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When assessing soft tissue injuries, whether that’s muscle, tendon, ligament or nerves, I’m looking for what brings on your symptoms. It can include basic everyday movements like bending forward to do your shoelaces, looking down at your phone or just sitting on the sofa. Usually during an examination, I’ll ask the patient to move into the position that causes the pain, which gives me a good idea of what type of injury has developed. The majority of soft tissue problems I see are caused by over-used muscles that result in the body producing tough, dense scar tissue that builds up. Eventually muscles become shorter, tendons become inflamed and nerves can become irritated. I have found that Active Release Technique (ART®) is a fantastic tool for the management of these conditions. ART® uses manual therapy to apply compressive, tensile and shear forces to address repetitive strain injuries, cumulative trauma injuries and constant pressure tension lesions. Its design is 3 fold:
 I treated a patient recently who had suffered shooting pain down their leg for the last 3 months. They
visited PhysioImpulse seeking assessment for a suspected disc bulge. After the initial assessment it turned out to be chronic irritation of a muscle around their hip which I treated with a combination of manipulation and ART®. This initial session alleviated the shooting leg pain and with a few more follow up sessions the localised hip pain had resolved fully restoring the patient back to normal pain free activities. If you have persistent pain feel free to give us a call and book in for your initial consultation to assess if ART® is the solution for you.
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Parkinson’s Disease is a progressive neurological condition, which can cause a number of symptoms that impact on walking, balance and everyday tasks. An area of the brain known as the substantia nigra normally produces dopamine, which is a chemical that transmits signals to another part of the brain responsible for coordinating movement. When a person has Parkinson’s, there is less dopamine produced, which can cause the following symptoms:
Neurological physiotherapy is extremely beneficial for patients with a diagnose of Parkinson’s Disease. Our experienced physiotherapists will create a treatment plan with you tailored towards your specific goals and needs. Treatment can be in clinic or as a home visit if required. Treatments can include:
Have a look at the latest Parkinson’s Disease blog on PD Warrior. PD Warrior PD Warrior is a relatively new and exciting treatment concept started in Australia and now used all over the world to improve the symptoms of Parkinson’s Disease. It is based on the latest evidence and research and consists of a programme of rehabilitation that is specific to a person’s Parkinson’s symptoms. It can be tailored to each person and works through key movement patterns and has been shown to slow down disease progression. Unlike other exercise-based treatments, PD Warrior works ensures that treatment is tailored to specific difficulties that a person may be experiencing that are directly related to the condition. By doing this, goals can be worked towards more effectively. PD Warrior can be used with any age group and can be tailored to the stage of Parkinson’s Disease that a person is at. Patient Experience Darren was diagnosed with idiopathic Parkinson’s Disease at age 65. He had been finding that his walking had slowed down considerably over the past 18 months and often tripped when going up stairs at home. After a number of tests and visits to specialists, he was seen by a neurologist who gave the diagnosis of Parkinson’s Disease. Darren loves to walk and would happily walk in the countryside for up to 10 miles. 2 months after his diagnosis, he decided to try neurological physiotherapy as he was desperate to get back to his local walking group. Darren had a combination of hands on treatment to address his stiff muscles and joints and also started the PD Warrior exercise programme, which he could also do at home in between physiotherapy sessions. He is now able to walk 5 miles including hills with his walking group and his neurologist has arranged his appointments once a year rather than the initial 6 monthly reviews. He has had no trips or falls in the past 6 months and feels more active and energetic than before his Parkinson’s diagnosis! Please contact Physioimpulse to book an assessment or contact Katie our specialist neurological physiotherapist for further details. Have a look at the video below describing PD Warrior. https://youtu.be/Hy02Ka-rsKs The benefits of running are countless, from weight management to disease prevention (Harris, 1981). Unfortunately these benefits can be offset by injury. Annually it is seen that up to 65% of people experience pain as a result of running (Marti et al, 1988). For this reason, it is essential to put in place preventative strategies to reduce the probability of injury. Common strategies include rest, painkillers, injections and even surgery. These approaches may improve the symptoms in the short term but are likely to fail tackling the root cause resulting in a re-injury (Noakes, 1991).
