| About this Page |
SPS Clinics Ltd |
This page is not designed to offer you treatment advice and explanations for the innumerable medical conditions and injuries we are able to treat at SPS Clinics. There is a great link to the Mayo Clinic in the USA which gives a really good overview of many conditions and their management. Also at the end of this section we have pasted a list of links that have proven to be very useful to us. Hopefully you will find good information and advice at these sites.
What you will find is an extension of the SPS philosophy of treatment (based around the Maitland Concept) and exercise and a little more detail on our treatment protocols and technique selection for the listed conditions that we treat.
Sports Physiotherapy
You will see from our list within the testimonials page that SPS have been the Clinic of choice for athletes of all abilities, from Premier League Football, Olympiads right down to the average Joe on the Sunday pitch. Our beliefs regarding sports injuries are identical to any soft tissue injury, that is - "a sprained ankle is a sprained ankle", regardless of whether it is a Beckham or your granny. However, it is the knowledge and application of the correct diagnosis and subsequent rehabilitation needed to return each individual back to their optimum fitness for their daily function that is important. At SPS we draw upon many years of experience of treating sportsmen and women and pride ourselves on the advice and exercise prescription we offer to keep our patients at the cutting edge of peak performance.
A good link to the Online Running Magazine is www.onrunning.com which will direct you to the "treatment table" where excellent advice and information is available from my best friend Alan Leigh MSc. MCSP SRP. Adv Dip Manip Ther NZ. - Lifestyle Fitness, Shewsbury & The Department of Physiotherapy Studies, Keele University
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| The Dripping Tap |
SPS Clinics Ltd |
The image of the dripping tap underscores the SPS Philosophy.
Left unattended the drip, drip, drip effect of unattended injury can lead to progressive and reactive dysfunctions.
It is simply no use just simply putting a metaphorical bucket under the injury as this only alleviates the symptoms. Only when the washer (the real problem) is changed is the condition truly treated.
SPS Clinics "hands on" treatments and inclusive rehabilitation programmes have shown to be very successful in assisting our patients to achieve maximum potential in terms of long term and preventative effects.
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| First Aid |
SPS Clinics Ltd |
SPS Guide to First Aid for Soft Tissue Injuries
Soft tissue injuries are one of the most commonly encountered problems by physiotherapists and one of the most reported problems to our Riverside fitness instructors.
In brief a soft tissue injury can be classified to strains / sprains to ligaments, tendons and muscle. Although treatment should only be administered by a Chartered and State Registered Physiotherapist, appropriate first aid management undertaken at the time of injury helps reduce the pain and discomfort caused by damaged tissue and inflammation, prevents further injury, minimises scar tissue formation, and will ultimately speed up recovery.
R.I.C.E - M.I.C.E or S.P.I.C.E?
"RICE" is an acronym for:
- Rest
- Ice
- Compression
- Elevation
For the first 48-72 hours following acute injury, all soft tissue injuries should be treated with the RICE regime. However, many people receive either misleading or wrong advice on the application of this treatment protocol
- Rest. Resting the injured part will prevent further tissue damage, allow blood clots to stop bleeding from damaged vessels, and help reduce overall blood flow to the damaged part, thus helping to minimise bleeding and swelling.
Note: Rest does not mean take to your bed, this in fact can slow your recovery by decreasing the natural "pumping" of excess tissue fluid and also allow affected joints to become stiff. Mobilisation of all joint movements not compromised by the injury is important to aid a swift recovery. This is the "M" in MICE.
- Ice. Icing the injured part also helps to reduce swelling and bleeding by reducing the blood flow to the injured part. It does this by causing constriction of the blood vessels and increasing the viscosity of the blood.
Ice also helps to reduce pain by inhibiting the release of pain causing chemical irritants at the site of injury. Pain may also be decreased via the so called "pain gate mechanism". Stimulation of cold nerve receptors may act to help "block out" the signals to the brain from the pain receptors.
The bag of peas is the most famous first aid ice pack although you can make an ice pack simply by placing a quantity of crushed ice into a plastic bag. Never apply an ice pack directly to the skin, as ice burns (frost bite) can occur; a damp tea towel or bandage should be applied to the skin first and or cover the affected area with a layer of baby / olive oil as a protective barrier.
