Inside Therapyworks Pontypridd

Acupuncture is a form of ancient Chinese medicine in which fine needles are inserted into the skin at certain points on the body.

It is a complementary or alternative medicine (CAM). This means that acupuncture is different in important ways from treatments that are part of conventional western medicine. Unlike conventional treatments, the use of acupuncture is not always based on scientific evidence.

Theory

Acupuncture is based on the belief that an energy, or ‘life force’, flows through the body in channels called meridians. This life force is known as Qi (pronounced ‘chee’). Practitioners who adhere to traditional beliefs about acupuncture believe that when Qi cannot flow freely through the body, this can cause illness. They also believe that acupuncture can restore the flow of Qi, and so restore health.

Uses

Practitioners – called acupuncturists – use acupuncture to treat a wide range of health conditions. It is often used to treat pain conditions such as headache, lower back pain and dental pain, but is also commonly used against conditions ranging from infertility to anxiety and asthma. To learn more, see Common uses of acupuncture.

The availability of acupuncture on the NHS is limited (see box, left). Most acupuncture patients pay for private treatment.

Does it work?

There is some evidence that acupuncture works for a small number of conditions, including migraine and post-operative nausea. However, there is little or no scientific evidence that acupuncture works for many of the conditions for which it is often used. More scientific research is needed to establish whether acupuncture is effective against these and other conditions.

There is no scientific evidence for the existence of Qi or meridians. Some scientists and acupuncturists believe that acupuncture may stimulate nerves and muscle tissue, and that this may be responsible for the beneficial effects that have been observed in some scientific trials. More research is needed before acupuncture’s method of action is fully understood.

For more information, see Evidence for acupuncture. If you choose to have acupuncture, make sure that your acupuncturist is fully qualified and practises the treatment under safe and hygienic conditions.

Currently, the National Institute for Health and Clinical Excellence (NICE) recommends acupuncture as a treatment option only for lower back pain. Read the NICE 2009 guidelines on l

Older people back exercise classes aiming to reduce falls

Falls prevention exercise classes are beneficial for older people, according to a report published this week by the Royal College of Physicians (RCP).

The delivery of evidence-based exercise classes varies widely between healthcare providers, and many patients need to be made more aware that therapeutic exercise can help to prevent falls, researchers found.

The RCP report is based on feedback from more than 1,700 older people who attended NHS-run exercise programs that aimed to reduce falls.

The results showed that 96 per cent of older people felt the exercises were beneficial, while 95 per cent were either satisfied or very satisfied with their exercise program.

Physiotherapist Jill Phipps, falls prevention coordinator at Southern Health NHS Foundation Trust welcomed the report. She was a member of the Fall Safe steering group, a project led by the RCP which promoted best practice in the prevention and management of falls in hospital wards.

Strength and balance

She said the results showed that Physio should be striving to raise awareness of how strength and balance exercises can promote healthy ageing, as well as ensuring that they adhere to the evidence base for exercise.

‘We are delighted that older people enjoy their NHS exercise class and find it beneficial,’ said Ms. Phipps.

‘Physios enjoy taking the classes and we’d like to do more. But as the report says there is still work to be done in raising awareness of the evidence base, and the fact that exercise is more cost effective than any other intervention for falls prevention. Exercising in groups also provides an opportunity for social interaction.’

To download the report, see the website link below.

WEBSITE LINKS

Royal College of Physicians report

Physiotherapy works: Fragility, fractures and falls

Physiotherapy and clinical Pilates

With the focus now on control of muscle rather than strength a “new” approach had to be taken to meet the criteria.

The Pilates (Pi-lart-ees) system of exercise been popular amongst performers for many years. With a basis of submaximal /variable resistance work in potentially unstable positions it had many of the right ingredients to satisfy stability training criteria. The exercises can encourage efficiency and submaximal muscle control by using variable (i.e. spring loaded) resistance and movement. To execute the exercises properly a stable, controlled pelvic and shoulder girdle is established with load facilitating both deep and global stability musculature.

