1. What is physiotherapy?
Physiotherapy is a professional health care discipline that works closely with general practitioners orthopaedic specialists, sports and general physicians and other health care professionals. One of the many different areas of physiotherapy is treatment of varying conditions by means such as stretching, strengthening, re-learning movement patterns which are all part of exercise rehabilitation, joint and spinal mobilisation (applied movements to reduce stiffness and relieve pain) and deep tissue mobilisation. Physiotherapy makes use of active and passive manual therapy techniques, exercise facilitation, exercise rehabilitation and other modalities to improve the functional outcome of acute and chronic conditions and provide a better quality of life.
2. Why see a physiotherapist?
Physiotherapists have an advanced understanding of anatomy, biomechanics, pathology and exercise prescription with enriched skills through ongoing post graduate education. Physiotherapists are registered by the Health Professions Council of South Africa which upholds the highest standard of ethics and professionalism.
Physiotherapy is very beneficial for many conditions such as:
- post surgical rehabilitation (e.g. joint replacement or arthroscopic repairs)
- ligament sprains (e.g. sprained ankle)
- strains or muscle tears, (e.g. pulled or torn muscles)
- overuse/repetitive strain injuries
- tendonitis (e.g. tennis/golfer’s elbow)
- low back pain
- neck and shoulder injuries (e.g. rotator cuff pain or frozen shoulder)
- knee pain (e.g. torn cartilage, patellofemoral pain, osteoarthritis); ankle, foot injuries/pain
- fracture rehabilitation including compression fractures
- Chronic Pain conditions (i.e. regional complex pain syndrome)
- Sports Performance Enhancement
3. Is a doctor’s referral needed to see a physiotherapist?
No, a doctor’s referral is not necessary to see a physiotherapist in South Africa. At SSPC we do believe in maintaining good communication with the physician to ensure a positive outcome for each client. We also recommend that clients keep regular appointments with their doctor to address any medical or additional health issues.
4. What is orthopaedic physiotherapy?
Orthopaedic physiotherapy is physiotherapy in which the physiotherapist manually mobilises the joints and nerves in order to reduce stiffness, relieve pain and increase range of movement. It also includes soft tissue mobilisation, postural assessment and specific exercise and stretching programs.
5. What does orthopaedic physiotherapy do?
In addition to reducing stiffness, relieving pain and increasing range of movement, orthopaedic physiotherapy can assist in the restoration of strength, proprioception, balance, coordination and function.
6. What is a sports physiotherapist?
A sports physiotherapist uses their knowledge of sport and the specific requirements of a sporting code to treat acute & chronic musculo-skeletal type injuries, traumatic( e.g. post-op shoulder dislocations or fractures) and repetitive strain injuries (e.g. tennis elbow) resulting from participation in sport or social activity. Rehabilitation after a sports injury is often done by the sports therapist, reducing pain and swelling, improving strength, flexability, function, endurance and performance.
7. What is deep tissue mobilisation?
Deep tissue mobilisation involves the application of manual techniques such as pressure, compression, bending, longitudinal gliding, kneading, stretching and rolling the tissue.
The aim of deep tissue mobilisation is to stretch and release the soft tissue of the body including the fascia.
8. What does deep tissue mobilisation do?
The intention of deep tissue mobilisation is to:
- restore balance in the musculoskeletal system
- restore balance in the nervous system
- restore range of motion to stiff joints
- relieve muscular tightness, spasms or restrictions
- improve muscle tone and balance
- correct problems due to poor postural alignment
- reduce The physical stress placed on bones and joints
- reduce muscle fatigue and soreness by promoting rapid removal of toxins and waste products from the muscle
- increase flexibility in the muscles
- bring more oxygen and nutrients into the muscle by increasing blood circulation
- provide pain relief
- improve the function of the fascia
9. What conditions does deep tissue mobilisation address?
Deep tissue mobilisation is effective for any conditions involving lack of mobility and/or pain caused by a dysfuntion in the soft tissue.
