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.

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Image physiotherapy sydney

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 !

Some FAQs concerning Physiotherapy- Part 1 is a post from: Musculoskeletal Consumer Review

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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.

Neck-related headaches

Regards,

Chye Tuan

Neckache from Deskbound work. Can Physiotherapy help? is a post from: Musculoskeletal Consumer Review

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"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.

Ultrasound Therapy, Imaging and Shockwaves is a post from: Musculoskeletal Consumer Review

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What is Proprioception?

Proprioception is the ability to sense the movements and position of our body without looking at it. There are receptors in our ligaments that receives and transmit these spatial information to our brain to process the appropriate reactions.

How it works is that there are nerves in our muscles and ligaments which sense the tension of these structures. These nerve receptors receive the information and transmit them to the brain, cueing it to contract or relax the necessary muscles to prevent your joint from going into an awkward position. These activities are done in spilt seconds, just like a reflex.

Ankle sprains with injury to structures like ligaments and muscles can cause deficit to the proprioception system because the receptors are also damaged from the sprain. With poor proprioception, inability to react or coordinate movements in time especially during sports can lead to a recurrent sprain.

Prevent a sprain

To prevent that from happening, your muscles have to learn when and how fast to contract before an injury happens. Therefore it is important to do exercises targeting on proprioception.

Balancing and agility drills are very good form of training to perform better in your sports and of course to prevent another sprain. 

Train Proprioception to Prevent Sprains is a post from: Musculoskeletal Consumer Review

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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

Hi Agnes,

Yes, that is a common phrase used by many therapists even by massage therapists or personal trainers. Essentially, the term ‘soft-tissue’ refers to the soft materials of your body’s musculoskeletal system such as muscles, the fascia surrounding muscles, tendons and ligaments.

If it used in a even broader medical sense, it even covers blood vessels such your veins and arteries and soft body organs.

Another way to think about ‘soft-tissue’ is what is it not. Non-soft tissues or ‘hard tissues’ are hard bony structures like bones, nails and teeth.

There are other types of tissue that are soft but not termed as soft tissue. They include some types of nerve tissue and hormone producing cells. Usually the first paragraph is a good enough descriptor for most.

In the context of therapy, ‘soft-tissue’ work refers to massages or release techniques on the soft tissues. Some examples of soft-tissue work include deep-tissue massage, trigger point release, reflexology and myofascial release.

‘Hard-tissue’ work refers to techniques where force is exerted on the bones themselves. Examples include joint mobilisation or spinal manipulation.

Physiotherapists do both ‘soft-tissue’ as well as ‘hard-tissue’ work. However, looking on from outside, it is often hard to distinguish which is which.

Sylvia Ho

Soft Tissue Work? is a post from: Musculoskeletal Consumer Review

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Dear Mr Ho,

Thank for your enquiry.

Your achiness may be coming from your overworked foot muscles because of your high arch. Your regular massage will give you good temporary relief to the muscles but it won’t change the underlying issues.

People with a high arch foot tends to under pronate. The pronation or rolling inwards of your foot helps your body to absorb the shock coming from the impact of your foot hitting the ground. When there is a lack of pronation, the muscles underneath the foot has to work harder to react to that impact. Therefore the achiness of your feet comes from the overworked or fatigue muscles in the foot.

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One of the solution is to get a customised foot orthortics, commonly known as insoles. These orthotics do not correct high arched foot but what it does is it aids in supporting your arch, normalising your foot mechanics, thus decreasing the pain. Hence your foot muscles do not have to work so hard to help in the shock absorbtion  process.

You should also do some exercises to strengthen up the intrinsic muscles of your foot. When these muscles of the foot are weak, they are more prone to fatigue, hence causing you the achiness. Read on here for the exercises for the intrinsic muscles of the foot.

There are also other reasons why your feet may underpronate. The joints in the foot and ankle may be very stiff in a high arched foot. This stiff mobility between the joints are not able to help much with shock absorption and so your foot muscles have to work harder to absorb the impact.

I suggest that you get a customised foot orthotics to help with the high arch. You should also consider a proper physiotherapy assessment so that the physiotherapist can treat and teach you the relevant exercises to resolve this problem.

Best Regards,

Chye Tuan

Orthotics for Achy Feet is a post from: Musculoskeletal Consumer Review

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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.

Dear Terence,

The SpineCor programme is a unique programme for the conservative treatment and management of scoliosis. It works well with scoliotic children (idiopathic scoliosis) especially those at pre-puberty age.

What is unique about the SpineCor programme as compared to the conventional method is the type of brace used and the specific exercises designed to improve the muscle strength required in the active re-aligning of the spine.

The traditional or conventional method of bracing for prepuberty kids uses a rigid brace. A rigid brace does not allow much movement in the spine. The aim here is to re-align the spine with an external force, locking it down in desired position as the kids grow. The disadvantages with this brace are:

1. Low compliance. Kids dislike using the brace as it is bulky and aesthetically not pleasing especially with girls
2. Hot to wear in our humid environment
3. Weaken the muscles. As the idea of the rigid brace is not allow movement, it makes it difficult for the kids to undertake sports in the brace.
4. When the children come off the brace, it has been found that the curvature of the spine continues to progress.
5. Physiotherapy sessions are aimed at releasing the tight muscles and building overall core strength.

With the SpineCor programme, the type of scoliosis the child presents with is first classified. With this classification, the direction of the curvature can be determined as it progresses. Based on this knowledge of expected progression, SpineCor aims to specifically reverse the direction of the curvature by bracing them in the opposite direction as the spine curves.

