Physiotherapy for Injuries and Movement Disabilities

In essence, physiotherapy helps restore movement and function when someone affected by injury, illness or disability.

Especially, Chronic pain can affect your day to day activities and decrease your quality of life. Our team of physiotherapists specialized to assess, diagnosing and treating your musculoskeletal problems from General Physiotherapy. We believe that pain not necessary and not something you have to live with.

Physiotherapist treating back pain with Physiotherapy

Our Core Aims

Physiotherapists at Core Concepts have a few main aims we wish to achieve with clients:

  1. Reduce the immediate pain and treat the symptoms
  2. Uncover the underlying cause of the pain
  3. Strengthen muscles to prevent recurring injuries
  4. Restore normal function, quality of life and strength

Musculoskeletal Issues We Treat

We treat most musculoskeletal (Physiotherapy) issues including:

  • Ankle Sprains
  • Back and neck pain
  • Cervicogenic Headaches
  • Carpal Tunnel
  • Frozen Shoulder
  • Incontinence
  • Physiotherapy for Pregnancy
  • Post-surgical rehabilitation
  • Sciatica
  • Sports Injuries
  • Tennis/Golf Elbow
  • Whiplash

What are the usual complaints from cervicogenic headaches?

Most sufferers complain of a deep dull ache starting from the base of the skull to the top of the head, usually over just one side of the head. It may present on both sides if the neck pain and stiffness are on both sides of the neck. Other complaints include feeling pressure at the back of the eye and discomfort in the jaw.

Therefore, another symptom that confirms the diagnosis the presence of tenderness when pressure applied over the area of the cervical spine immediately under the skull. In some cases, when pressure is applied for long enough, sufferers feel some relief from the headache.

What are some of the activities that aggravate this condition?

Typically, activities that require the neck in a sustained strained position for a prolonged period of time will aggravate this problem. The neck posture is often faulty, the head is turned or tilted to one side or if the sufferer is adopting the “poke chin” position.

For Example; such activities include reading, using the computer, especially the laptop, putting on makeup, looking up for too long or watching movies or theatre when seated on the side of the hall.

Why do these activities aggravate the headache?

Therefore, when we adopt the “poke chin” posture, we apply compressive stress to the upper part of the cervical spine, namely, C1 and C2 levels (C1/C2 refers to the first two cervical vertebrae in the spine). Similarly, when we turn our heads to one side, we compress the C1-2 level on the same side.

For that reason, this happens as most of the movement of the head occurs at these 2 spinal levels. So if we sustained these postures or repetitively perform them, these 2 levels will start to degenerate and the cartilage wears out over time. This in turn results in stiffness of the upper cervical spine.

What is the relevance between the C1-2 levels and headaches?

The nerves that exit C1-2 and sometimes C3 supply sensation to the back of the skull to the top of the head and in some people, to the jaw area. The nerves that exit from the right side of the neck will supply only the right side of the head, likewise for the left.

When these joints are stiff or mal-aligned, the nerves at the affected levels will irritated causing pain. So when one has right-sided upper-neck pain or stiffness, the pain always referred to the right side of the head.

What can we do?

We need to improve the cervical joint alignment and mobility at the C1-2 levels and to remove the compressive forces, which is to adopt good posture. This will reduce the irritation to the nerves.

If the cervical facet joints are slightly rotated due to contractile forces of tight muscles surrounding the neck, the affected joints are already in some amount of compression and may not allow full functional or physiological range. In this situation, physiotherapists can apply the “MUSCLE ENERGY TECHNIQUE” to realign the joint position. This technique uses the muscles to reposition the joint.

Various Physio Techniques

Once the joint is in a neutral position, the actual stiffness (hypomobility) can then accurately assessed. Stiffness can be treated by various techniques, such as passive mobilization through the MAITLAND technique or with the clients’ active movement with the MULLIGAN SNAG technique. If the joints remain stiff even after a few sessions of mobilization, MANIPULATION can be applied. Once the ideal mobility achieves, the client will expect to maintain it by self-mobilization with a strap.

