Print- Share
Email- A A A
PrintSome FAQs concerning Physiotherapy- Part 1
Trying anything for the first time can be stressful, then add in the PAIN factor and understandably concerns are greater. Physiotherapy can be daunting especially when you hear comments such as NO PAIN NO GAIN, or the thought of grueling exercise session.
However the purpose of physiotherapy is simply to work out the cause of the problem and pain and sort it. It is normal to have some apprehensions and question when you attend physiotherapy, why, what, how?
So some Frequently Asked Questions or FAQs :
Will I be better after one session?
In most cases NO. It all depends on the type of injury and whether the problem is acute or chronic.
Lets take the analogy of when a preson is ill and requires antibiotics for an infection. You would not just take one pill and expect to get better? You would be expected to complete the full course of antibiotics similarly physiotherapy to treat a musculoskeletal problem will entail more than just one session.
In the acute phase initial treatment will focus on protective measures to reduce inflammation and scarring. In chronic patients, the nature of chronicity will mean changes to posture, movement patterns, muscles, joints as well as anxiety levels. All these things will therefore take time to change.
In most cases, there will be a combination of both muscle and joint involvement. Muscles are tight, stressed, strained all describing the same phenomena. Muscle can also be weak and therefore painful when exerted. In this instance a person may benefit from strengthening and stretching exercises all which will take a little time to achieve.
If the joint is the source of pain, it may be mal-aligned, stiff, bruised and in the worst case scenario be sore due to a fracture.
Again it is the role of the physiotherapists to decide what he/she feels is the best treatment modality to reduce the joint abnormality and thus the patients symptoms. However one session of joint mobilising may not be enough or be too painful, if for example the joint has been stiff for a year. Therefore more often than not a several sessions are required to loosen and mobilise the joint effectively.
After the initial assessment the physiotherapist should have a good idea about the prognosis of your condition and should be able to provide you with a rough estimate of how many session you will need and over what period.
Can you not see me once a week?
Well the answer is of course yes and obviously depends on the problem itself, but would you like to feel better after 2-3 weeks or drag your symptoms out over 6-8 weeks?
Expanding on the previous analogy whilst taking antibiotics you would not suggest taking the pill once a week only, instead of the recommended daily suggestion; you would follow the prescription that the doctor or pharmacist best advises for you.
Spreading sessions out on a weekly basis especially during the initial phase can mean that any loosening of stiff joints, stretching of muscles achieved during the session of physiotherapy may be lost in 7 days of you doing the “incorrect activities” that caused your pain in the first instance. This may mean that each week you return for physio potentially back at square one with slower and smaller progression. So more frequent sessions in a shorter period will allow the therapist to keep a close eye on your symptoms, activity and achieve faster progressions. The frequency of sessions may tail off as a person is closer to being discharged.
In addition shorter session of physio (half hourly) may be more useful than hourly sessions during the acute and inflamed stage of an injury in particular, as too much mobilising, stretching and strengthening of aggravated tissue may worsen symptoms, so gentle and often is often the better approach.
I Feel 90% better and wish to discontinue treatment?
Now this is something which you may think, and in some instances 90% is as best as you are going to get, as is the nature of some injuries.
Again drawing on the antibiotics analogy you would have to complete the full course of treatment for the full effect of treatment, you would not stop taking the antibiotics as soon as you think your feeling better if your GP/ Phramacist has advised you to take the course of antibiotics for ten days.
Similarly in physiotherapy, if your someone who comes in for a quick fix, an example being a low back strain, your initial sessions will consist of reducing the symptoms and pain. This will be mobilising the joint that is stiff, releasing the muscle spasms and inflammation, and this alone may require 2-3 sessions depending on its severity.
At this point you may feel your back is pretty much better, however your back has not been strengthened and is therefore at great risk of recurrent injuries. You may also not have received all the information for normal movement; you may not be aware of what faulty movement actually caused your strain or not had the chance to process it due to the previous pain. This could mean you return to your normal day-day activities with a weaker back and continue to do the things that may be strain your back.
The problem with repeating this cycle, is each time you strain your back, it produces scar tissue in the affected ligaments and muscles. Scar tissue at its best, will never be as strong or as tensile as muscle tissue and therefore will further compromise the integrity of the affected structures leading to an even greater risk of recurrent injuries.
Hence it makes more sense to reduce your initial symptoms, learn how to look after your back, discover what is straining your back and strengthen your core muscles with individually prescribed exercises.
So here’s hoping that some of your questions have been answered. Look out for some more FAQs next week.
Bottom line: if you don’t ask, you don’t know, so if you are not sure, just ask !
Neckache from Deskbound work. Can Physiotherapy help?
"Dear Sir / Madam,
My neck has been aching on and off when I am working at my desk. Recently, I started to experience heavy headedness and I tend to lose concentration due to that. I have gone through an X-ray and I was told that I have cervical Spondylosis with a bone spur pressing onto the nerve. Are my heavy headedness and neck ache due to spondylosis? Can physiotherapy help me in my condition?" – Josh
Dear Josh,
Thank you for your enquiry.
Spondylosis is a medical term for signs of degeneration or wear and tear to the structures around the spinal bones. It is a problem faced by many people especially deskbound office workers.
There are many other underlying factor and one of them is the bone spurs which can pinch a nerve causing symptoms like pain and numbness. This may cause by excessive mechanical pressure from a poor sitting posture. According to your description, it seems like your heavy headedness is likely linked to excessive physical stress to the neck causing Spondylosis.