Ice should be applied for approx 8 minutes (studies have shown a reflex vaso dilation after this time on acute injuries) on a new injury every 2-3 hours for the first day then for 20-30 minutes every 2-3 hours thereafter. Ice should not be used in the case of vascular disease, elderly, diabetics, or any other condition in which circulation is compromised.
- Compression. This is one of the most important parts of the regime. Applying an elastic bandage or similar to the injured part will considerably reduce the amount of swelling and bleeding at the injury site. Tubibandage is popular but it must be the correct size for the right body part.
Note: Never sleep in a tubibandage! It could lead to thrombosis.
When applying a bandage, ensure that it is firm but not too tight. Signs that a bandage is too tight are numbness, tingling, or the part distal to the bandage turning cold or pale.
- Elevation. Elevating the part above the level of the heart while resting also helps reduce the blood flow to the area, thus controlling swelling and bleeding. For example, water flows downhill so an ankle or knee injury should be elevated above the height of the hip in the lying position.
S.P.i.c.e. - is the acronym designed by Southport Physiotherapy Services and stands for Support, to allow Performance - I.C.E
Correct strapping applied by a trained professional will allow the injured part to be suitably protected so that immediate rehabilitation can be performed. However a badly applied strapping can significantly hinder your recovery. Note : tubibandage does not support it only compresses. Supports and splints should only be purchased on the advice of a professional as the wrong splint will be either ineffective or detrimental to your problem.
A note on the use of heat
Whilst I.C.E. is an effective first aid measure that may be used as long as symptoms remain, heat should not be applied as it will act as a vaso dilator drawing blood to the skin under the heat source and will tend to increase swelling. Heat may however be recommended later to relieve muscle tension and promote relaxation.
A note on the use of creams and gels
Creams and gels, like those advertised for sports injuries, may not have any role in first aid as their "anti-inflammatory" effects are really only superficial to a couple of mm. Gels however can be effective when use as a carrier medium for ultra sound by a Chartered and State Registered Physiotherapist for a specialised treatment known as phonophoresis
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| Injury Classification |
SPS Clinics Ltd |
Strains, sprains & immune systems:
This hopefully is a user-friendly guide to some frequently asked questions. Don't be put off by the title all will become clear.
The treatment table will remain a forum for you to present your injuries and queries for us to give some guidance and some thoughts about what to do, what to expect or where to go get help.
- Strains:
Are muscular injures (this includes tendons and tendon-bone junctions). They are usually an indication of minor damage, not major tears and certainly not ruptures. However, there will always be some mild disagreement over where a strain becomes a notable tear. Lets not get bogged down with that.
They very often are ably treated with some straightforward self-help. The average healing time can be expected to be:
- Muscle only - 5 days to 3 weeks.
- Tendon only - 2 - 6 weeks
- Tendon - bone junction - 6 - 9 weeks.
It is fair to say that some strains are so minor that they seem to resolve miraculously despite how they may feel initially. This can be difficult to fathom but is related to our "pain systems". Never has something so complex and wonderful as pain been so simplified. Suffice to say there is NO pain centre or dedicated pain tracks.
NB: I belong to an organisation known as the International Association for the Study of Pain (IASP) which is an enormous body of incredibly dedicated and intelligent people (with a few exceptions!) that has spent decades trying to unravel the topic of PAIN. It is true to say the more you know the more there is to know.
However I will try to unravel what I can.
- Sprains:
Sprains are a term usually applied to ligament or similar connective tissues. And again are not major tears or ruptures.
Any injury outside a strain or sprain has more clearly de-marked medical classifications or grades given to it.
Ligaments sprains on average take:
- 5-days to 3 weeks to resolve.
A very important note at this point - symptoms like pain are not necessarily an indication that all your trouble started at one point or that when pain is gone that all your trouble is over. Your injury may have been developing for weeks or years due to training style, footwear and dare I say it ..... genetics. Likewise the healing process goes on after the pain and becomes a continuous structural re-organisation that you can influence positively or NOT.
