Posture

This is the one subject which every patient who attends my clinic with neck or back problems will get nagged about. I find it astounding how little self awareness the majority of the population possess and although this may sound slightly harsh try and think about the last time you actually gave any thought to the position your body or body parts are in at any one time. Stop for a moment and think how you feel physically? Is there excess tension in the neck, shoulders, upper back or lower back? Are you straight on or twisted? Are your legs straight and relaxed or screwed round the chair? Is your chin poking forwards, your shoulders rounded and your lower back slumped. The answer for most people, if sat at the computer, is probably yes! Now for short periods the body can cope with being pulled out of position, however if this takes place over weeks, months and years then tissues such as ligaments, muscles and joint structures start to adapt to this twisted and tight position. They will eventually fix in shortened/tight or stretched/weak positions and then the problems really start. This is the first step on the way to spinal degeneration. A common mistake many people make is to think of posture as a fixed position when in reality "a state of equilibrium" would be a much more accurate description. There has to be a certain amount of tension in the muscles at all time otherwise we would just be a bag of bones and jelly on the floor. This equilibrium is achieved by producing equal tension in the antagonistic muscle groups (neck flexors/extensors/rotators, shoulder rotator cuff, biceps/triceps, forearm flexors/extensors/rotators, chest/upper back, abs/back extensors, quads/hamstrings, calf/shin, toe/finger flexors/extensors. In this state there should be a feeling of balance without excess tension, this is the perfect posture and in an ideal situation should be attainable through any movement. To view how the ideal posture can be used in any situation watch toddlers as they move. They are able to crouch with perfect alignment, heels on bum and not fall over (try it!) bend from the knees not the back. They have not learned bad habits and are also not strong enough to pull themselves out of shape. So in essence if you do not want poor posture and possible chronic joint conditions then you could go a long way to avoiding this by increasing your self awareness!

Osteoarthritis

There are various types of arthritis, Osteoarthritis (OA) is a degenerative condition which causes weakening and calicum leaching from the bones, also damaging cartilage in the joints. This can have multiple causes and can include joint trauma, genetic factors, prolonged drug use and repetetive strain. Joint trauma after injury, to the internal joint surfaces, will over time develop into OA and is seen most often in sports people although any joint injury can develop into OA, the speed of progress will depend on the extent of the injury, incidence of reinjury and aftercare/rehab. Genetic factors often handed down through the female line can increase likelyhood of OA development. With some drug use over long periods especially repeated steriod use for example in asthma can leach calcium from the bones and make sufferers susceptible to OA and brittle bones. All this sounds fairly depressing however there are a number of techniques which can be used to combat and slow down progress of the condition. The main factor to bear in mind with any condition, injury or disease is not to generalise. Every individual is different has a unique genetic make up, physiology, immune system and ability to heal. Thus OA can attack any joint in the body in no particular order and an individual may also have one joint affected or multiple. This means that different people will respond to different treatments in a variety of ways. The initial point is to make sure that prescribed painkillers and anti-inflammatories are correct and your GP should be consulted for this. Your physiotherapist can provide pain relief with acupuncture along with gentle mobilisation can be very beneficial for affected joints, hydrotherapy is also fantastic for getting stiff weak joints and muscles moving due to the therapeautic buoyancy qualities of warm water. Exercise in general is the key and it is essential to find the right balance between mobilisation and strengthening of OA joints and activities which will aggravate the symptoms. Cycling is excellent for leg strength and can give new lease of life to weak sore knees. Theraband can be used to give continuous resistance over range with no impact, again excellent for muscle strengthening. Some impact is needed and again this will vary from individual to individual. The bones gain strength from impact as it builds crossbridges in the calcium matrix which makes up the main bone structure. as can be seen onset of OA is not the end for an active life and if anything should spur people on to increase activity in the right way to increase quality of life. The main message is to tailor activity to your own condition and seek professional help to do this.