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10. What is soft tissue?
The soft tissue includes muscles, tendons, ligaments, capsules and fascia (connective tissue).
11. What is fascia?
Fascia is a loose to dense fibroelastic connective tissue that contains myofibroblasts. It is found throughout the body from the head, face, neck and trunk to the arms and legs and covers the bones, tendons, muscles, ligaments, nerves, organs and bloodvessels. Superficial fascia is loose, fibroelastic and fatty. Deep fascia is tough, compacted and irregularly woven fibroelastic tissue. Three important properties of fascia are contractility,plasticity and elasticity with the latter diminishing with age. The function of the fascia is to act as a supportive mechanism enveloping the above mentioned structures, , supports tendons, muscles, ligaments and joints. The latest research also explains its role as a feedback mechanism to the brain which reciprocally plays a role in improving strength, reduce stiffness and reduce pain. As a result of injury or chemical disruption, fascia may thicken, shorten, calcify which will restict its function and result in pain and stiffness.
Acute Injuries – What do I do when I get injured?
With any acute traumatic injury (muscle tear, ankle sprain) the body responds in a specific way. Initially, the healing process starts off with the inflammatory phase. The body sends many inflammatory cells and substrates to the injured area which is associated with swelling and pain. Although this is a necessary part of the healing phase, it is imperative that we control this phase as best as possible by following the PRICER regime.
Try and protect the injured area through strapping or immobilization. For instance, if the ankle is painful to walk on, a temporary walking aid (crutch) will help to limit the weight bearing through the area
The body needs time to heal. Rest is very important to allow the body to protect itself initially.
The use of ice will limit the amount of swelling in the injured area. It is recommended to use an ice pack for 20 minutes five times per day.
There are many specialized bandages for this purpose. If nothing is available, try and use a stocking for this purpose.
Elevation will improve the blood flow through the system, which will help with the re-absorption of the inflammation.
If the injury is severe, or there continued swelling and pain, the injury needs to be assessed by a healthcare professional, such as physician or physiotherapist. It is recommended that you see your physiotherapist as soon as possible after the injury to assess the appropriate management
TOP TEN SPORTS INJURIES
Because different sports have different components that is required for each specific discipline, the top ten list will be different for impact/contact sports vs non-impact sports. This list refers to common injuries in general, attempting to account for all sporting codes.
1. Muscle Strain
Probably the most common injury that any athlete will experience in their lifetime. Commonly referred to as a muscle “pull”, a muscle is strained when it is over exerted. This often happens when we haven’t trained sufficiently, and we expect our muscles to perform beyond their current capabilities. Other causes include fatigue or trauma. Because the muscle is unable to withstand or generate the force required, failure occurs in the muscle fibre and their ability to contract is interrupted. This could lead to a tear in the muscle if the force is great enough.
Often there is little that can be done to prevent a muscle strain. It is however important to warm up and cool down well before and after exercise. Recently, dynamic stretching has been emphasized in the warm up (i.e. big movements that will stretcg the muscle instead of keeping a muscle in a static position for a period of time).
Long Term Treatment:
When returning from this injury, it is also important to increase the muscle force gradually to allow the muscle to build up strength and avoid re-injury. A sports physician or physiotherapist must assess the extent of the injury to implement the appropriate graded training programme. When there has been severe disruption of the muscle tissue, some manual treatment of the area are also beneficial. Underlying reasons for the muscle dysfunction also needs to be investigated (such as the muscle pattern in the lower leg – this would be identified with a muskulo-skeletal assessment).
2. Sprained Ankle
An ankle sprain occurs when the foot rolls over to the outside, and the ligaments on the outside of the ankle is injured. This is a common injury in runners and any sport that requires change of direction. It usually takes a long time for these injuries to recover, and patience is required to allow for the healing to take place.