- Immune Systems:
This is an enormous topic. Without an immune system we die. Without it even a basic cut will not heal. The IMMUNE SYSTEM is the governor of our healing capabilities - inflammation to name one small part that it controls. The system is made up of a variety of key areas:
- A special part of the nervous system (The Autonomic Nervous System)
- Various parts of the brain (notably the hypothalamus)
- Glands like your thymus (in the neck and upper chest)
- Lymph nodes (all over the place like your armpit)
- Part of your kidney (the adrenal gland).
It communicates its actions and exerts controls via nervous impulses and nerve chemicals and via the circulation. It is intimately integrated with all the "pain systems" and with everything that makes us us; our thoughts, knowledge, feelings and emotions. The term psychosomatic, most of us have heard of it or have used. It means mind and body - it does NOT mean imagined, made up or that we have some mental illness; it is real. Therefore the way your mind works affects your body. Think on when you are getting more and more naffed off because you cannot run!
Therefore getting fit or over injuries has a lot to do with how we are, how we are feeling, coping and enjoying our lives. It has to do with general health and what we believe is wrong with us when injured or unwell.
It is powerful and can be harnessed to your advantage.
More about it along the way.
- Repair:
All tissues (bar skin - to some degree and bone) heal with scar tissue they do not regenerate. Scar tissue is not as good as the original tissue but encouraged properly is pretty damn good - certainly good enough. Scar tissue is the end product of repair / healing.
There is a minefield here - "what about anti-inflammatory pills then" .... "What about those steroid injections". Good questions that will be answered along the way. However, correctly used at the right times they are invaluable to the repair system but are not always necessary. AND, there are alternatives, more later.
The healing process is three phases (they are not rigid, definite time scales but a blended integrated series of stages):
- Inflammation - acute and chronic (chronic is a very different beast to acute and I am sure will come up for discussion). It is acute (new) that most of us are familiar with. The usual signs of heat, redness, swelling and pain to some degree are the tell-tale signs.
- Cell proliferation - the initial structural building of real consequence.
- Remodelling - probably goes on forever.
Pain is usually diminishing through 1 & 2 and is more "tightness" and odd twinges in early 3. It is not always like this, as either you have found out or will.
Reproduced by Kind Permission AJ Leigh 2001
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| The Mayo Clinic |
SPS Clinics Ltd |
The Mayo Clinic First-Aid & Self-Care Guide
Medical emergencies don't occur every day. But when they do, you should have the information you need to deal with these situations. The same is true of common medical problems, which require you to take proper care or yourself or others on a more regular basis.
MayoClinic.com's guide to First Aid and Self-Care offers practical and easy-to-use information on everything from how to treat a sunburn or recognize the signs of a heart attack to ways to avoid back injuries or deal with a range of aches and pains.
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| Biomechanics |
SPS Clinics Ltd |
The key to accurate clinical diagnosis along with the thinking process of the Maitland Concept
The knee bone connected to the thigh bone
Tri modular assessment
www.asb-biomech.org
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| Hands on Treatment - Advanced Manual Physiotherapy |
SPS Clinics Ltd |
SPS is committed to implementing the highest levels of patient care and base their treatments on research and evidence based practice. There are many ways of treating injury and dysfunction but as explained within the dripping tap, success is dependant on treating the cause and not the effect (the symptom). We believe that this is best achieved by hands on manual therapy, particularly within the confines of the Maitland concept.
This innovative approach to manual physical therapy was developed by physiotherapist G. D. Maitland of Australia in the early 1970's. His concept provides a framework for the evaluation and treatment of neuro musculoskeletal disorders. In brief the concept allows the clinician to:
- Practice by a belief that there are fine details of information that the body can tell you which can play an important role in the assessment of your disorder. The therapists can only learn of them if you are encouraged to have the trust to discuss them.
- Make sense of the information which you provide.
- Develop strong listening skills which makes them able to listen, believe and understand you with an open mind and without any pre-judgment.
- Use your terminology in all communications. SPS therapists adapt themselves to you rather than expecting you to adapt to us.
- Use skills in understanding and using verbal / non-verbal communication.