Once the mobility improved, the headache will be resolved. The client can remain pain free for a long time provided the original cause of poor posture solve. Good ergonomics here paramount.

First appeared at /neck-related-headaches/

Whiplash, a type of neck pain that results from an injury that occurs following a sudden acceleration-deceleration force or movement of the head backwards, forwards, or sideways.

The movement unrestrained, rapid and abrupt, often due to a car accident or any other mishaps. Hence, the force causes the head into forward-flexion (head-down position) and the head gets whipped back very quickly into extension (head in a looking up position).

Aside from road traffic accidents, the following reasons can also cause whiplash:

  • being struck on the head by a solid or heavy object
  • the head is suddenly jolted backwards due to a slip or fall
  • a sudden blow to the head, such as during sports like rugby or boxing

movement of the head and injury areas during whiplash

When this occurs, the forces may result in injuries to bony or soft tissues such as in the neck muscles, disc, tendons, ligaments, and nerve roots.

Several Grades of Whiplash Severity

There are several grades to the severity of whiplash-associated disorders (WAD).

  • Grade 0: No physical signs of injury. No pain or discomfort.
  • Grade 1: No physical signs of injury. Neck pain, tenderness or stiffness.
  • Grade 2: Neck pain, stiffness or tenderness. Some physical signs of injury such as point of tenderness or trouble turning the head.
  • Grade 3: Pain, tenderness or stiffness and neurological signs of injury, such as changes to the reflexes or weakness experienced in the arms.
  • Grade 4: Pain, fracture or dislocation of the neck.

The above grading also known as the Quebec Classification Disorder and used as the guideline by the Singapore courts to assess neck injuries.

What are whiplash symptoms?

Because the soft tissues in the neck become stretched and strained, a number of symptoms can also occur following whiplash injury. Symptoms after the initial trauma can occur immediately after the injury or even after a few days. Additionally, do note that whiplash can also occur at relatively low-speed crashes.

People who experience whiplash may develop one or more of the following symptoms which include:

  • Headache
  • Pain in the shoulders and arms
  • Dizziness
  • Altered sensation, pins and needles, numbness in the arms
  • Weakness
  • Visual and auditory symptoms
  • Difficulty concentrating
  • Difficulty in swallowing

Less common symptoms include dizziness, memory loss, pins and needles in your arms and hands, poor concentration and irritability. The symptoms usually worsen the day after the injury and may continue to worse for the next several days. People experiencing such symptoms should seek proper medical advice as soon as possible, within 24 hours if possible.

Why is your neck so stiff and it hurts to move?

In most cases of mild or Grade 1 or 2 whiplashes, the muscles attached to the neck joints (cervical spinal vertebrae) are strained and suffer some form of bruising. In anticipation of the shock (from the oncoming accident or fall), the muscles of the neck will tense up to support the neck and head before being forcibly stretched by the force of the accident. The force will exceed these muscles’ ability to support and will cause a strain.

It is these sprained muscles that hurt when you later move your head as they very much involved the movement of the head and neck.

Stiffness

Stiffness comes on later as a result of a lack of movement to avoid the pain. This is a form of pain avoidance. Stiffness often the result of neck joints losing their mobility from the lack of movement and the muscles that become tight and taut as a result of being held in place for long periods of time. The stiffness later makes it hard to move without pain in a vicious circle.

Physiotherapy Options

Treatment options for whiplash with physiotherapy include mobilisation, manipulation and exercises. Most whiplash patients will start to feel better within a few weeks of treatment. Needless to say, the sooner you start your treatment and follow the treatment plan, the shorter your recovery period will be. Putting off treatment will often lead to chronic issues setting in and making it that much harder and longer to recover.

  • Reduce neck pain, headaches and inflammation.
  • Improve the range of motion of your neck joints (see manual therapy and joint mobilisation)
  • Improve your neck posture through neck position awareness (proprioception), fine motor control and balance.
  • Lengthen tight-and-shorten muscles by releasing taut and tense muscles.
  • Strengthen your neck and upper back (thoracic spine) muscles.

