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 our goal is to always tailor your physio input and rehabilitation programme to your specific needs after a thorough assessment of your problems, goals and the amount of time you have available.
Therefore you may not always receive all of the physiotherapy modalities discussed below. This may be because the modality is just not helpful with your particular problem, there may be a more appropriate approach for you and your problem or the modality may in fact be contraindicated or unsafe for use with your particular problem.
It may be the case that some other non musculoskeletal medical problem is the reason that a particular modality is contraindicated. For example if you have a clotting disorder this would contraindicate the use of manual therapy. As a side note this last point is one of the reasons why your physiotherapist will ask seemingly unconnected and what may appear to be irrelevant questions 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 and to manage your pain, discomfort or other symptoms.
However it is important to remember that your treatment plan is not set in stone and your physiotherapist will discuss with you how the plan evolves as your recovery progresses. It is important to bear in mind that different approaches are more relevant at different stages of recovery. Therefore expect things to change as time goes on, as approaches that are helpful on day 1 may not be necessary helpful on day 20.
Often when people think about physiotherapy they associate it with some form of 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.
Whilst manual therapy can and sometimes does have a role in the assessment and appropriate management of musculoskeletal problems, it is important to note that it is not always appropriate, sometimes it is completely contraindicated and even when used it is often a relatively minor part of an optimal management approach.
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 your aims and goals. Taping is often used to support injured structures to improve function and protect the area against further injury in the short term. We also use taping as a reminder to the patient to adopt or to indeed avoid certain postural habits.
Whatever the rationale in your case behind using tape or strapping, it is important to bear in mind it should be used in the short term. The long term aim would always be to restore appropriate muscle power, joint and soft tissue flexibility and balance; to ensure that the injured area is robust and resilient enough to return to normal function without requiring support.
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.
Patient specific rehabilitation or exercise programmes
It is increasingly clear from the available scientific evidence that in the long term rehabilitation is the key to an optimal outcome. Both in terms of return to function and in terms of management of pain and other symptoms. 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 your time is precious, many of our patients are juggling career, family and other commitments. All of our clinicians have family of their own, so we know how busy life can get at times.
Therefore you will not be given a generic exercise sheet or a list of exercises which may or may not 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 exercises and how many times and how often you should be doing them. We will progress your programme as efficiently as possible, so you will not be doing exercises that are no longer required.
Broadly speaking the exercises will fall into four categories; mobility, strength, balance/proprioception and whole body exercise. It is almost impossible however to perform an exercise which only effects one of these categories without any effect on at least one of the other categories.
Following any acute injury such as a sprained ankle or surgery 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. While your physio may feel that one or more of the manual therapy methods discussed above are appropriate to restore joint and soft tissue range of movement, it is important to maintain and progress this in between appointments.
In cases where there has been no history of trauma there can still be limitations in joint and/or soft tissue mobility which need to be addressed. Although in these cases the restricted mobility will not be due to scar tissue, but instead may be due to postural habits, training load or type of training, working habits, previous injury, etc.
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 key priority is to strengthen the surrounding muscles. These will almost certainly be weak as a consequence of the initial injury and then subsequent disuse due to pain etc. Unless this is addressed the patient will not be able to return to his or her previous level of activity and will be increasingly be prone to reinjury. 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 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 effectively and efficiently 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 can contribute significantly to loss of function, lack of confidence as well as increasing the risk of reinjury. A classic example of this is the importance of balance retraining following ankle sprain which has consistently been shown to reduce the risk of reinjury.
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 or intensity of exercise is not possible due to your injury or condition or is aggravating your problem, it may be necessary to curtail or indeed stop this exercise or activity entirely in the short term. As your condition improves your physiotherapist would then discuss with you reintroducing this activity or exercise in a progressive graded manner within the limits of your pain or other symptoms.
Secondly the introduction of new activities in order to restore or improve your normal level of function. For example; in the case of low back pain walking programmes have 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.