Encouraging a feeling of confidence and trust in the therapist is key to success of treatment.
We have a fuller explaination of the Maitland Concept
As its name suggests it is a concept not a technique. As the late Gregory Greive once wrote, "Technique is the brain child of ingenuity". SPS Clinics whole-heartedly endorse this view and will draw upon an arsenal of varied techniques from many schools of manual therapy including Maitland, Cyriax, Mulligan, Kaltenborn, McKenzie, Edwards etc.
All of the above concepts use manual techniques for peripheral joint and Spinal Mobilisation
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| Characteristics of the Maitland-Concept® |
SPS Clinics Ltd |
Definition
The Examination, Assessment and Treatment of neuro-musculo-skeletal disorders within the Maitland-Concept
Commitment to the Patient
A commitment to the patient is achieved by relating everything that is said and done within this model of manipulative physiotherapy to the patients' main problems as he/she sees them. The body's capacity to give information about how the patient is affected by his/her problems (symptoms, functional loss etc.) is used to decide how manipulative physiotherapy may be applied. For example: if a patient is unable to put his socks on in the morning because he experiences severe left buttock pain, the prime aim should be to use this functional loss in examination and assessment to discover the cause of the symptoms and treat them in a way that allows the patient to function without pain. To achieve a high level of commitment it is also essential to achieve a highly developed level of verbal and non verbal communication and a self critical approach to the task of translating the patient's story into a clinical picture that can be helped by manipulative physiotherapy.
Mode of thinking - the primacy of clinical evidence
At the heart of the concept is what has been called the 'two compartment' method of thinking in which clinically-related knowledge (e.g. biomechanics, neurophysiology, pathology, biobehavioural medicine) is clearly separated in the clinical situation from any individual patients' precise history of their problem and its signs and symptoms. Whilst a free flow of information takes place (as across a semipermeable barrier, separating the two areas of thinking) for the process of hypothesis-formation in relation to diagnosis and/or management, it is the clinical area which has supremacy over the theoretical area.
Making a diagnosis is a good example because, whilst it is considered fundamentally important to do so, the dangers of mere 'diagnostic labelling' of an individual's problem is emphasised. Chronic tennis elbow may serve as an example. Its narrow definition as a purely local condition, with a purely local cause at the elbow may limit the examination and assessment of the problem and so confine treatment which thus may be ineffective. A detailed examination of the associated joint structures and muscles, the sensitivity of the neural tissues in the arm, neck and thoracic spine and their reaction to movement testing, as well as associated cervical and thoracic joints, may reveal relevant comparable signs to consider in treatment. The precise handling and management of the patient's problem will depend not so much on the diagnosis but on such factors as the severity and irritability of the movement signs and symptoms found, whether these fluctuate in response to activity more or less readily and what stage the condition has reached in its development and history. In effect, a working hypothesis is made in which all the features of the condition and its clinical presentation fit.
This hypothesis may be modified in light of the subsequent response to treatment or further information which may emerge. Details of treatment and overall management of the patient's problem are modified accordingly.
The Maitland Concept is a holistic approach which not only seeks to clarify the physical components of an individual's movement disorder but takes full measure of the many aspects of the individual's personal illness experience, life-style and emotional state and how these impact on their problems.
Assessment
Repeated assessment and analytical assessment are the means of evaluating and reflecting on everything done during the clinical decision making process. Proof of whether treatment is working or not is achieved by continually comparing the effects of the selected treatment forms on the patient's symptoms and signs.
At the same time hypotheses about the cause of the problem, the structures at fault and the pathology affecting them and optimum treatment strategies can be confirmed, discarded or changed.
Forms of Assessment
In the first session an initial analytical assessment takes place in order to define contra-indications or precautions for physical examination and treatment procedures and to define a treatment plan with short term and long term objectives.
Foremost in examination is attention to detail during the subjective examination (C/O) and during the physical examination. The C/O aims to establish a working hypothesis about the kind of disorder the patient has. Pain is normally the main symptom for which treatment is sought. Therefore it is relevant to obtain detailed information about the area, relationship and behaviour of the pain (symptoms) in order to form hypotheses about its origin, pathological nature and its mechanism of production.
