Things To Know Before Your First Physiotherapy/Physical therapy Visit

 

If you have never been to see a physiotherapist, you may be a little unsure or uneasy about what to expect during your initial visit. Your age, extent of pain and preferred treatment procedure may have a direct bearing on the type of physiotherapist you can expect to receive. Your course of treatment really depends on the age and intensity of the your injury.

Below is a short overview of what you will encounter on your initial visit to the physiotherapist:

Should I speak with a Physician before setting up time with a physiotherapist?

It’s not necessary .You can directly go to a Physiotherapist/physical therapist.

How do I set up an appointment with a Physiotherapist/Physical therapist?

When you call the physiotherapist's office, you will generally get a receptionist answering the phone. Ask for an appointment. You will be required to provide your name and telephone number along with a convenient time to arrange your first visit. The treatment cost can be discussed when you meet with the physiotherapist/Physical therapist.

What You Need to Know Before Seeing a Physiotherapist/Physical therapist?

Be sure to arrive at the clinic on time. An intake form is used to collect your information. You may be requested to provide your medical history, injury details, as well as other types of related information. All information is kept private and secure. Make sure you also bring in your doctor's letter of reference or a prescription form and X-rays, if available. It is advisable to wear clothes that are loose fitting and allow for easy movement, since physiotherapy/physical therapist involves exercise.

What to Expect on your first physiotherapy/Physical therapist appointment?

You will be asked to discuss the physical problems that you are experiencing and the symptoms associated with it, when you meet your physiotherapist. Your physiotherapist may go over your past medical history, and review some of your test results with you. The first physiotherapy visit can take up to an hour. Communicate every detail to the physiotherapist. Give him or her details like that of how and when the injury occurred, what was applied by you on the injured portion, how old the injury is etc. Your physiotherapist will more than likely prompt you on most questions. Always ensure not to conceal any information from the therapist. Providing the exact details related to the injury allows you to obtain the most effective treatment. After examining the injury, your therapist will discuss treatment with you and suggest options to restore normal function to the site of injury. Your physiotherapist will detail your treatment plan specifically for you. Discuss any aspects of your therapy options with your physiotherapist if you feel uncomfortable. Your physiotherapist is there to work with you and help you achieve your goals.

It is highly recommended that you follow the physiotherapy treatment procedure given to you consistently. Following your therapy program closely can help to ensure a speedy and full recovery. The physiotherapist may request that you schedule additional appointments. Your injury will dictate if multiple sessions are needed.

Once you have experienced your first physiotherapy session you may be feeling a little sore afterwards. It is common to experience a little stiffness and even feel sore after the first treatment. If you feel any discomfort, tell your physiotherapist. It is important they are made aware of any pain you may be feeling throughout therapy. They can provide more details on what you are experiencing and provide advice on how to alleviate any soreness.

*Physiotherapy/Physical therapy is very beneficial for many type of injuries. Early treatment, the right plan of therapy, and commitment by you are the keys to you achieving full benefit from physiotherapy/ Physical therapy.

Neck pain/Neck spasm

Neck pain can occur due to many reasons but most common cause is neck spasm and it occur due to injury, overuse, poor posture,or stress.

What are neck spasms?

Neck spasms are involuntary contractions of the muscles in your neck. The muscles become tight, hard, and painful..

How do they occur?

Neck spasms may occur from an injury, overuse, poor posture, or stress. For example, it is common for a person doing a lot of computer work to feel his or her neck stiffen. Spasms may even occur from an uncomfortable night's sleep.

What are the symptoms?
The muscles in your neck feel hard, tight, and painful. When the muscles that extend from your shoulders to your head go into spasm, the spasms may even cause headaches. You may have tender spots in your neck, sometimes called trigger points that cause pain elsewhere.

How are they diagnosed? 

Your doctor will review your medical history and examine your neck.

How are they treated?

• Stretching: Spasms are best treated with stretching exercises.

• Massage: You may be able to massage your neck yourself by finding the tight muscles and putting deep pressure on these muscles. You might also get a massage from a friend or therapist.

• Medication: Your doctor may recommend an antiinflammatory medication such as ibuprofen or naproxen or may prescribe a muscle relaxant. 

