Headache

There are many reasons why head ache occurs. If you suffer from headaches you might like to check with your doctor before consulting a physiotherapist. If you choose to go straight to a physiotherapist for an assessment then you can be reassured that we will take a detailed history and perform a careful examination.

Tension type headaches, can arise from irritation of the structures between the base of the skull, and the top two vertebrae: the atlas and the axis.

Physiotherapy research into the characteristics of what are known as cervical headaches has found them to occur frequently, several times each week, often starting in the morning, on waking, to occur predominantly on one side of the head, either at the back of the head or behind the eye and often to be associated with a feeling of neck pain and stiffness. A patient with this type of headache will often respond really well to treatment by physiotherapy, and can learn how to look after the neck so that the headaches do not recur.

Aims of Physiotherapy with Headache patients:

• Rule out serious pathology
• Rule in cervical spine involvement
• Specific treatment to dysfunctional segments/muscles involved
• Appropriate onward referral if no significant improvements

www.migraine.ie

Neck/Cervical Pain

Neck pain is very common and most people have one or more episodes of neck pain at some point in their life. The pain usually resolves within a few days or weeks, and serious or permanent damage is rare. Disc problems and trapped nerves are very uncommon as the cause of typical everyday neck pain.

Physiotherapy has an important part to play in the management of your neck pain. See your North East Physio for assessment, treatment and an exercise programme. Manipulation, acupuncture and other treatments are available to physiotherapists to help treat your neck pain.

Shoulder Pain

The shoulder joint is the most mobile joint in the body - loads of movement is available in just about every direction, but stability is limited, so this has to be provided by the muscles and ligaments surrounding it. The head of the humerus (the long bone of the upper arm) moves on the glenoid, a slightly convex surface on the outer aspect of the shoulder blade. The collar bone also connects up with a part of the shoulder blade called the acromion. The muscles surrounding the joint, running between the humerus and shoulder blade are known as the Rotator Cuff.

Shoulders dislocate relatively easily, once the dislocation is treated it is important to get all the muscles back working correctly again. Shoulders can become painful and restricted for no apparent reason, and the term frozen shoulder is quite often used.

Shoulder problems need really careful examination, they can be very difficult to diagnose because the whole mechanism is so complex. Not only that, in a significant number of people with shoulder pain, the source of the problem can frequently be in the neck and the pain is actually referred to the shoulder, shoulder blade or down the arm.

Tennis Elbow/Lateral Epicondylitis

Symptoms and signs:

Painful elbow over lateral aspect, often radiating into forearm

Aggravated by carrying or heavy work (eg gardening). Tenderness well localised to/just distal to lateral epicondyle. Pain aggravated by resisted extension of fingers or making a power grip with the elbow fully extended

Treatment:

If possible identify and temporarily avoid exacerbating factors.

A forearm clasp (obtainable from your Physiotherapist or online). Physiotherapy - strengthening exercises, electrotherapy, deep tissue massage/trigger point release, taping, joint mobilisations (if indicated).

If conservative treatment fails after 3 to 4 months:
Local injection of steroid preparation and local anaesthetic into the most painful and tender point. Consider using 10-20mg methylprednisolone or 12.5-25mg hydrocortisone. If you are uncertain of any injection techniques please seek advice Give maximum of 2 steroid injections over 6 months. Avoid directly injecting into the extensor tendon insertion on the lateral epicondyle.

Prognosis:

Most patients' symptoms will resolve spontaneously with treatment but this may take several months.

Back Pain

Back pain is debilitating and affects 80% of the population at some time in their lives! Some incidents resolve with time; others can become a source of chronic pain and disability. It is essential that you understand your condition and take early steps to treat it before the condition deteriorates.

As a guide to the many complex issues associated with back pain we have produced a comprehensive set of essential back pain resources to help explain the causes of back pain and the treatment options.

Acute back pain

Episodes of back pain happen to most of us. How we manage them is important for our quick recovery, return to normal activity and our long term outlook.

There is good scientific evidence on how we should deal with acute low back pain.

Back pain is extremely common and nothing to worry about. It may recur but this does not mean re-injury and there will usually be no permanent problems.

The level of pain you suffer is mostly not related to the level of internal “damage” or inflammation. The nervous system magnifies pain symptoms in the early stages as a protective mechanism.

Managing episodes of back pain successfully can make a difference to your abilities in the long term.

About 90% of normal back pain sufferers can return to work quite quickly and this should be seen as part of the rehabilitation process. If someone cannot get back to their work in 4 to 6 weeks the emphasis of rehabilitation needs altering to minimise time lost out of work and the likelihood of long term pain and disability.

Wrists & Hands

Common problems around the wrist and hand can arise from repetitive activities such as keyboard use. Factors which can contribute include unusually prolonged periods of time using the keyboard, or using the keyboard in an awkward position (too high, too low, at an awkward angle etc) or switching from one type of use to another - (keyboard to mouse, scrolling etc).

