis 2010, 5:25
  3. A new concept for the non-invasive treatment of Adolescent Idiopathic Scoliosis: The Corrective Movement principle integrated in the
    SpineCor System Disability and Rehabilitation: Assistive Technology, May 2008; 3(3): 112 – 119
  4. The SpineCor Dynamic Corrective Brace – The first and only dynamic corrective brace for Idiopathic Scoliosis 
  5. SpineCor System Overview And Treatment Results
  6. Effectiveness of the SpineCor brace based on the new standardized criteria proposed by the S.R.S. for adolescent idiopathic scoliosis Journal of Pediatric Orthopaedics, June 2007, P. 375-379
  7. Survival analysis of a group of 365 idiopathic scoliosis patients treated with the Dynamic SpineCor Brace Résonances Eurospéenes Du Rachis. 14(43):p. 1782-1786. French.
  8. Standardization of criteria for adolescent idiopathic scoliosis brace studies: SRS Committee on Bracing and Nonoperative Management, Spine, v. 30, no. 18, p. 2068-2075.
  9. Evaluation of segmental postural characteristics during quiet standing in control and Idiopathic Scoliosis patients, Clin Biomech (Bristol, Avon);20(5): p. 483-490.

The rehabilitation specialists under this division are:

SpecialistsLocation

Tian Li Feng

Raffles Place, George Street

Misako Okazaki

Novena Square, Orchard Road

Lenia Teo

Orchard Road, Parkway Parade

Sylvia Ho

Raffles Place, Parkway Parade

Spinal Back and Neck Care Division

Spinal Back Pain and Neck pain is a significant area in the treatment of musculoskeletal conditions. Spinal conditions inflict a large percentage of the population (see Causes of Back Pain and Neck Pains)

The areas of focus that falls under the Spine division include:

  • Neck Pain conditions
  • Mid-Back Pain/Thoracic conditions
  • Lower Back Pain conditions
  • Pelvis / Sacro-illiac Joint (SIJ) Conditions

Scoliosis is a specialised condition that we treated separate under our Scoliosis division.

List of related conditions:

Treatment of spinal and pelvic conditions such as neck pains and back pains depends firstly on getting the right diagnosis (symptomatic relief is not the same as resolving the problem). Aside from the differential diagnosis (see case study), we offer a range of treatment techniques such as

 

Areas of Focus

Core Concepts is a Multi-Speciality practice where a group of specialist is different areas come together to provide a more completely and comprehensive diagnosis and treatment for our patients. Learn about the different areas of musculoskeletal conditions that Core Concepts focuses on. These areas of focus are centered around several divisions

We understand that sometimes that the rehabilitation field classify certain conditions into non-intuitive areas. For example, headaches and pains around the jaw is a neck (cervical spine) related condition hence is a condition look at by our Spine division. To help you find the appropriate division, we have alphabetized the different body areas linking to the relevant divisions.

A

  • Ankle
  • Arm

B

  • Bladder

C

  • Coccyx
  • Core Muscles

D

E

F

G

H

I

J

  • Jaw, see Temporo-Mandibular Joint

K

L

  • Low Back Pain
  • Lumbar Pain

M

N

  • Nerves
  • Natal, Pre and Post

O

P

Q

R

  • Radius, see forearm

S

T

  • TMJ, see Temporomandibular Joint
  • Temporomandibular Joint
  • Thoracic Spine
  • Tail-bone, see Coccyx
  • Transversus Abdominus

U

  • Ulna, see forearm

U

V

W

X

Y

Z