Important factors that will help to avoid this injury is to make sure you have the appropriate running shoes or footwear for your specific foot. Again, include the muscles of the lower leg in your warm up and cool down routine.
Long Term Treatment:
Gradual improvement of the range of movement must be achieved as well as building up muscle strength. If there is any residual stiffness or weakness after the initial healing period, this must be addressed. Strengthening of the intrinsic foot and ankle muscles using resistant elastic bands are often very successful.
3. Runners Knee (Patella Tendinopathy)
This is commonly seen as an overuse injury. The knee cap needs to move in its groove as the knee bends and straightens when running. Misalignment of the knee cap in this groove causes the cartilage in the joint to wear out. This will also lead to increased load through the tendon running over the knee cap due to muscle dysfunction occurring around the knee. Often, incorrect muscle patterns in the leg can lead to the development of this kind of condition. This is mostly seen in runners, but can occur in any sport that involves running.
The latest research suggest eccentric training helps to improve any form of tendonopathy, and is especially beneficial with runners knee. Eccentric training involves improving the neuromuscular control (i.e. train the brain). This will allow greater muscular control and less load on the knee joint and the tendon.
Long Term Treatment:
Soon as any knee pain is experienced, the source of this pain must be assessed. It is difficult to prevent overuse injuries, as the knee needs to do the repetitive movement to do the sport. Good hip and pelvic stability as well as strong hip muscles (gluteal muscles) seems to help lessen the load in the tendon and the knee joint.
4. Lower Back Pain
The incidence of lower back pain in the general population is more than 80%, and it is also common among the sporting fraternity. Most of the load absorb through the spine is concentrated in the lumbar spine (lower back). With sport, lower back injuries are often seen due to over-exertion, heavy lifting or twisting in an unnatural way (golfer trying to make a big swing). Our posture, level of activity and whether we perform repetitive tasks often influence the occurrence of lower back pain.
Good mobility of the lower back is important to avoid the build up of muscle tension. Pilates exercises are a great way of keeping the back loose. Pilates exercises also targets abdominal muscles needed for support of the lower back. Specifically, the transversus abdominal muscle runs like a natural corset across the lumbar spine, and retraining these muscles (commonly known as the “core muscles”) will improve the stability of the back.
Long Term Treatment:
Good hip and pelvic stability as well as strong hip muscles (gluteal muscles) also seems to decrease the load in the lumbar spine by tensioning the fascia (connective tissue) that supports the lower back. It is important to include these in your regular training programme.
5. Shoulder impingement
Shoulder injuries are very common in throwing or racket sport, but also occurs because of trauma experienced during other sports. Commonly, the muscles responsible for stabilizing the shoulder joint called the rotator cuff muscles get injured by being impinged in the shoulder joint. This usually causes severe pain and inflammation. These muscles (supraspinatus, infraspinatus, teres minor and subscapularis) are responsible for most of the movement in the shoulder. The shoulder needs to be able to perform a variety of activities in a wide range of movement, and is therefore a dynamic joint with little ligamentous support. Because of this, a high frequency of injuries is seen of shoulder injuries.
Because the rotator cuff muscles are essential to the strength and control around the shoulder joint, retraining the rotator cuff muscles will alleviate many of the symptoms associated with shoulder impingement.
Long Term Treatment:
It is important to assess the mobility of the spine, especially the neck and middle back, as this could often influence the shoulder mobility. A long term rehabilitative exercise programme to facilitate the correct muscle pattern for the rotator cuff muscles is important.
6. Neck Pain
Neck pain is often seen with overhead sports such as tennis (looking up to hit the ball, or with endurance sports i.e. cycling (holding on to the handle bars could cause neck pain). Often the cause of the neck pain is a muscle that has been strained (usually referred to as muscle spasm) due to a sudden movement, or having to sustain a certain position for a long time. Sometimes the vertebral alignment in the spine could be out of place, and then this needs to be addressed.