Pain can arise from local inflammation in the tendons and / or small joints of the hands and wrist. There may also be irritation of the nerves supplying the hands/ wrist/ forearms.

Careful examination will identify the source of symptoms. Treatment can include improving the mobility of the soft tissues: muscles, tendons, ligaments; the joints of the hand and wrist. Clearly it is often worth reviewing the working environment to prevent recurrence of this sort of problem. Use of an appropriate splint may be beneficial along with therapeutic exercises

Hip Pain

The diagnosis of hip pain is difficult as many structures can refer pain around to the hip area.

A Chartered Physiotherapist will give you a skilled assessment of your back, hip and pelvis for your hip pain and a treatment plan to help you.

Pain in the hip can be caused by many conditions including lumbar disc lesions, lumbar joint problems, sacro-iliac joint problems, trochanteric bursitis, muscle strains, sports injuries, hernias and osteoarthritis.

A hip injury may be less common than other joint injuries in sports and general activities but can often be under-diagnosed. The hip is a strong, deep and stable joint and disruption of the hip itself and its ligaments is uncommon. However, labral tears (tears of the cartilaginous rim around the joint), tendon and muscle strains are common and can become chronic. Understanding the hip structure is a useful basis for understanding the various kinds of hip injuries.

It is important to get an accurate diagnosis of your hip injury from a Chartered Physiotherapist or specialist hip surgeon as the source of hip pain can be referred from the lumbar spine, the sacro-iliac joint, buttock problems and true hip problems. Groin strains in sportsmen may often be mis-diagnosed and may actually be labral tears of the hip joint.

A Total Hip Replacement is now the treatment of choice for arthritic conditions of the hip if key hole surgery is not appropriate. Your Physio will explain which is more likely and why. It has matured into an established, well accepted medical intervention with excellent and predictable results.

The benefits of total hip replacement are pain relief, undisturbed sleep, functional range of motion of the joint and painless weight bearing on your hip when walking.

Osteoarthritis is the main condition for which hip replacement is considered, with rheumatoid arthritis also important. The arthritic surfaces of the joint are replaced by metal components.

Total hip replacement produces some of the largest improvements in quality of life of all medical treatments. Hips were the first of the major joints to be replaced regularly and reliably and many people have had more than twenty years good service from their new hip. The following total hip replacement resources will answer many of your questions:

As our populations age, more and more people will need access to hip replacement technology and research continues into more advanced and less invasive joint replacement techniques.

Total hip replacement is performed by highly skilled and specialist surgeons in major hospital units. To get a hip replacement you need to be referred by your GP to a private or HSE consultant orthopaedic hip specialist.

After your hip replacement you will need physiotherapy to regain muscle strength and normal gait.

Knee Injuries

The normal knee is fairly robust, but knee injuries are nevertheless common, and include patellar dislocation, jumper’s knee, worsening of Osgood-Schlatter’s syndrome (commonly suffered by active teenagers), cruciate ligament injuries, medial and lateral ligament injury, meniscal (cartilage) tears, joint cartilage damage and in the longer term, osteoarthritis.

A knee injury benefits from early treatment by a physiotherapist who is skilled in diagnosing the problem and in the management of acute knee injuries. Longer term rehabilitation of knee injuries is important for future prevention of knee injury and restoration of normal knee function.

Getting the correct diagnosis and treatment for your knee pain from a physiotherapist is very important, as this can prevent a worsening of your knee pain and stop it developing into a more serious problem.

Knee arthroscopy is the main diagnostic and treatment operation used by specialist knee surgeons for knee pain, as it clearly visualises the interior structures of the knee. Many conditions can be treated by arthroscopy which is minimally invasive and allows a rapid and short rehabilitative period back to normal function.

Ankle Injuries

One of the commonest injuries at the ankle is a sprain of the ligament (running from bone to bone) on the outer aspect, from the base of the fibula to the calcaneum. Easily done, by missing your footing, or slipping, the foot turns in and the lower leg doesn't. The fibres of the ligament are over-stretched to varying degrees depending on the force involved.

There will be an inflammatory response at the time of injury. Inflammation is the body's defence response to injury, what you see is redness and swelling, what you feel is tenderness to the touch and pain on movement. A normal healthy inflammatory response is, if anything, rather overdone, so it is important to reduce swelling which in turn reduces pain and support the injured tissues, enough to make movement more comfortable and allow the ligament to repair (the inflammatory exudate contains fibroblasts, cells responsible for tissue repair). As the ligament heals it is important to keep the fibres approximated so that the ligament heals at the the appropriate length - not too long or the ankle will be unstable after repair, not too short or the ankle will lack its normal flexibility.

The ankle ligament contains loads of proprioceptors: nerve endings sensitive to position which feed up to the brain and inform balance reactions in the leg muscles. It is important to retrain these balance reactions after ankle injury, otherwise the ankle performs poorly on uneven ground or in complex rapid movements and the ligament will be vulnerable to re-injury.