This programme is more specific to the type and curvatures of each child compared to the rigid brace.

1. The pre-puberty kids are still braced, but in a dynamic brace. This allows the spine to move as required by functional activities hence maintaining joint mobility and muscle strength
2. The brace is made up of elastic straps that assist the body to hold the spine in a more neutral, aligned position while allowing movement. This is the most important aspect of SpineCor. By allowing movement in a more neutral position (opposite to the direction of the curves), the brace retrains the neuromuscular function of the body. This means that the brace is re-teaching the brain, the muscles that this new position is normal, that it is correct. It is postulated that because of this retraining of the brain and muscles that the results are maintained even when the brace is removed.
3. SpineCor also has a specific rehabilitation program that facilitates the action and goals of the brace. This exercise program focus on strengthening the muscles required to help the brace hold the spine in a more neutral position.
4. Regular Physiotherapy sessions for SpineCor will be targeted at releasing the tight muscle and joints, hence facilitating the correction of the spine.
5. Results are the most optimal when braced are used from pre-puberty to about the age of 16-18. The minimum no of years required is 2 years. e.g. if you started at 16 years of age, then only after 2 years should you stop using the brace- this is on the premise that with the removal of the brace that there is not progression or regression of the curvature.

On the SpineCor programme, you are expected to re-check the fitting by a SpineCor accredited fitter every 2-3 months initially. Gradually weaning to every 6 months after 1 year. With the SpineCor rehabilitation programme, ideally a session once a week for the first month and gradually weaning to once a month until the removal of the brace. The frequency of the sessions is also dependent on how quickly the child understands and learns the exercises.

For more information on SpineCor, do visit our website, scoliosis.coreconcepts.com.sg

SpineCor Brace is a post from: Musculoskeletal Consumer Review

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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"

source: Flickr - trickyech

Hi Eu Chen,

I think you are right in not worrying about it too much.

Firstly, the coloured strings are there to give an indication of symmetry, i.e. if both shoulders are at the same level, and hips even in terms of height. As most of us are dominant on one side, it is not unusual to have one shoulder lower than the other. It is also quite normal for most people to have a leg length discrepancy of approximately 1cm which will affect the height of you hips. Therefore, it is unlikely anyone is truely symmetrical.  You should only be concern if there is a significant difference of at least 1.5cm and accompanied by pain or discomfort.

Secondly, I think to assess if there is anything actually wrong, we need to do a more thorough assessment. This consultation will include asking if you’ve actually had any problem as well as any history of back or neck pain. On top of that a proper full physical exam is essential to diagnose the problem and treat the mechanical faults present.

Therefore, in my opinion, unless you have actual discomfort or pain, a bit of asymmetry is fine.

Best Regards,

Sylvia

Sloping Shoulders and Unlevel Hips is a post from: Musculoskeletal Consumer Review

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"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."

Dear Melinda,

International Breastfeeding Symbol

Some things you can try out:

• Make sure you sit well supported, preferably with a high back chair or using pillows to support behind your back (place pillow vertically).
• A footstool to raise your lap, if your feet is not resting firmly on the floor and the baby is not high enough to feed. 
• Place a pillow or two on your lap to support your baby (so baby lay at chest level), draw your shoulder blades back and keep your chin in as you bring your baby towards you for nursing. Experiment with the placing of pillows to achieve the most comfort. Alternatively,there are several "nursing" pillows on the market that help raise baby to a comfortable height and position. Whatever position you choose to nurse in, make sure you have a good posture and feel comfortable.
• Have frequent short breaks (about 30s) while breastfeeding to stretch your neck.
• Place hot packs around neck and upper back for about 20 minutes each time.  Alternatively, try showering with warm water over the neck and upper back where it is sore. 

If your neck pain does not resolve within 3 months, it is best you seek a women’s health physiotherapist to help assess and manage your pains.

Breastfeeding postural related aches and pain is a post from: Musculoskeletal Consumer Review

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Hi, I am suffering from neck pain. My doctor ordered an x-ray for my neck. He said there are bone spurs but there was no need for surgery. Does that mean i have to live with my neck pain permanently? Will it get worse?" – Peter 

Hi Peter,

Source: Flickr

Many patients have gone for x-rays and been told that they have bone spurs (also known as osteophytes) in their neck or back with the implication that the spurs are the cause of their pain. However, bone spurs are simply just an indication that there is degeneration going on in the spine. They are not necessarily the actual cause of the patient’s pain. Bone spurs are by and large normal findings as one age and are quite common in people over the age of 60. It is important to know what is the actual cause to your neck pain because that will impact your treatment options.

However, if your doctor has determined that the actual cause of your neck pain is from the bone spurs, you can still manage your symptoms effectively and recover from your neck pain through conservative measures without the need for surgery; this is provided that you do not have severe nerve compression resulting in unremitting pain or weakness / motor loss.

Conservative or non-surgical treatment for patients with neck pain arising from bone spurs might include:

• Medication. Anti-inflammatory drugs, muscle relaxants or pain medication.

• Cortisone Injection. Cortisone shots help reduce joint swelling and pain. The effects of these are temporary and may need to be repeated.

• Physiotherapy. Physiotherapy, exercises and joint manipulation help restore flexibility and strength of the neck, improve posture and decrease the compression on the nerves.

Bone Spurs in the Neck Area of the Spine is a post from: Musculoskeletal Consumer Review

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