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

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.

Q: What is physiotherapy?

Physiotherapy uses a variety of techniques to help your muscles and joints work to their full potential. It can help repair damage by speeding up the healing process and reducing pain and stiffness.

Physiotherapists also have an important role in rehabilitation, for example, helping people who have had strokes to relearn basic movements. However, physiotherapists don’t just offer treatment, their advice can help you prevent problems returning or even happening in the first place.

Q: What types of problem can physiotherapy help?

Virtually any condition that affects your muscles, joints or nerves. Common problems that can be helped by physiotherapy include:

•   Painful conditions such as arthritis

•   Back and neck pain, including whiplash

•   Problems affecting children including cerebral palsy

•   Pregnancy related symptoms such as back pain and stress incontinence

•   Upper limb work related problems, also known as repetitive strain injury (RSI)

•   Asthma and other breathing difficulties

•   Sports injuries

•   Strokes and other neurological problems

•   Symptoms of stress and anxiety.

Q: What does the treatment involve?

Before any action is taken, the physiotherapist will assess your condition, diagnose the problem and help you understand what’s wrong. They will work with you to develop an effective treatment plan that takes into account your lifestyle, leisure activities and general health. This will include advice on how you can help yourself, for example, you may be shown exercises that you can do between treatment sessions. Where appropriate, physiotherapists also advise carers how they can help.

Physiotherapists use a variety of treatments. For example:

•   Exercise programs - designed to improve mobility and strengthen muscles

•   Manipulation and mobilisation - to reduce pain and stiffness

•   Electrotherapy - for example, ultrasound to speed up the healing process

•   Acupuncture - used by some physiotherapists qualified to practice this technique

•   Hydrotherapy - exercise in water

•   Massage.

Q: What should I do if I injure myself? Do I need to be referred by a MD, or can I make an appointment to see a physiotherapist immediately?

If the nature or extent of your orthopedic injury is unclear, you must make an appointment for a consultation with your personal medical physician or specialist. The specialist may in turn recommend x-rays, medication or any other course of action, which is deemed appropriate, including perhaps physiotherapy.

If, however, you are very familiar with your injury, and you know that a physiotherapist can address it, you may choose to skip the medical consultation and make an appointment directly with our physiotherapy services. But remember, when in doubt about the nature of your injury, consult a physician. These consultations are fully covered by Medicare, so there’s no need to gamble.

Q: How effective is physiotherapy?

Physiotherapists measure their clinical effectiveness by the same standards applied to other health professionals, including doctors and nurses. This is done through independent research to prove that physiotherapy works. For example, studies show that exercise-based cardiac rehabilitation, led by physiotherapists, results in a reduction of sudden death rates after a heart attack by 25 per cent. There is also strong evidence that physiotherapy is an effective treatment for back pain.

To ensure physiotherapists in Quebec apply equally high standards, the Order des Physiotherapeutic du Quebec, the professional body representing physiotherapists, circulates guidelines based on research to all its members.

Thanks you reading our post. If there is anything we left out please feel free to comment your question below, we’d be happy to help you.

THERAPEUTIC ULTRASOUND IN PHYSICAL THERAPY

Ultrasound is a therapeutic modality that has been used by physical therapists since the 1940s. Ultrasound is applied using a round-headed wand or probe that is put in direct contact with the patient’s skin. Ultrasound gel is used on all surfaces of the head in order to reduce friction and assist in the transmission of the ultrasonic waves. Therapeutic ultrasound is in the frequency range of about 0.8-3.0 MHz.

The waves are generated by a piezoelectric effect caused by the vibration of crystals within the head of the wand/probe. The sound waves that pass through the skin cause a vibration of the local tissues. This vibration or cavitation can cause a deep heating locally though usually no sensation of heat will be felt by the patient. In situations where a heating effect is not desirable, such as a fresh injury with acute inflammation, the ultrasound can be pulsed rather than continuously transmitted.

Ultrasound can produce many effects other than just the potential heating effect. It has been shown to cause increases in tissue relaxation, local blood flow, and scar tissue breakdown. The effect of the increase in local blood flow can be used to help reduce local swelling and chronic inflammation, and, according to some studies, promote bone fracture healing. The intensity or power density of the ultrasound can be adjusted depending on the desired effect. A greater power density (measured in watt/cm² is often used in cases where scar tissue breakdown is the goal.

Ultrasound can also be used to achieve phonophoresis. This is a non-invasive way of administering medications to tissues below the skin; perfect for patients who are uncomfortable with injections. With this technique, the ultrasonic energy forces the medication through the skin. Cortisone, used to reduce inflammation, is one of the more commonly used substances delivered in this way.

A typical ultrasound treatment will take from 3-5 minutes depending on the size of the area being treated. In cases where scar tissue breakdown is the goal, this treatment time can be much longer. During the treatment the head of the ultrasound probe is kept in constant motion. If kept in constant motion, the patient should feel no discomfort at all. If the probe is held in one place for more than just a few seconds, a build up of the sound energy can result which can become uncomfortable. Interestingly, if there is even a very minor break in a bone in the area that is close to the surface, a sharp pain may be felt. This occurs as the sound waves get trapped between the two parts of the break and build up until becoming painful. In this way ultrasound can often be used as a fairly accurate tool for diagnosing minor fractures that may not be obvious on x-ray.

Some conditions treated with ultrasound include tendonitis (or tendinitis if you prefer), non-acute joint swelling, muscle spasm, and even Peyronie’s Disease (to break down the scar tissue). Contraindications of ultrasound include local malignancy, metal implants below the area being treated, local acute infection, vascular abnormalities, and directly on the abdomen of pregnant women. It is also contraindicated to apply ultrasound directly over active epiphyseal regions (growth plates) in children, over the spinal cord in the area of a laminectomy, or over the eyes, skull, or testes.