The most important factor to prevent neck pain is mobility exercises and gentle stretches of the neck. Done regularly, this will prevent the build up of tension in the neck. This is very important for any sport requiring a long period in one position.
Long Term Treatment:
For athletes that experience a lot of pressure on the neck, I think a regular maintenance session with a physiotherapist will allow the prevention of the build up of pain and tension. Training the stability muscles in the neck could also improve the regular functioning and prevent neck pain.
7. Achilles Tendonopathy
Achilles tendonopathy is inflammation and degeneration of the Achilles tendon that runs along the back of the ankle. This is the strongest tendon in the body, and therefore exerts a large amount of force. If this inflammatory condition continues, it could lead to rupture that most often needs surgical repair. Achilles tendonitis is most often caused by overuse, such as repetitive jumping activities. Pronation of the ankle and foot could be a predisposing factor.
A good warm up and cool down programme is important to prevent injuries such as Achilles tendonopathy. Eccentric and Isometric exercises have shown to improve Achilles tendonopathy. After any initial injury, there must be a period of time not doing the aggrevating activity. If you have experienced discomfort in the ankle and foot, it might be sensible to consult a podiatrist about your running shoes and possible orthotics.
Long Term Treatment:
According to the research, the best way of treating Achilles tendon problems is doing heel drop exercises. This is again a form of eccentric training. Standing on a step with the ball of your foot, you let your heel drop past the step and return to the start position. Improving the muscle strength of the intrinsic foot muscles are also important.
8. Tennis Elbow (Lateral epicondylitis)
This condition is characterized by inflammation and degeneration of the tendon in the forearm connecting to the elbow. Pain is then often experienced at their insertion over the outside of the elbow. These muscles turn the palm inwards and lift up the hand at the wrist. Usually this injury is caused by overuse movements. Golfers also suffer from “tennis elbow”, but on the non-dominant hand.
There are many orthotic devices available with limited success. Strengthening of the forearm extensor muscles are important, and making sure that your training programme does not overload these muscles.
Long Term Treatment:
Manual mobilizations (moving the elbow joint in a specific way) and releasing the soft tissue (muscles and fascia) in the forearm has been shown to have great success in the treatment of this condition. If it does not improve, you must consult your doctor.
9. Shin Splints
Shin splints is a common term referring to pain on the inside of the shin bone. This pain can be caused by three different conditions, i.e. inflammation of the muscle inserting onto the shin bone, pressure building up in the lower leg (known as compartment syndrome), or a stress fracture of the tibia (shin bone). It is commonly caused by running or jumping on hard surfaces, but could also be an overuse injury. Running shoes, frequency of running and position of the foot could also contribute to developing shin splints.
Most often changing the surface on which you train will allow great relief from the pain in the shin. Again, running shoes/footwear is important to be assessed by a podiatrist/physiotherapist.
Long Term Treatment:
Hip and pelvic stability as well as correct muscle pattern of the leg often influences the position of the foot and the forces in the lower leg. Gluteal muscle retraining could be introduced. Mainly the correct training programme is needed to prevent further complications.
10. Plantar Fasciitis (arch pain)
Fascia is a specific kind of connective tissue that is arranged in a very specific way to support the arch of the foot. When this shock-absorbing cushioning becomes inflamed, a dull aching pain is experienced along the arch of the foot. Plantar fasciitis is often experienced by people suddenly returning to high levels of their sport after a period of inactivity. Appropriate footwear also play an important role, especially if the sport requires long periods of standing.
Usually using an orthotic to provide some arch support will alleviate the symptoms. Appropriate training programmes allowing for gradual build up of strength and endurance will have the greatest contribution to prevention of these injuries.
Long Term Treatment:
A thorough evaluation of your foot biomechanics is needed to make the correct adjustments in running style and possibly footwear/running shoes. Retraining of the intrinsic foot muscles to provide greater stability to the foot will also improve the ability of the muscles of the foot to support the arch.
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