Clinical Pilates description



The Clinical Pilates program has been developed by Australian physiotherapist Craig Phillips since 1990 to develop training of functional stability by progressing static stability into dynamic. Drawing on the original work of Joseph Pilates the program needed refinement to improve safety and highlight the components valid in stability training and injury diagnosis and management.

Developed specifically as a treatment tool for physiotherapists, Clinical Pilates is unique as a tool for establishing differential diagnoses, identification of radiological false positives / false negatives, establishment of outcome predictors  and  application of pathology specific exercise programs. 

DMA Clinical Pilates is the first to use real time ultrasound to determine if muscle activation patterns are being achieved. As a result changes had to be made to the traditional Pilates approach as a predominance of “bracing” activity was being consistently noted instead of appropriately sequenced, controlled tonic activity of the deep stabilisers.

Movement dysfunction often leads to pathology and vice versa. Low level Type 1 endurance musculature is the primary focus of stability training, and the aim is for early onset, at low loads, of both the local / deep stabilisers such as transversus abdominus and the deep multifidus and the more superficial global stabilisers such as the oblique / superficial multifidus, latdorsi etc. The difficulty in getting patients to activate stability musculature is because low % maximum voluntary contraction (MVC) required for stability and postural control is not as easy to “feel” as higher % MVC.

Therefore the exercises must facilitate and challenge those muscles irrespective of whether the patient is consciously aware of the muscle activity or not. If the muscle is to act as a background to movement it stands to reason that it should then be trained in the background and a “movement pattern” developed .Stability training must progress from the static to the dynamic and incorporate the connection between the shoulder and pelvic girdles. Static isolated muscle activity does not guarantee carry over into the dynamic situation. Load and movement are key factors in muscle activity so “if you want a muscle to do a job it must have a job to do” and it must be appropriate.

Injury management with clinical Pilates

An important issue in stability training is the effect of pathology. Pathologies are generally load sensitive as well as direction sensitive. Therefore if a pain producing pathology exists it must be determined if it has a direction preference. The neutral position required for ideal posture may in fact be provocative in the initial stages leading to pain, hence, muscle inhibition. Unloading the pathology in either flexion, extension or off center may well protect the pathology and allow muscle activity to occur. With progression, neutral is incorporated and eventually the provocative position used to determine the “threshold of function” of the injury.

As the research and knowledge develops in this area it is encouraging to know that the CLINICAL PILATES program can be “tuned” to both satisfy the guidelines of the researchers and meet the needs of the clinician.

Exercise Ball Safety: Do’s and Don’ts For Safe Exercise Ball Use

DO’S:

DON’TS

BE SMART – BE ON THE BALL

** Use of resistance equipment such as bar/dumbbells while on a ball is not recommended as it dramatically increases the risk of serious injury

The best way to deal with back pain is to stay active and continue doing regular exercise.

The advice 20 years ago was to rest, but research has shown that inactivity only makes things worse,” says Dries Hettinga of BackCare, a charity that offers support and information to people with back pain.

“When you’re in pain you may want to stay in bed and not move around, but that results in further [loss of mobility] and will only prolong the pain.”

Staying active means continuing with regular day-to-day activities to avoid becoming sedentary. Examples include walking to the shops rather than taking the car, getting off the bus one stop early, gardening and taking the dog for a walk.

If you experience moderate pain, take painkillers that are available over the counter from your pharmacist or supermarket. Your pharmacist or GP can advise you on how to use your medication effectively.

Exercise program

In addition to maintaining an active lifestyle, try to exercise. You can do any activity that gives your body a good workout.

“It’s important to pick an exercise you enjoy,” says Hettinga. “If you do something you enjoy, you’re more likely to stick with it. There’s no quick fix for back pain so you need to work at it.”

