At Midlothian Physiotherapy LLP, we realise that our patients are all different, have different problems, different priorities, different demands on their time, and have different goals. Therefore we always individualise your physio treatment and rehabilitation programme to your needs after a thorough assessment of your problems, goals and the amount of time available.
Therefore you won’t necessarily receive all of the physio treatment modalities discussed below. This may be because the treatment method is just not helpful in your particular problem, there may be a more appropriate treatment approach for you and your problem or the treatment method may in fact be contraindicated or unsafe for use with your particular problem. Additionally it may be the case that some other non musculoskeletal medical problem is the reason that a particular treatment modality is contraindicated. For example if you have a clotting disorder this would contraindicate the use of acupuncuture. As a side note this last point is one of the reasons why your physiotherapist will ask seemingly unconnected questions to your presenting problem about your general health and past medical history.
Your physio will first take a thorough history as discussed here, they will then thoroughly assess you and your problem by carrying out an objective assessment as discussed here. Once they have done this they will make a plan in conjunction with you to return you to your desired level of function to and manage your pain, discomfort or other symptoms such as numbness or pins and needles.
However it is important to remember that your treatment plan is not set in stone and your physiotherapist will discuss how the plan evolves as your recovery progresses and perhaps even more importantly if you don’t make progress. It is important to bear in mind that different treatment modalities are more relevant at different stages of recovery. Therefore expect things to change as time goes on, as modalities that are helpful on day 1 are not necessary helpful on day 20.
The physiotherapists at the clinic all use manual therapy. Manual therapy covers a variety of “hands on” techniques affecting joints which include manipulation and joint mobilisation. It also refers to soft tissue techniques such as transverse frictions, myofascial release techniques and neural mobilisations.
These are usually used in treating spinal problems such as low back pain or neck pain. The technique is a high speed short range thrust aiming to improve joint range of movement and to reduce pain. Whilst there are some contra-indications to their use, the staff at the clinic are extremely well trained and you can rest assured that you are safe in their hands. As mentioned above ensuring that there are no contra-indications to a course of treatment is one of the reasons for taking a detailed subjective assessment or history.
Joint mobilisations are used to treat both spinal problems and problems affecting peripheral joints including the knee and the shoulder. They tend to be slower and performed through a larger range of movement than manipulations, however the goals are the same though, to increase joint range of movement and to reduce pain. Different grades of joint mobilisation are used dependent on the degree of joint “stiffness” present and the degree of pain and/or swelling present .
Soft Tissue Techniques
Soft tissue techniques such as transverse frictions and myofascial release techniques are used to reduce pain, improve range of movement and facilitate recovery.
Taping and strapping
There are a variety of different types of tape and strapping used and a variety of different methods used, depending on the aim or goal of your physio. Taping is often used to support injured structures to improve function in the short term and protect the area against further injury. We also use taping to give a reminder to the patient to adopt or to indeed avoid certain postural habits.
Two of our physios use Acupuncture, this can be helpful to reduce pain in conjunction with other treatment approaches to optimise outcome. If you are seeing one of our staff who do not use acupuncture and they feel it would be helpful for you, they would of course liaise with their colleagues to arrange this for you.
Although electrotherapy has generally fallen somewhat out of favour we do use Ultrasound when appropriate to facilitate recovery following acute soft tissue injuries such as muscle strains or ligament sprains. It is however only used as part of a overall treatment approach.
Patient specific rehabilitation or exercise programmes
Rehabilitation or exercise covers a wide range of different types of exercise with very different aims and objectives. The staff at the clinic realise that time is precious, many of our patients are juggling career, family and other commitments. All of our clinician’s have family of our own so we know how busy life can get at times. Therefore you will not be given a generic exercise sheet or list of exercises that may or may not all be necessary. Instead any exercises that we give you will be specific to your particular problem and tailored to fit into your lifestyle. Your physio will ensure that you know exactly how to do the exercise and how many times and how often you should be doing them. We will progress your exercises as efficiently as possible, so you will not still be doing exercises that are no longer required.
Broadly speaking the exercises will fall into four categories; Mobility, strength, balance/proprioception or whole body exercise. Whilst it is impossible to have an exercise which only affects one of these categories without any affect, however minimal at all on at least one of the other categories. It is worth discussing these categories so that you can understand the rationale for the exercise programme you have been given.,
Following acute injury such as a sprained ankle or more chronic problems such as arthritis, there is often a loss of range of movement in joints and/or the soft tissues surrounding them. Following injury scar tissue is laid down as part of the healing process. This scar tissue has a tendency to shorten, therefore an important part of your treatment is to regain an appropriate range of movement. Whilst your physio will use the manual therapy methods discussed above to restore joint and soft tissue range of movement, it is important to maintain this in between appointments.
Strength training has an extensive list of benefits including increasing bone density, increasing muscle power and beneficial changes in tendons and other soft tissues. In the case of chronic problems such as arthritis the surrounding supporting muscles are often weak. There is considerable evidence that strengthening these muscles has a beneficial effect on pain and function. In the case of acute injuries once the acute pain and loss of movement has been dealt with, the surrounding muscles will still be weak due to disuse atrophy. Unless this is addressed the patient will not be able to return to his or her previous level of activity and will be more prone to re injury. The classic example of this would be the runner with recurrent calf strains or the footballer with recurrent hamstring strains. In the case of tendon problems such as tendinopathy or tendonitis strengthening programmes are at the core of their effective management due to the changes in tendon structure which appropriate eccentric strengthening evokes.
Proprioceptive information refers to the information that is sent from a variety of receptors or sensors in your joints and the surrounding soft tissues to your spinal cord and brain. This information is essential for you to move well without pain or other problems. We know that following pain or any sort of injury that this mechanism is disrupted and that if not retrained contributes significantly to loss of function, feeling a lack of confidence as well as increasing the risk of re injury. The good example of this is the importance of balance retraining following ankle sprain which has consistently been shown to reduce the risk of re-injury.
Your physio may give you advice regarding whole body exercise. This will generally fall into two categories, advice regarding activity that you are doing at the moment and advice regarding new activities.
Firstly advice regarding modification of current activity or training, if your chosen form of exercise is not possible due to your injury or condition. As your condition improves this would then be replaced by a graded return to your chosen activity.
Secondly in order to restore your normal level of function, for example in the case of low back pain a walking programme has been shown to be helpful in the management of both acute and chronic low back pain. Additionally it is important to know that inactivity generally is detrimental to your health.
Can we help you?
If you would like to book an appointment with one of our physiotherapists at our Eskbank clinic just outside Edinburgh, then please contact us. Our physios all have a minimum of 15 years of clinical experience in a broad range of different settings. So you can rest assured that we will have experience of your particular problem, no matter how unusual you may think it is. We are based in Eskbank serving Edinburgh and the surrounding area. We are open from 8 am to 8 pm and can often see you within a few days if not the same day. If you are paying yourself you can self refer to us, you do not need a GP referral. If you are using health insurance we would advise you to speak to your insurer before making an appointment with us.