• Ice: If your neck spasm has just occurred, put ice packs on your neck for 20 to 30 minutes three to four times a day.
• Moist heat: Sometimes ,especially with recurrent spasms, moist heat can help. Put warm, moist towels on  your neck for 20 minutes, or take hot showers or baths.
 • Physical therapy: Your doctor may recommend physical therapy for an exercise program and other treatments.

• Injection: If the above treatments do not help the spasm get better, your doctor may recommend a shot of an anesthetic or a medicine like cortisone into the muscle.

•Stress management: Neck spasms are a common physical symptom caused by stress or depression.Identification of theseproblems and treatment of them may help considerably with neck spasms.

When can I return to my sport or activity?

You may return to your sport or activity when:

• You no longer have neck pain.
• You can move your neck fully and comfortably. 

How can I help prevent neck spasms?

Know what you can do about the common causes of neck spasm: overuse, stress, and poor posture. For example, use good posture at your computer terminal, take frequent breaks, and do stretching exercises.When you first feel tightness or pain in your neck start the treatment that has helped you the most. Treating early, mild symptoms right away can often stop the symptoms from becoming worse.You may do these exercises right away.

Neck Spasm Rehabilitation Exercises

1. Neck flexion forward: Clasp your hands behind your head and let the weight of your arrms pull your chin to your chest. Relax. Hold for a count of  10. Do this 3 times.

2. Neck flexion, right side: Turn your head to the right and clasp your hands behind your head. Let the weight of your arms pull your chin to the right side of your chest. Relax. Hold for a count of 10. Do this 3 times.

3. Neck flexion, left side: Turn your head to the left and clasp your hands behind your head. Let the weight of your arms pull your chin to the left side of your chest. Relax relax. Hold for a count of 10. Do this 3 times.

4. Ear to shoulder right side: Lean your right ear toward your right shoulder. Reach your right arm over your head and place your fingers over your left ear. Gently pull your    head toward your right shoulder. Hold for a count of 10. Do this 3 times.

5. Ear to shoulder left side: Lean your left ear toward your right shoulder. Reach your left arm over your head and place your fingers over your right ear. Gently pull your head toward your left shoulder. Hold for a count of 10. Do this 3 times.

   6. Neck rotation right side: Rotate your neck by looking over your right shoulder. Lift your right hand  and   place your palm on the left side of your chin. Push your chin with your palm toward your right shoulder. Hold for a count of 10. Do this 3 times.

  7. Neck rotation left side: Rotate your neck by looking over your left shoulder. Lift your left hand and place your palm on the right side of your chin. Push your chin with your palm toward your left shoulder. Hold for a count of 10. Do this 3 times.

Exercise 'protects brain from ageing'

“Regular exercise may be the best way to keep ageing brains sharp.

A new review of research has shown that even low to moderate exercise prevents the milder forms of cognitive decline in older age.

The research pooled the results of 15 studies and found that low to moderate exercise, such as playing a round of golf once a week or tennis twice a week, was linked to a 35% reduction in the risk of cognitive decline. The researchers think that this could be due to physical activity increasing blood flow to the brain.

This review of observational studies was well conducted and reported. It includes an analysis of over 30,000 people and it seems likely that the researchers have sourced the most important studies on this topic. Although these were not randomised studies, the consistency and strength of the evidence appears to provide the best current estimate of activity’s ability to prevent normal, age-related brain changes such as the decline of memory.

Back Pain Relief and Sitting Position

Sitting down is known to be a factor in lower back pain and recent research has shown that sitting upright is not the most helpful position in the office. As large numbers of people spend much of their day sitting both at work and at home this is an important issue in the development and maintenance of low back pain.

The Aberdeen UK researchers, reported on the BBC Health website, using an MRI which could scan people in alternative positions to lying down, found that an angle of 135 degree leaning back in sitting was the posture in which the lumbar spine suffered the least stress.

The 135 degree position was compared to slouching and to sitting up straight and judged to be the posture which was most likely to allow back pain relief. However, Manchester Physiotherapists know that at 135 degrees the person is likely to slide repeatedly off the seat, so that 120 degrees may be a better compromise.

A helpful idea can be to use a posture chair such as a kneeling chair or knee chair, which allows maintenance of the better posture with less strain.