Ideally, your choice of activities should involve elements of endurance, strength and flexibility. Examples include walking, running or jogging, cycling, dancing, swimming, hydrotherapy (exercising in water) and aquarobics.

Consider a variety of exercises as part of a weekly exercise programme, which could include yoga, t’ai chi, working out in a gym and sport in general.

Hettinga says exercise programmes are most effective if performed regularly and over prolonged periods of time.

Aim for at least three to five sessions a week (approximately 30 minutes each session). You may want to build this up over a number of weeks.

Hettinga says an individually designed exercise programme gives the best results. A physiotherapist or exercise professional can help you with this.

Manual therapy

Hettinga suggests combining an exercise programme with a course of manual therapy, especially when the pain is persistent. Manual therapy is provided by chiropractors, osteopaths and physiotherapists.

“Evidence suggests manual therapies can be effective. Your back is examined to see if any joints need to be freed up.

“They can do it with a gentle massage, mobilisation or manipulation. It’s especially helpful if your back is stiff and flexibility is an issue,” she says.

Manual therapists are also qualified to advise you on the type of exercises that will be most effective at dealing with your type of back pain.

“You should see improvements after a few weeks,” says Hettinga. “If the pain hasn’t disappeared after a few weeks of treatment, seek further medical advice to explore alternatives.

“There is always something that can be done about back pain, but it requires some work and dedication from you.”

Physiotherapy is clinically effective and cost effective in the management and treatment of musculoskeletal disorders (MSD). MSDs are on

Physiotherapy

Early intervention with physiotherapy can reduce the amount of time people are off sick and are vital in order to prevent an acute problem becoming chronic.

Two government departments in Northern Ireland provided early access to physiotherapy for staff
with musculoskeletal disorders. 80 per cent indicated that physiotherapy had prevented them from going absent and, of those already off sick, over 80 per cent indicated that physiotherapy had shortened their absence. Respondents indicated that the service shortened their absence by an average of six weeks.(1)

West Suffolk hospital trust, Bury St Edmunds, was commended in the Boorman report for having achieved savings of £170,000 through a system of priority referrals to a local Physio for injured staff. For a cost of £21,000 it had achieved a 40 per cent reduction in lost days through sickness absence and savings of £170,000 in the cost of MSDs.

Based on the latest available statistics from the HSE (3) 227,000 people have an MSD of the back, 215,000 of the upper limbs or neck and 96,000 of the lower limbs. Low back pain is the number one cause of long term absence amongst manual workers and MSDs are the most common reason for repeat consultations with GPs, accounting

For up to 30 per cent of primary care consultations.

Self referral

Self-referral to physiotherapy has been proven to be clinically successful with high patient satisfaction as well as cost effective. The self referral pilots that took place across six
 NHS England sites between 2006 and 2008 were found to reduce the number of associated NHS
costs, particularly for investigations and prescribing, with 75 per cent of patients who self referred not requiring a prescription for medicines. In addition
there was no increase in demand for services and self-referral reduced work absence amongst patients.

An analysis of self-referral in Scotland found that the average cost of an episode of care was established as £95.48 for a self-referral, £113.24 for a GP-suggested referral and £126.17 for a GP referral. The average cost benefit to NHS Scotland of self-referral was identified as being approximately £2.5 million per annum.

Doncaster and Bassetlaw Trust piloted a successful self-referral Physio service for 6500 staff in
2005. The service was

Made permanent after
an evaluation identified
potential savings of more
than £330,000. It is
used by employees from
all corners of the trust,
and it offers an average
waiting time of 2.8 days.
More than half the users say
they would have taken time off
work if the service were not available.

In Cambridge, self-referral for MSD outpatient services has reduced costs due to less GP use of prescribing and diagnostic tests. 75 per cent of patients who self- referred did not require a prescription for medicines, giving an average saving of £12,000 per GP practice.