On the other hand the severity and irritability of the pain during the patient's daily life should be established. The present and past history of the symptoms is taken to establish the nature of its onset and its stability and its progression over time. Precautionary questions will establish whether there are any contra-indications or precautions to manipulative physiotherapy or whether potentially harmful situations may arise.
The aim of physical examination is to use functional movement and manual tests to stress the neuro-musculo-skeletal structures sufficiently to reproduce the pain that the patient complains of or to produce relevant signs (e.g. stiffness) within the disordered structures. The amount of examination required to fulfil this aim is proportional to the severity, irritability and nature of the symptoms.
With the principle of reassessment a continuous comparison of the patient's symptoms and signs takes place before and after each selected treatment form. Also during the application of therapy treatment goals are evaluated to ensure that no undesirable side-effects occur.
During retrospective assessments the overall progression of treatment is monitored.
In a final analytical assessment at discharge the overall outcome of treatment as well as the effects of home exercises and prophylactic measures is evaluated and a prognosis with the likelihood of recurrences is made.
Treatment objectives and therapy
The Maitland Concept aims to assess and to normalise the levels of disablement as defined by the World Health Organisation in the ICIDH2: the levels of impairment (movement components), activity limitations and participation restriction (WHO 1997).
What is actually treated in the Maitland Concept, in most instances, is a movement-related, painful disorder and the interrelationship of functional movements and pain, spasm and inert tissue resistance. The direction, amplitude and force (grade), and the rhythm of each passive treatment procedure is decided and recorded. The response of symptoms and comparable signs including functional movements is monitored meticulously for changes be they major or minor.
The treatment will be continuously adapted to the changing condition of the patient's movement disorder ('Progression of Treatment'). Whilst manual techniques of passive movement are the mainstay of the treatment methods in this concept, other modalities such as home programmes of active exercise and self-treatment procedures, the assessment and correction of muscle imbalance as well as attention to ergonomics of the workplace and recreational activities, are incorporated as necessary based upon sound clinical reasoning and evaluation.
Hence this system has developed as one which incorporates rather than excludes new methods and techniques of assessment and treatment which are clinically valid.
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| Podiatry |
SPS Clinics Ltd |
Simon Walpole. D.Pod.M. M.Chs SR.Ch.
is the Podiatric Consultant to SPS Clinics. Mr Walpole is qualified and State Registered to perform all chiropody services including nail surgery and he also provides a custom made orthotic service to our patients.
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Your foot consists of twenty six bones, supported by a network of ligaments, muscles, blood vessels and nerves
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Our feet help us balance, and carry us the equivalent of five times round the earth in an average lifetime. In return, we rarely give them the attention they deserve, hiding them away in shoes and forgetting about them... until they rebel.
Along with our eyes and hands, your feet do more work than most parts of our body, so it's little wonder that things sometimes go wrong. Our feet are also mirrors of our general health. Signs of diabetes, arthritis, circulatory and neurological diseases, often appear first in the feet
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What's the difference between a chiropodist & a podiatrist?
Podiatry is the new name for chiropody.
The name was changed recently to podiatry, to be in line with North American countries and as it is historically more accurate 'pod-' refers to feet while 'chir-' refers to both feet and hands.
What do the other letters that podiatrist's use mean?
M.Ch.S. or F.Ch.S. - This means that the podiatrist is a member or fellow of The Society of Chiopodists and Podiatrists. A practising member of this society is assured of having full proffessional indemnity insurance cover.
D.Pod.M. or B.Sc. - This signifies that the podiatrist has completed a full training course in podiatry. Originaly this course was a diploma in podiatric medicine (D.Pod.M.) but was later changed to a degree course (B.Sc.).
Some podiatrist may have other letters after their name that signify further qualifications, for example in surgery, but as long as the podiatrist has those above and S.R.Ch. you can be assured that the podiatrist is fully qualified for all usual treatments
What is State Registration? And why is it important?
State Registration, means registration with the Council of Professions Supplementary to Medicine (CPSM). This is only available to those who have successfully completed at least a 3 year full time course at a CPSM recognised school of podiatry. The letters S.R.Ch. are protected by law to ensure that only registered people use them. The National Health Service don't accept anything less, so why should you!