Exercises for knee strength

The following exercises are commonly prescribed to patients with arthritis of the knee. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 3 times daily and only provided they do not cause or increase symptoms.

1.     Static quadriceps exercise

 Tighten the muscle at the front of your thigh (quadriceps) by pushing your knee down into a towel (figure 1). Put your fingers on your quadriceps to feel the muscle tighten during contraction. Hold for 5 seconds and repeat 10 times as hard as possible without increasing your symptoms.

 Static Quadriceps Contraction

2.     Inner range quadriceps 

Sit with your knee bent over a rolled up towel, high enough to be able to lift the heel off the ground.Tighten up the knee muscles and lift your heel off the ground. Keep your knee firmly down on the roll.Hold for a few seconds, trying to get the heel as high as you can, relax and repeat. People with patellar (kneecap) problems may need to avoid this exercise if it causes pain.I think this is by far the best exercise to do for the strength of your quadriceps, as when you do it, only the correct muscles can be working. If you find it difficult, increase the size of the roll. The bigger the roll the easier the exercise is, so start with a big roll and gradually reduce. Hold for 5 seconds and repeat 10 times.

  Inner Range Quadriceps

3.   Straight-leg raise: sitting 

Get into the habit of doing this every time you sit down. Sit well back in the chair with a good posture. Straighten and raise the leg, hold it for a slow count to 10, then slowly lower it. Repeat this several times with each leg – at least 10 times with each. If this can be done easily, repeat the exercises with a weight on the ankle (buy ankle weights from a sports shop or improvise, for example with a packet of salt wrapped around the ankle).

4.    Straight-leg raise: lying

 Get into the habit of doing straight-leg exercises in the morning and at night while lying in bed. With one leg bent at the knee, hold the other leg straight and lift the foot just off the bed. Hold for a slow count of 5 then lower. Repeat with each leg 5 times every morning and evening and then gradually increasing the repetition till 10.

5.    Muscle stretch

 At least once a day when lying down do the following exercise. First, place a rolled-up towel under the ankle of the leg to be exercised. Then bend the other leg at the knee. With the straight leg, use your leg muscles to push the back of the knee firmly towards the bed or the floor. Hold for a slow count of 5. Repeat with each leg 5 times. Not only does this exercise help to strengthen the quadriceps muscles, but also it prevents the knee from becoming permanently bent.

6.    Clenching exercises 

During the day, whether standing or sitting, get into the habit of clenching and releasing the quadriceps muscles. By constantly stimulating the muscles, they become stronger.

7.    Hamstring Stretch

Keep one leg on ground; put one foot on chair with leg straight. Bend forward at the hip. Do not attempt to touch your toes as this will stretch your back, and the goal of this exercise is to isolate your hamstring muscle in the leg that is being supported by the chair. Hold for 30 seconds. Repeat on other side. (Fig-7).

Sit in a chair, put fist between knees, squeeze together knees. Hold for count of 10. Relax for count of 3. Do 10 repetitions.

*It is better to do the exercises under the supervision and guidance of a qualified physiotherapist at least initially because faulty exercises may cause further damage to the joint.

Knee Arthritis (Osteoarthritis) (Also known as Knee Osteoarthritis, Osteoarthritis of the Knee, Arthritis of the Knee, Degeneration of the Knee)

N.B. The term knee arthritis will be used in this document to describe the condition known as knee osteoarthritis.

What is knee arthritis? 

Knee arthritis is a condition characterized by a degenerative process whereby there is gradual eroding of the surfaces of the knee joint with subsequent inflammation. This may occur following a specific injury or due to repetitive forces going through the knee beyond what it can withstand over a period of time. In a normal knee, joint surfaces are smooth and there is cartilage between the bone ends which allows for efficient shock absorption. 