Spondylosis (pronounced – spon – di – lo – sis ) a degenerative condition of the spine vertebral joints. It is also commonly known as Cervical Spondylosis or Lumbar Spondylosis when it occurs in the neck and lower back respectively. Primarily as a result of wear-and-tear of the bones and cartilage, the space between two spinal vertebrae narrows with spondylosis.

Therefore, it is this narrowing of the space that leads of the sensation of pain and numbness. As the space between the vertebrae narrows, it impinges on the nerve root emerging from the spine at the location. Depending on the location of the nerve root, pain may be felt down the arm or legs (See Dermatome Patterns)

Type of Spondylosis

When spondylosis occurs in the neck, it is known as “cervical spondylosis”. At the lower back, it is known as “lumbar spondylosis”.

Whether Bones spurs or osteophytes sometimes occur together with spondylosis. These bone spurs are abnormal growth that occurs usually as a result of the body attempting to stabilise the degenerated joint. Like in the case of an unstable building, we building extra scaffolding to better support the building. Unfortunately, these bone spurs can sometime further aggravate the spondylosis condition by pressing onto a nerve themselves.

Although cervical spondylosis and lumbar spondylosis; condition arising from wear-and-tear and is often found in older adults, it is not uncommon to find spondylosis in younger adults in their late 20s or 30s. Early wear-and-tear of joints usually exacerbated by un-even pressures or forces of a joint as a result of poor bio-mechanics (e.g posture), excessive repetitive movement of the joint and excessive loads on the joint.

In conclusion, Spondylosis should not confuse with spondylitis, spondylolysis, or spondylolisthesis which sound and spelt similarly.

Symptoms of Spondylosis

Spondylosis symptoms often develop slowly over time but may start suddenly as a result of the nerve compression. The most common symptoms are:

  • Neck pain (may radiate to the arms or shoulder)
  • Neck stiffness that gets worse over time
  • Loss of sensation or abnormal sensations in the shoulders, arms, or legs
  • Weakness of the arms or legs
  • Headaches, particularly in the back of the head (see Tension Headaches)

More severe but less common spondylosis symptoms are:

  • Loss of balance
  • Loss of control over the bladder or bowels (if the spinal cord is compressed)

Treatment for Spondylosis

While the degeneration cannot be cured or reversed, the symptoms and pain that results from the spondylosis degeneration can manage and alleviated. At Core Concepts, we may treat spondylosis with one or more of the following techniques or approaches

Studies show that about 1 in every 5 Singaporeans1 suffer from back pain and neck pain, and you have some 80% chance of suffering from back pain and neck pain sometime during your lifetime.

Common Causes

Common causes of back and neck pain include:

  • Straining the muscles or ligaments
  • Pressure on the inter-vertebral discs
  • Nerve compression or entrapment
  • Damage to the vertebra (spine).

Back pain and neck pain may either occur suddenly or over time due to repetitive strain. The same survey found that about 1 in 10 Singaporeans suffer attacks of pain once a month or more frequently. In most cases, nothing abnormal shows up in tests such as X-rays and there is no permanent damage.

Pain is a complex symptom that affects us both physically and mentally. Your response is as individual as you are. (See “Pain Layers“)

Find out how physiotherapy techniques such as manual therapy and core stability training helps to relieve and assist in the prevention of back and neck pain.

Reference:

  1. Feb 2000 survey conducted by Back Society of Singapore

Specialised Physiotherapy Services

What’s more, we also offer a range of specialised services that complement pain management and treatment of conditions.

Some of our other specialised services include:

Please contact us for General Physiotherapy appointment booking or for further information on these particular services.

Located in Singapore, our team of physiotherapists at Core Concepts can aid in your road to recovery by effectively resolving your injury with treatment options tailored to your individual condition. With actively guided treatment, you can expect to recover with reduced neck pain, improved neck posture and minimising your chances of future neck pain.