As summer approaches and better weather is arriving, there is nothing quite like going for a run. To ensure your running is as pleasurable and pain free as possible why not take advantage of the running analysis service we offer here at Physioimpulse. What is running analysis? Running analysis is the assessment of running technique. It highlights abnormalities within running gait with the result of preventing or at the very least limiting running injuries. What to expect We run 60 minute sessions, during which we will take video recording of your running technique. We record multiple angles to ensure we capture all possible abnormalities, these include videoing from the front, side, back and also specifically your feet. We then assess each of these videos with you in slow motion, highlighting potential issues which may in time result in injury or reduced running efficiency. Benefit of having your running analysed by Physioimpulse We also complete a physical assessment and combine thiswith the information gained in the running analysis to create a bespoke exercise program. This effective combination alongside tailored manual therapy allows us to better prevent injury and improve running performance. In addition to this we can make recommendations on different types of footwear which may benefit you. We can also refer you on to our specialist gait analysis and orthotics service, where customised inserts can be created for you. To find out more, read this Page What is PGP? PGP (previously known as Symphysis Pubis Dysfunction (SPD)) affects 20-50% of all pregnant women. PGP is localised around the back of the pelvis, and described as a pain between the posterior iliac crest (the back of the pelvis) and the gluteal fold (the line where the buttock meets the thigh), particularly around the sacroiliac joint (SIJ). The pain may radiate down the back of the thigh and can also occur in conjunction with/or separately of pain in the symphysis (a cartilaginous joint located between the left and right pubic bones near the front midline of the body, just in front of the bladder). PGP can cause pain and stiffness in the pelvic joints, difficulty walking, climbing stairs and turning in bed. Common painful areas:
Pelvic girdle pain has been explained as the result of a combination increased pelvic joint mobility, mechanical strain, and altered neuromuscular control, which also affects the myofascial structures around the sacroiliac joints and the symphysis pubis. Causes Several factors have been identified as potential risk factors for PGP, including a history of previous low back pain, trauma of the back or pelvis, the number of previous pregnancies, high levels of stress, emotional distress, physically demanding work, smoking and high body mass index (BMI). This does not mean that if you have one or more of these factors you will automatically develop PGP as every women and every pregnancy is unique. However, having an understanding of potentially contributing factors can help you to take more care of yourself. Management PGP can be treated by a physiotherapist because it is a mechanical joint problem rather than a hormonal problem. Manual therapy can consist of gentle mobilisations of the pelvis and spine and soft tissue release techniques such as massage and myofascial release. Mobility exercises, postural re-education and core stability/pilates exercises are very beneficial to get your muscles working properly so that they can support your lower back and pelvis. Other management techniques include the use of a pelvic belt, which helps to reduce pelvic pain and improve comfort of pregnant women by providing gentle compression and support. Some research has shown that the narrow flexible belts allow a decrease in SIJ and overall pain; and the broader and more rigid belt can help to decrease back pain but ultimately it is important that individuals choose the style of belt that is most comfortable and offers support where they feel they need it. Women can also talk to their GP or local pharmacist about pain relieving medications. From a physiotherapy point of view, pain relief can prove very helpful in the initial instances if individuals feel that they are in too much pain to receive manual therapy. Pain relief can allow a window of opportunity to engage in physiotherapy, which will help with treatment progression and PGP management. PGP is treatable at any stage during pregnancy. Women may also choose to engage in pilates-based exercises to improve pelvic stability ante-natal, post-natal or in preparation of getting pregnant. Should you require further guidance with these matters then please feel free to get in touch with the clinic. Renu is one of our Chartered Physiotherapists who is a qualified matwork pilates instructor, accredited by The Australian Physiotherapy and Pilates Institute, and is experienced in ante and post-natal pilates. Useful links:
Pelvic Obstetric and Gynaecological Physiotherapy http://pogp.csp.org.uk/publications/pregnancy-related-pelvic-girdle-pain-mothers-be-new-mothers The Pelvic Partnership http://pelvicpartnership.org.uk/ NHS https://www.nhs.uk/conditions/pregnancy-and-baby/pelvic-pain-pregnant-spd/ NCT https://www.nct.org.uk/pregnancy/pelvic-girdle-pain-pregnancy References: Albert, H. B. et al. 2006. Risk factors in developing pregnancy‐related pelvic girdle pain. Acta Obstetricia et Gynecologica Scandinavica 85(5), pp. 539-544. doi: 10.1080/00016340600578415 Bertuit, J. et al. 2018. Pregnancy and pelvic girdle pain: Analysis of pelvic belt on pain. Journal of Clinical Nursing 27(1-2), pp. e129-e137. doi: 10.1111/jocn.13888 Bjelland, E. K. et al. 2010. Pelvic girdle pain in pregnancy: the impact of parity. American Journal of Obstetrics and Gynecology 203(2), pp. 146.e141-146.e146. doi: 10.1016/j.ajog.2010.03.040 Mackenzie, J. et al. 2018. Women's experiences of pregnancy related pelvic girdle pain: A systematic review. Midwifery 56, pp. 102-111. doi: 10.1016/j.midw.2017.10.011 Vleeming, A. et al. 2008. European guidelines for the diagnosis and treatment of pelvic girdle pain. European Spine Journal 17(6), pp. 794-819. doi: 10.1007/s00586-008-0602-4  Medial Tibial Stress Syndrome (MTSS) is a common musculoskeletal condition associated with running and walking activities. Recovery times in MTSS range greatly, but tend to be long – 4 weeks to 18 months in some cases. For this reason, it is something to spot and treat early. Let’s look at MTSS more closely: The tibia bone is the larger of the two bones in your lower leg; Medial refers to the inside part of the leg; and Stress refers to the forces, or loads, applied to the body. Quite simply, MTSS is thought to be a consequence of mechanical overload; when the capacity of the tissues (the tibia bone for example) is outweighed by the load and demands placed upon it: causing injury. The phrase ‘shin splints’ has been used for a long time to describe pain vaguely localised around the shin. Interestingly, ‘shin splints’ is a term that in fact doesn’t help our understanding of lower leg pain at all – not only has it been used to describe MTSS, it also refers to other similar clinical presentations of pain, such as: stress fractures of the tibia or fibula; chronic compartment syndrome; and ischemic shin pain, to name a few. ‘Shin splints’ can contribute to confusion in understanding the cause or causes of MTSS, which doesn’t help those researching it – so it may well be a phrase of the past quite soon. MTSS is often reported to include strain on the muscles and other tissues around them (myofascial strain), inflammation of the tibia bone itself (periostitis) and bone stress. Pain usually comes on suddenly linked with an increase in training load, is worse with exercise, and is alleviated with rest. The pain is usually localised to the medial bottom third of the tibia, spreading at least 5cm in distance. MTSS is debilitating and can be a frustrating condition to get over, with no ‘gold standard’ treatment identified as of yet, but there are certainly things we can do. Running is an enjoyable, liberating form of exercise that only requires some basic tips to help steer away from potential injuries like MTSS. Here’s one of my favourite tips for runners: Monitor 3 key training variables: distance; speed; and incline. Gradually increase one variable at a time and slowly build your body’s capacity to do more. Be mindful that doing too much, too quickly, can be a risk factor for MTSS and over conditions. The team here at Physioimpulse can help advise how to prevent, treat and manage Medial Tibial Stress Syndrome, with hands on techniques and rehab whilst also exploring your training plans and assessing for load:capacity mismatches. Good luck and stay active! Chris, PhysioImpulse Bath Physio 01225 683007References
Becker, J., James, S., Wayner, R., Osternig, L. and Chou, L.S., 2017. Biomechanical Factors Associated With Achilles Tendinopathy and Medial Tibial Stress Syndrome in Runners. The American journal of sports medicine, 45(11), pp.2614-2621. Newman, P., 2016. Medial Tibial Stress Syndrome (Doctoral dissertation, University of Canberra). Winters, M., Backx, F.J.G., Franklyn, M., Moen, M.H., Weir, A. and Bakker, E.W.P., 2016. The medial tibial stress syndrome score: item generation for a new patient reported outcome measure. South African Journal of Sports Medicine, 28(1), pp.11-16.  Orthotics are appliances that are used to improve the function, alignment and mobility of a particular area of the body. These include splints, ankle-foot-orthoses (AFOs), braces or insoles. The NICE guidelines recommend that patients with a neurological condition should be considered for an orthotic assessment as early as possible to promote optimal independence and function. They can also reduce pain and improve a person’s confidence. Here are a few commonly used orthotics: Lower Limb Ankle- foot-orthosis
Please get in touch if you would like an assessment from our specialist neurological physiotherapist to advise on the best orthosis for you.