The Long Suffering Foot
The foot takes up a fair part of my everyday practice, whether it is specific foot related problems or aches & pains elsewhere attributable to the foot.
It is fair to say, "I like the foot" it is an amazing structure. You could of course argue that the rest of the body isn't bad, but you have to stand back and marvel at the design and tolerance of the foot.
Running, probably more than any other activity taxes the foot to its limits.
This article is a little about the foot and how it functions and some simple "maintenance tips" that would be sensible to carry out. Maintenance is about limiting potential damage or keeping the "part" at its optimum.
The foot has several jobs to do, the main ones are:
- Shock absorption which it does with the rest of the limb.
- Transfers force direction and stores force for re-use.
- Propulsion
- Balance.
Shock absorption occurs during pronation. The foot is a flexible structure from initial heel strike to the mid stance phase of walking and running. This changes as the speed of running approaches sprinting as progressively less pronation can or does take place, as in sprinting propulsion becomes the key point.
It may well be true that some people who like to jog/run reasonable distances actually have feet more organised for sprinting.
Pronation needs to occur at the right time and for the right amount of time. So you either have too much (hyper), the right amount (within certain limits) or too little. This is what physio's and podiatrists try to assess.
Having a shoe that compliments your foot helps. Simple indications like increasing hard skin (callus) and pains may be a pointer that all is not well between your foot and shoe.
Reasonable pronation needs balanced muscles from the spine to the foot, functional knee and hip mobility and ALIGNMENT are also the corner stones that contribute with the pronation phase; then there is the use of stored force to be used to finally achieve supination for propulsion.
Supination is about the flexible foot becoming rigid or "locked" to provide a good support or leverage to propel you forward. Again timing is the issue. This should take place over mostly the big first toe. This is why you have a big toe.
Balance (proprioception) is particularly important as the foot and all its structures contribute to your ability to balance; walking and running is complex enough without the right information coming back from your foot. So any injury may severely disrupt this function even after it healed.
Maintenance Tips:
- Look after the skin on your feet and check using a small hand held mirror for red areas and thickening hard skin. Pumice these or see a chiropodist for advice about foot care. Orthotics are not always the next step.
- Change you shoes regularly, general guidelines like every 500 miles are ok, but you should look at the way your foot and shoe are getting along.
- Do not be sold on shoe hype. Whilst some of the large shoe companies do put a lot into research and produce valuable benefits. If you and your shoe are getting along why change?
I personally feel that a mid range shoe that has at least a heel cushioning device and is not so ridged it won't bend or on the opposite side does not crumple when you try to bend is the first important thing, later add orthotics if things are really are not working out, may be a more sensible option. These shoes tend to retail in at £35 - £55.
- Stretch your foot. Pay particular attention to the amount your big toe bends backwards. Twist the foot gently and slowly through the mid part of the foot - use your hands to do this.
- Practice balance activities; like standing on one foot with your eyes closed. Good balance is very beneficial to healthy feet.
- Maintain good hip mobility and strength. To check your mobility:
- Lie on your front
- Have one knee bent to a right angle
- Allow your leg to fall out as far as it can without your opposite side lifting. Now try letting your leg fall in, without letting the SAME side as the moving leg lift.
- You should have equal movement and it should be approximately 45°
The main strength issue is that you have good muscle that take the leg sideways and turn outwards.
- Stretch on rest days.
The functioning of the foot plays a large part in the healthy functioning of the whole lower limb and spine, so taking time over your foot will have beneficial effects elsewhere. Naturally this does work both ways. A stiff hip could cause problems with you foot. Indeed there are occasions where patients complaining of "headaches" have benefited from treatment to the foot. It does have to be said that this would not be my first site for examination but cannot be ignored regardless of the sense or science that might suggest otherwise.
Reproduce by kind permission AJ Leigh 2001
Podiatry Links:
All of the sites listed below are from reputable organisations but please remember that the information provided is meant to compliment treatment. There is no substitute for seeing a trained health professional in person!