In a poor sitting posture, the neck is poked forward from the shoulders and the shoulders are rounded with the lower back in a slouched position. As the neck is hanging away from the shoulders, the muscles in the neck and shoulders will have to work harder to pull the neck back in order to support it. This increases the mechanical pressure on the joints which further aggravates the degenerative process. The muscles will also get fatigued and overworked, giving you the achy sensation to the neck and shoulders.
When your muscle tension becomes bad, it potentially can radiate pain up to the base of the skull. This is because there are sensitive nerves that supply to the head, eye, ear and the joints near the base of the skull . Excessive pressure over these areas can give rise to tension headache, stabbing pain behind the eye, ringing in the ears, jaw pain. The heaviness you felt from the head is most likely from the same upper neck joints at the base of the skull.
To solve your problem, our physiotherapists will
- Mobilise the neck joints to give it flexibility and reduce the mechanical pressure over the joints.
- Some soft tissue work on the muscles may need to be done to reduce your muscle tension.
- Regular stretching or range of movement exercises to reduce muscle fatigue and maintain flexibility.
- Ergonomic advise will be given on how to sit properly at work and there will be some training exercises to increase your awareness of your sitting posture so that you can decelerate the degenerative process and prevent the problem from returning.
It will usually take about 6-8 sessions to have significant improvement on such a case. You can refer to this link for more information on neck related headaches.
Regards,
Chye Tuan
Ultrasound Therapy, Imaging and Shockwaves
"Hi MCR, I keep hearing about ultrasound therapy but I get confused with the seemingly different answers I get about them. There appears to be one for healing bruises and swells. And another to 'see' inside and another to blast off pieces of our bones at the heel of our foot. Are they all the same thing?" – Swee Yong
Dear Swee Yong,
Thanks for your question. Yes, indeed it can be confusing because medical professionals tend to just to refer to it as 'ultrasound', leaving their specific context to mean which type of ultrasound.
Therapeutic Ultrasound
The first one you mentioned about healing swelling is what is called 'Therapeutic Ultrasound'. Used in physiotherapy, this is a high frequency (0.7 to 3.3Mhz) but low energy sound wave. Absoprtion of these sounds waves by the tissues causes the cells to vibrate. The vibrational energy stimulates the cell-repair effects which helps to expedite the healing process. Also, when the sound waves are absorbed into the tissues, they are converted to heat energy which helps to improve circulation.
Compared to other types of 'heat' treatments such as a hot pack, ultrasound is able to penetrate deep into the affected area. When we say 'ultrasound' in the physiotherapy context, we actually mean this form of ultrasound.
Usually at Core Concepts, we use 'therapeutic ultrasound' as an adjunct to our main treatment option as healing the tissue is not enough. We first need to fix the reason behind the tissue injury.
Ultrasound Imaging
The second type of ultrasound you mentioned to 'see' inside, is 'Ultrasound Imaging'. This the type of ultrasound device used by your OBGY to see the baby inside. Much like the 'sonar' of a submarine, sound is used to look inside. The higher the frequency of the sound, the image is sharper but does not penetrate as deeply. (7-18Mhz) for structures nearer the skins such as muscle and 1-6Mhz for deeper body parts such as livers and kidneys. Gyneas and OBGY means this when they say, 'ultrasound'.
At Core Concepts, we use a similar version of Real-Time Ultrasound Imaging to help our clients visually and confirm deeep muscle contraction, particularly for their core muscles.
Shock-wave Therapy
The last type of ultrasound you mentioned is commonly referred to as Extracorporeal Shockwave Therapy (ESWT). Compared to the continuous lower-energy waves of'therapeutic ultrasound, ESWT machines send higher-energy pulses 2 or 3 times per second. These high-energy shockwaves blast off hard structures like heel spurs or kidney stones. The high-pressure waves also help promote healing. ESWT is never referred to as ultrasound though all three types use sound waves.
Hope this helps clear up some of the confusion.
Train Proprioception to Prevent Sprains
Hi, I hear from my personal trainer that i need to train my proprioception because of my ankle sprains. What is proprioception and how is it relevant to my ankle problem? – John Koh
What is Proprioception? (more…)
Soft Tissue Work?
Hi,
I have come across this term, “soft-tissue work” on the internet several times. Usually it is something a therapist will say. What’s does it mean? – Agnes Choo
Orthotics for Achy Feet
"Dear Sir, I am a lecturer and an avid, regular sports player. My feet aches every week and I go for regular foot massages. I did an analysis on my feet during one of the orthotic analysis booths at some shopping centre which reported I have high arch and pronation. I wonder what can be done to correct that and reduce my achiness? " - Mr Ho
SpineCor Brace
Hi,
My daughter has been diagnosed with Scoliosis. We are not keen on her having surgery at this point in time. I have heard about the SpineCor brace. Could you tell us a bit more about it.? Thanks. – Terence.
Sloping Shoulders and Unlevel Hips
I recently took a "posture test" at a roadshow. One of those system, where your body’s alignment is measured with bright colored strings. Seems like my shoulder slopes to the right and hip aren’t quite level to the ground. But I feel fine. Should I be worried? – Eu Chen"
Breastfeeding postural related aches and pain
"I am a recent mother. And I have been breastfeeding my 3-month old baby daughter. Since about 2 months ago, I have started have neck aches and around my upper back. I think this is related to my breastfeeding posture. Is there anything I can do about it? Thanks in advance! – Melinda Q."