Thinking of starting running but don't know where or how to start? The NHS Choices 'Couch to 5k' is a free running plan for absolute beginners helping you gradually work towards running 5km in just 9 weeks!
Running has so many health benefits such as:
https://www.nhs.uk/LiveWell/c25k/Pages/couch-to-5k.aspx Bath Physio Specialists 01225 683007A stroke is a sudden neurological event caused by a clot in the blood vessels supplying the brain (ischaemic stroke) or a bleed in the brain due to weakened blood vessels (haemorrhagic stroke). Both types of stroke restrict blood supply and oxygen to brain tissues and can cause a variety of different symptoms. These include:
Neurological Physiotherapy at Physioimpulse Our specialist and experienced neurological physiotherapists can help to maximise your recovery and potential following a stroke. Our physiotherapists are able to use a number of specialist treatments to ensure you can reach your rehabilitation goals and regain independence as soon as possible. Physiotherapy treatment may include:
Martin was a very active man in his mid 40’s who loved any outdoor adventure sports including rock climbing, mountaineering and bouldering. He was highly successful in his career and owned a small advertising company, which he thoroughly enjoyed. Martin had a left middle cerebral artery stroke (MCA), which meant that the right side of his body was affected. Initially his main symptoms were:
Early days Martin spent a total of 10 months in hospital, which included time in an acute stroke unit and then in a neuro-rehabilitation unit. During this time, some progress was made and Martin started to use an electric standing hoist to be transferred from his bed to the chair. This meant that his right leg had sufficient power in it to be able to take weight through it when using the hoist with the carers. His right arm had started to be able to joint in with daily tasks such as eating and washing but needed assistance. Unfortunately, as Martin’s progress was relatively slow, he was discharged to a nursing home after 10 months of rehabilitation and looked after by carers 24 hours a day. Martin had been severely affected by fatigue but after 6 months in the nursing home, decided to start physiotherapy again to see if any further progress could be made. Our specialist neurological physiotherapist, Katie, started seeing Martin twice a week at the nursing home. A thorough assessment was carried out and a treatment plan and individualised goals were set between them. Treatment varied and included:
After another 6 months, Martin was able to stand independently and step around to a chair using a specialist quad stick for support. He had also started taking a few steps. 1 year on Martin’s mobility and balance progressed to such an extent that he was able to return home after a year of being discharged to the nursing home. He initially needed carers 3 times a day to support with showering, meals and shopping and was independent with all of his transfers and mobility including his stairs. He is now independent with all of his activities of daily living and just has a cleaner to help with his housework once a week (which he is very pleased about!). Martin can drive an adapted car and go out independently to meet friends and socialise. He is still continuing with physiotherapy, which now even include sessions in the local climbing centre! It is often reported that recovery gains start to significantly slow down after 6 months following a stroke and no further changes can be made after 2 years. Martin’s story is an important example that everyone should be treated as an individual rather than a statistic. In the right environment and with specialist rehabilitation, improvements can continue to be made for many years. Bath Physio 01225 683007 Great reminder of how intricately made our body is. Keep this system healthy with regular exercise and as its Xmas why not have a little glass of red ;-)
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AuthorPhysioimpulse Chartered Physiotherapists Archives
May 2018
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