Osgood Schlatters Disease

A condition is most often seen in very active early teenagers who have just gone through a growth spurt. This may seem like a gross generalisation however those are the facts. Now this does not mean that we never see Osgood Schlatters (OS) in any other individual, just more often in this age/activity bracket. Although called a disease OS is strictly a biomechanical problem caused by the long bones in the leg (femur, tibia and fibula) growing at a very swift rate as often happens in the teens at very unpredicteable times, usually around hormone fuelled radical changes in character!! The muscles in the legs get rapidly stretched beyond the length they can comfortably work at and this places excessive strain on all the joints they control or move over. In the case of OS we are dealing with the bimechanical changes in the Patellofemoral (between kneecap and the femur) and the tibiofemoral (Femur in upperleg and Tibia in lower leg) and the tibiofiblar (tibia and fibula) joints. The changes in the way the quadriceps, hamstrings and calf muscles act on the bones places a large amount of strain on the bony muscle attachments. In the case of OS this is specifically the tibial tubercle (the bony protruberance on the front of the shin just below the knee). With time the repeated overload from the quadriceps muscle causes the surface of the bone where the patella tendon muscle attaches to become inflamed and to swell. The next stage is progressive and the body lays down new calcium to try and repair the damage resulting in an ever increasing lump below the knee. This is accompanied by pain which will gradually appear earlier in exercise so that eventually walking will be uncomfortable. This is a tricky problem to treat and the only real answer is rest and time allowing the inflammation to calm down and the muscles to adjust to the new leg length. Physiotherapy can help with advice, stretches, ice, unloading strapping and ultrasound and should be accompanied with a course of antiinflammatories prescribed by a GP. However as mentioned time and rest are the best healers for this problem. No miracles!

Neck Pain

Pain in the neck, it certainly is, second only to lower back pain in the list of complaints seen by physios. This is due to the lower back carrying much more load so exposed to much greater everyday strain. The neck however is vulnerable due to it's girth, or lack of it, and the fact that the average head weighs the same as a middle weight bowling ball. Not a small amount to support! Couple this with a huge number of nerves and blood vessels running out to the upper (thoracic)back, shoulders and arms there is plenty scope for problems to arise. By far the greatest cause of neck pain is poor posture, much more so since the majority of people lead such sedentary lives. Posture is much misunderstood and is not as most people think a static position to be held which in itself promotes increased tension. Good posture should be a free flowing state of movement where every component of the head, neck and shoulders is balanced without any excess tension. If the head is held too far forward, backwards, to the side or rotated, repeatedly over a long period of time then one set of muscle opposing this postion are going to be under constant strain. Imagine holding a bowling ball in your hand with a bent elbow for longer than 20 mins. The biceps and shoulder muscles would get tighter and sorer as time went on. If you repeated this with those tight muscles then the tension would increase and the muscles would eventually go into spasm. The same applies for the neck, however where posture is concerned this occurs over months and years, the muscles around the neck tighten to the extent that movement is restricted and actually increases pain. Postural neck pain has a snowball effect and over time starts to involve the nerves and bloodvessels in the neck possibly leading to neural and vascular symptoms such as dizzines, blurred vision, blackouts, pins/needles, numbness and tingling in the head, shoulders, arms and hands. Severe cases over time can lead to degenerative changes in the spine including spondylosis and arthritic conditions. The message here is look to your posture and see if any improvements can be made to yourself and working, home or leisure environment. Posture is controlled by habit and to break an ingrained habit can take up to a month or 6 weeks. The best result I have found are through using visual aids, specifically brightly coloured sticky dots which catch the eye and can be stuck wherever you will see them. They act as a reminder and the more you think about improved posture the more the brain sets down a new better habit. There are of course many other causes of neck pain which will be addressed in future blogs