Telephone assessment and support

Assessing the severity of a patient’s condition over
the telephone has been found to be very resource efficient. This telephone triage saves patient and physiotherapist time as well as costs and ensures those needing the most urgent treatment are prioritized.

Where appropriate, follow up support by telephone has also been found to be a clinically and cost effective way of enabling patients to self manage their condition, helping to prevent relapses.

An occupational health physiotherapy service used telephone triage and follow up support as part of a program to tackle MSDs experienced by staff of NHS Lothian. Over £300,000 was saved in salaries alone by reducing sickness absence and there was a 74 per cent reduction in recurrence of MSDs nine months following the program

Conclusion

Speedy Access to physiotherapy for people with MSDs is clinically and cost effective for the health service, including GPs, for employers and for society. Physiotherapist has helped to pioneer innovative ways of providing speedy access within existing services.

The best way to deal with back pain is to stay active and continue doing regular exercise.

The advice 20 years ago was to rest, but research has shown that inactivity only makes things worse,” says Dries Hettinga of BackCare, a charity that offers support and information to people with back pain.

“When you’re in pain you may want to stay in bed and not move around, but that results in further [loss of mobility] and will only prolong the pain.”

Staying active means continuing with regular day-to-day activities to avoid becoming sedentary. Examples include walking to the shops rather than taking the car, getting off the bus one stop early, gardening and taking the dog for a walk.

If you experience moderate pain, take painkillers that are available over the counter from your pharmacist or supermarket. Your pharmacist or GP can advise you on how to use your medication effectively.

Exercise program

In addition to maintaining an active lifestyle, try to exercise. You can do any activity that gives your body a good workout.

“It’s important to pick an exercise you enjoy,” says Hettinga. “If you do something you enjoy, you’re more likely to stick with it. There’s no quick fix for back pain so you need to work at it.”

Ideally, your choice of activities should involve elements of endurance, strength and flexibility. Examples include walking, running or jogging, cycling, dancing, swimming, hydrotherapy (exercising in water) and aquarobics.

Consider a variety of exercises as part of a weekly exercise program, which could include yoga, T’ai chi, working out in a gym and sport in general.

Hettinga says exercise program are most effective if performed regularly and over prolonged periods of time.

Aim for at least three to five sessions a week (approximately 30 minutes each session). You may want to build this up over a number of weeks.

Hettinga says an individually designed exercise program gives the best results. A physiotherapist or exercise professional can help you with this.

Manual therapy

Hettinga suggests combining an exercise program with a course of manual therapy, especially when the pain is persistent. Chiropractors, osteopaths and physiotherapists provide manual therapy.

“Evidence suggests manual therapies can be effective. Your back is examined to see if any joints need to be freed up.

“They can do it with a gentle massage, mobilization or manipulation. It’s especially helpful if your back is stiff and flexibility is an issue,” she says.

Manual therapists are also qualified to advise you on the type of exercises that will be most effective at dealing with your type of back pain.

“You should see improvements after a few weeks,” says Hettinga. “If the pain hasn’t disappeared after a few weeks of treatment, seek further medical advice to explore alternatives.

“There is always something that can be done about back pain, but it requires some work and dedication from you.”

Most people with MS, regardless of their degree of disability, can benefit from some exercise. Many have some degree of ability. The right kind of exercise can bring positive physical and psychological health benefits.

Exercise helps you do the things you want to do and helps to prevent complications that can result from inactivity. It can improve flexibility, fitness, strength and stamina, circulation, muscle tone and mood. It can also help with the stimulation of fluids and excretion of waste products.

Many people with MS think they cannot do any exercise because they will become too fatigued but the strange fact is that it can actually give you energy rather than take it away from you – as long as you exercise sensibly and know your levels of ability. It is important to balance the exercise with rest.

You may wish to only undertake short sessions so you can avoid overheating. Remember, over-exercise can lead to weakness, fatigue, pain and spasticity. Therefore it is sometimes better to build up your exercises slowly.