Podiatry
Public website of the Society of Chiropodists and Podiatrists. Contains foot health information about common foot problems and information about careers in podiatry.
http://www.feetforlife.org
Sports injuries
US site of American Academy of Podiatric Sports Medicine. With recommendations for sports shoes and advice on different sports injuries.
http://www.aapsm.org
US site explaining some of the common sports injuries with advice on how to avoid them.
Dr. Stephen M. Pribut's Sport Pages
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| Spinal Mobilisation |
SPS Clinics Ltd |
Spinal mobilisation has always had its efficacy described in terms of improving mobility in areas of the spine that are restricted2. Such restriction may be found in joints, connective tissues or muscles. By removing the restriction - by mobilisation - the source of pain is eliminated and the patient experiences symptomatic relief3.
Physiotherapists find spinal mobilisation very effective in a wide range of painful spinal conditions, particularly where restricted mobility is present. Restoration of spinal mobility, both in physiological movement and in vertebral segmental mobility, often results in a reduction in the patient's pain and spasm. This outcome is equally effective in the cervical, thoracic and lumbar spine.
Role of physiotherapy
Manual techniques include manipulation, traction and mobilisation. All physiotherapists are skilled in applying these techniques safely. For example, physiotherapists routinely assess the integrity of vertebral artery blood flow before considering an upper cervical high velocity thrust technique i.e. manipulation.
The most frequently used mobilisation technique is oscillation. Oscillations are small, rhythmic movements applied by the physiotherapist to painful, stiff or inflamed tissue. These tissues include the zygapophyseal joints, intervertebral discs, dura and spinal nerves. The comprehensive assessment approach developed by Maitland3 enables the physiotherapist to identify which of these structures is the primary source of symptoms.
Benefits of physiotherapy
Modern theories propose that spinal mobilisation can reduce pain by moving swelling containing neurotransmitters such as substance P and histamine. In addition, the threshold, which stimulates nociceptors, may be raised by gentle oscillations4,5,6.
Spinal mobilisation has a significant role to play in the treatment of neck and back pain. It can be offered as part of a broader physiotherapy approach that includes aspects of self-management, education and advice or a home exercise program. The addition of spinal mobilisation to other management approaches to back and neck problems (analgesia, exercise) gives better outcomes in terms of reduced pain levels and better physical function1.
References
- Koes BW et al (1992): Randomised clinical trial of manipulative therapy and physiotherapy for persistent back and neck complaints: results of one year follow up. British Medical Journal 304(6827):601-605.
- Korr IM (1977): The neurobiologic mechanisms in manipulative therapy. New York, Plenum Press.
- Maitland GD (1986): Vertebral manipulation, 5th ed. Sydney, Butterworths.
- Melzack R and Wall P (1988): The challenge of pain. London, Penguin Group.
- Wyke BD 1985. Articular neurology and manipulative therapy. (In Glasglow E.F. et al (eds) Aspects of manipulative therapy 2nd ed. Melbourne, Churchill Livingstone.
- Zusman M (1986): Spinal manipulative physiotherapy. Australian Journal of Physiotherapy 32:89-99.
Courtesy of the Australian Physiotherapy Association
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| Evidence Based Practice |
SPS Clinics Ltd |
SPS have close links with the Department of Physiotherapy Studies at Keele University, and liase regularly with colleagues holding positions as lecturers and research fellows. These positions help to guide our practice in contemporary concepts of "evidence based practice"; this is in keeping with key aspects of the Governments "Our Healthier Nation" document.
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| Services |
SPS Clinics Ltd |
Text to follow
Some examples of SPS physiotherapy treatment and exercise protocols will include:
- Self spinal and peripheral joint mobilisations
- Correction of posture/alignment faults - self awareness
- Correction of identified muscle imbalances - PILATES
- Specific exercise programmes for maintenance or prevention of recurrence including warm up, stretch and muscle strengthening / power/ endurance protocols
- Self help exercise and ergonomic advice
(For examples of an SPS advice leaflet click here)
(To expand on some of the above visit our - Treatment Room)
SPS / Riverside exercise gymnasium facilities
- Physiotherapist guided programmes (Gym & Pool)
- Input from an accredited exercise physiologist
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