(figure 1)

                                Figure.1                                                   Figure. 2

When the knee is damaged or overloaded, particularly with excessive weight-bearing or twisting force, degeneration of the cartilage occurs which reduces the knee's shock absorption capacity. As the condition progresses there is eventual wearing down of the bone ends so that the surfaces are no longer smooth (figure 2) and may have small bony processes called osteophytes. This condition is known as knee arthritis. Arthritis of the knee usually occurs after the age of 45 years. It is more common in those patients who are overweight or have a past history of injury or trauma to the knee. Signs and symptoms of knee arthritis Patients with this condition usually experience symptoms that develop gradually over time. In patients with minor cases of knee arthritis, little or no symptoms may be present. As the condition progresses, there may be increasing knee pain with weight bearing activity and joint stiffness - particularly after rest and first thing in the morning. Swelling, decreased flexibility (i.e. an inability to fully straighten or bend the knee), severe joint pain, pain at night and grinding sensation during certain movements may also be experienced. Symptoms can sometimes fluctuate from month to month with patients reporting an increase in symptoms with colder weather. In more severe cases, muscle wasting (especially of the quadriceps), a visible deformity of the knee joint, and a limp may also be present.

Diagnosis of knee arthritis

A thorough subjective and objective examination from a physiotherapist may be sufficient to diagnose knee arthritis. An X-ray is usually required to confirm diagnosis. Sometimes an MRI may also be indicated.

Treatment for knee arthritis

Whilst little can be done to reverse the degenerative changes to the knee associated with this condition, patients can generally remain active by modifying their activities appropriately. The primary goal of treatment is to remain as active as possible without aggravating symptoms in order to maintain strength and mobility and to avoid deterioration. Treatment should be directed at improving knee range of movement, reducing swelling and pain, and restoring normal function. Most minor to moderate cases of knee arthritis can be managed with an appropriate physiotherapy program so the patient can remain relatively symptom free and active. The success rate of this program is largely dictated by patient compliance. One of the key components is that patients rest from aggravating activity and balance their weight bearing activity with periods of rest (e.g. sitting or lying) to keep symptoms to a minimum. This prevents further damage and deterioration and allows the body to clear any swelling or inflammation. Continuing to participate in painful weight bearing activity is likely to lead to a poor outcome. It is important, however, to keep as active as possible by choosing activities that do not increase symptoms. Better activities for knee arthritis include swimming, hydrotherapy or bike riding .It is very important that patients with this condition perform regular movement and strength exercises to prevent stiffness and weakness from developing and to ensure the knee is functioning correctly. Pain relief and anti-inflammatory medication may also assist in managing the symptoms associated with arthritis of the knee.

Physiotherapy for knee arthritis

Physiotherapy treatment for patients with this condition is vital to hasten the healing process and ensure an optimal outcome.

Treatment may comprise:

• Soft tissue massage
• Electrotherapy (e.g. Ultrasound,SWD,IFT)
• Taping
• The use of a knee brace or compression bandage
•  Mobilization
• Ice or heat treatment
• Exercises to improve strength, flexibility and balance
• Hydrotherapy
• The use of walker or other walking aids
• Activity and lifestyle modification advice
• Biomechanical correction
• Anti-inflammatory and supplement advice (e.g. glucosamine and chondroitin)  
• Weight loss advice where appropriate (As obesity is associated with the onset of osteoarthritis, weight loss, if needed, can have a significant effect on slowing the disease progression)

Other intervention for knee arthritis

In more advanced cases of knee arthritis, where symptoms are severe, patients may require surgical intervention. This may involve a knee arthroscope or partial or complete joint replacement surgery. The treating physiotherapist or doctor can advise if this may be required and will refer to an orthopaedic specialist for an assessment and opinion.

Listening To Knee Osteoarthritis May Help Knee Pain

UK researchers have developed an acoustic device which listens to the sounds noisy knees make and could screen for early onset of osteoarthritis or OA. Millions of people suffer from osteoarthritis of the knees in the world and the treatment and management of this condition is very expensive and difficult.

An arthritic knee typically makes sounds of varying kinds such as cracking and grinding, often but not always accompanied by pain. The aim was to identify the patterns of sound the joint is giving off to help indicate how the joint is changing internally. Professor John Goodacre at Lancaster University is the lead researcher and the research is publicised on the BBC Health Website.

Early indications that a knee joint is becoming arthritic may open the door to earlier treatments such as lifestyle modification, weight loss, use of walking aids and medication. The study looked at the noises coming from knees as the subjects stood up from sitting. The device is planned to be portable and could be used in practices to monitor the changes which occur in patients' knees with time.
Merseyside physiotherapists know that osteoarthritis has no effective drug treatments and that management rotates around physiotherapy such as exercise, self management, walking aids, weight loss, coping and medication.