Even if you are quite inactive, simple exercises like calf muscle lifts and stretches can be done at home on a daily basis. Passive exercisers are useful and there are many good products on the market, which can be used sitting down. If you suffer with spasticity a Physiotherapist can do assisted movements with you.

Good Forms of Exercise:

Physiotherapy

It is quite important to see a neurologically trained Physiotherapist as early on as possible. MS patients are often referred too late. Your G.P. or Neurologist should supply a referral. You can also receive Physio at one of the many MS Therapy Centers around the country, where the number of sessions are not rationed.

If you suffer with spasticity a Physiotherapist can do assisted movements with you and also help you to stand and balance properly, stand up from sitting and lying, walk better, position yourself to sleep, co-ordinate your movements better and help with posture etc.

It is a good idea to speak with your Physio if you are thinking of undertaking any of the under mentioned therapies and also ask their advice on any exercise machines available.

Swimming

Swimming is especially helpful because the water supports your bodyweight – the water will help to stabilize someone with balance problems. Weakened muscles can operate in this environment and will strengthen from the resistance. As swimming involves many muscles in your body, it can help to increase co-ordination.

There are now many more swimming pools and leisure centers having special sessions for people with disabilities or those who require special help and it may be worth trying one of these sessions first.

As a precaution it is best to ascertain the temperature of the water beforehand as many people with MS find water that is too hot or too cold a problem. The most comfortable temperature is about 30°C (86°F).

Pilates

Pilates is a type of exercise program based on correct body alignment. The focus is on co-ordination, moving properly and “core strength”. Good breathing patterns are important also.

As a holistic method of body maintenance, it prioritizes general fitness and body awareness, which contributes positively to rehabilitation.

In MS, Pilates can improve posture, boost the immune system, reduce stress, increase energy and bone density, improve circulation and respiration, improve muscle tone and balance.

T’ai Chi

T’ai Chi is meditation with movement. It concentrates on relaxation and correct breathing while performing graceful, circular, flowing exercises, sometimes to music. It is especially helpful for people with MS who no longer have the stamina to exercise at a high speed and another advantage is that you can exercise without overheating.

Really you need to be able to stand to be able to cope with all the range of moves. However, it is possible, according to the teacher, to do some of the moves sitting down, e.g. the arm movements and breathing exercises.

T’ai Chi can help in MS by improving balance, combating fatigue and giving you more energy. It can also help with spasms, exercises muscles and is very relaxing. Regular practice can also help with depression and maintain a calm and more serene inner state. T’ai Chi is a good method of self-development, focusing the mind and giving people with MS a sense of well being.

Yoga

Yoga is widely used by many people with MS and there are now specialist centers and teachers. It is a unity of mind and body and is as much about your breathing and your outlook on life as it is about postures. It can calm the mind and energies the body as well as helping to counteract stress, fatigue and depression.

It has a good effect on the endocrine glands, circulatory and respiratory systems and improves wellbeing. Yoga also tones the digestive organs and other glands in the body such as the thyroid and adrenals.The main concern with yoga and MS is that you should work well within your limitations in a relaxed way and be careful not to push yourself too far or raise your body temperature, as this may increase fatigue.

This article focusses on quick, simple and easy neck exercises. The pictures and text below make it easy.

Neck Range Of Motion Exercises, Neck Exercises

One very powerful way of controlling your neck pain is to do daily range of motion exercises, putting your neck through full movement several times a day. This prevents stiffness developing and stretches all the attached muscles, making them less vulnerable to sudden demands.

Please note that exercises can make your pain worse as well as better so please consult the simple exercise guidance before getting on with them. If you have any doubts, please consult your physio, other manual therapist or medical practitioner.

These exercises are meant to maintain range of motion or regain loss of movement in the neck region and to help control pain. Regular performance of movements can help with pain problems. They are simple and not magical in any way. If you have long term neck pain with some disability these exercises may help mobility or allow you to tolerate more activity but may not be very effective against pain.

Do each movement slowly five times, resting a short time in between each set of movements. Do two or three times a day although more often can be useful. Work out how much you should do by slowly increasing the frequency until you are doing enough or start to have problems.

Neck flexion

This is the movement of bringing the head forward so that the chin hits the chest and your face is staring straight down at the floor. Do slowly five times.

This exercise stretches the structures at the back of the cervical spine, which are often kept in a tight position in normal day to day postures. They can then become shortened and stop the neck moving naturally.

To make this more difficult you can retract the neck slightly to start with (see below) and then flex the head forward, increasing the stretch on the neck.

Neck extension

This is the movement of allowing the head to go back until the face is looking directly at the ceiling. Don’t do this movement fast or forcefully as it forces all the small joints at the back of the neck into an extreme position. This won’t do them any harm but might increase your pain.

Allow your neck to ease back steadily as you do this, leaving your neck at the end of the movement for a few seconds.

NB If you feel dizzy when you do this leave it out. Dizziness, especially if you are older, might indicate that the blood vessels in your neck are being squeezed by the position.

Rotation

Turn your head slowly round to one side until it cannot easily go any further. Once you have done five to one side do the other. Do not go from one side to the other in the individual movements or roll your neck about.

Hold your neck at the end of the movement for a few seconds as this is the most valuable part of the movement to maintain or increase your movement.
NB If you feel dizzy when you do this leave it out. Dizziness, especially if you are older, might indicate that the blood vessels in your neck are being squeezed by the position.

Side flexions

Keep your head facing straight forward and try and tip your ear down towards the same shoulder. It’s difficult to do this well and without
rotating to one side. She’s doing pretty well in the picture, just lifting her chin up a little more than ideal.

This movement is quite severe on the neck joints so don’t go hard at the exercise. Don’t move from side to side in the movement as that stops you getting to the ends of the neck range and may aggravate your joints.

Neck Retraction (Chicken Tuck)

This is one of the most useful neck movements as it counteracts the tendency we all have of allowing our heads to poke forwards in a poor posture. She’s showing the extreme position of “poking chin” here.

When we sit, which many of us do a lot of the time, we tend to slump and to keep our heads up so our eyes are horizontal we arch our necks backwards slightly

This gives a continual flexion (bending) posture to the lower neck and an extension (arching) posture to the upper neck. Over time the tissues can shorten and give us stiffness and pain. Typical pains are in the neck, upper shoulders, but this posture can also give you headaches.

Here’s the end point of the movement. Keep your face straight on during the whole movement, drawing the head back and the chin down slightly.

If you get it right, you will look funny, rather like a sergeant-major in an exaggerated military neck posture. If you do it in public people will either laugh or give you funny looks!

The whole movement is like the forward and back movement that chickens make. Hold the movement at the extreme of the backward posture for a few seconds.

Upper Neck Nodding

This movement particularly moves the upper cervical joints. In our bad postural habits we tend to poke our chins forward which puts our upper neck joints into extension (arching).

The nodding movement flexes these joints and can help with upper neck pain and headaches of joint origin. This is the neutral starting position for the movement.

Lying flat on your back for this movement is the easiest way to start this movement. You can be flat on the surface like she is in the picture or have a pillow if you don’t like your head down flat on a surface.

This is the end position of the exercise. Think of your head as a bowling ball which you rotate forward to rock the neck. You should not lift the head off the surface at all. You may feel a pull in the upper neck which is often tight.

This exercise should be done with caution as you could increase your pain if you push it too hard. When you get good at the movement you can do it standing up or sitting but it is harder to get the pure joint movement than in lying down.

Related movements which may be useful

When we have neck problems it is rarely just the neck which is the problem, the pain usually involves the thoracic spine and the shoulder girdle. It is good to do shoulder girdle exercises as well to loosen up this area.

1. Shoulder shrugs
Shrug your shoulders as far up as you easily can then downwards further than normal.