Massage

Many physiotherapists would balk at the thought of being called masseurs, however an integral part of our treatment involves various massage techniques. A massage can be defined as any technique involving the manipulation of soft tissue through external pressure and there are many benefits to be gained through these techniques. A physiotherapist will employ massage in a number of ways, whether as reduction of muscle spasm, breaking down of scar tissue, trigger point release, increasing blood flow to an area or aiding reduction of swelling, any muscle under strain or increased tension will benefit to some degree from a form of massage. The key is to guage the depth, duration and type of massage from thorough assessment beforehand. Conversley it is possible to cause damage and further trauma due to wrong use of techniques and this is why proper assessment of the problem being treated is essential. The most important thing to bear in mind is whether your masseur is properly qualified and registered with the relevant bodies. Physiotherapy is now a name protected profession and everyone calling themselves a physiotherapist has to be fully qualified and registered with the governing bodies CSP (Chartered Society of Physiotherapy) and HPC (Health Professions Council), if in any doubt about this you can check on the CSP website as all registered physiotherapists will be logged on this site. Many Private physiotherapists are also registered with the OCPPP (Organisation of Chartered Physiotherapists in Private Practice) who also have a website. Prior to going for a massage it is an idea to have in your head an aim whether relaxation, sports massage or lymphatic drainage (swelling reduction) for example. This makes the massage technique selection much easier for the therapist. In this country massage is often seen as a luxury, however in asia and the middle east it is part of life and not unusual to find families who all perfom massage on each other as part of a daily routine. The stress relieving propereties cannot be overstated and in todays mad life stress relief is hard to come by!

Manipulation

There is much misunderstanding regarding manipulation especially among patients. As physiotherapists we massage, mobilise and manipulate on a graded scale of intensity. Massage, for the purposes of this blog, refers purely to soft tissue techniques, whereas mobilisation and manipulation refer to joint techniques. Mobilisation is graded I-IV concerning depth of movement and amount of force used, this is a general description and there are finer details to each grade. A grade V technique is still a type of mobilisation but is refered to as a manipulation due to the fact that the therapist is taking the joint to the end of range and slightly beyond to act as a release or realigning tool. Now obviously prior to any therapist carrying out this technique a full assessment will have taken place not only physically but also close questioning to ascertain if there are any possible risk factors the present condition, in medical and drug/medication history. The physical exam will show any relative stiffness/excess movement between adjacent joints and highlight any which would be candidates for manipulation relative to the symptoms being suffered. Prior to any manipulation informed consent has to be gained from the patient involved. From my point of view informed means that the patient has had the technique about to take place fully explained including the reason for it and the actual process. This has to include explaining possible risks in a common sense manner. The patient is then placed in the appropriate position to isolate the joint involved and this can include any joint although will most often concern the spine whether cervical, thoracic or lumbar. After the manipulation has taken place all movements and subjective markers are revisited to establish any change in symptoms or movement. Following manipulation if any muscle imbalance remains then it is very likely that with patients habitual patterns of movement will cause the manipulated joint to start to cause future problems, therefore appropriate ongoing progressive exercises to address these imbalances are vital to stop a recurrence of symptoms. The important part of this is to give the patient knowledge to minimise the problem happening again. http://rannoch-physiotherapy.blogspot.com/2009/03/knowledge.html

Muscle

Muscle is the powerhouse which allows us to move in the way we direct with our brains. Without muscle we would just be a bag of bones and jelly slopping on the floor. We need to create a certain tension in muscle and control it even to stand still. Movement is an incredibly complicated process, to control my fingers as I type this, a multitude if connections have to be made in the brain and transmitted down the nerves to the muscles in the neck, back, shoulders, elbows, wrists and fingers to allow me to move all these joints in a certain way and type accurately with speed, precision and correct spelling (hopefully). So muscle provides power for movement, what then happens when a muscle is strained or torn? A complex process is initiated we know as healing and this is broken into specific stages which have overlapping timescales depending on the severity of the injury, the immediate aftercare and the body type of the person involved. Initially the trauma causes release of chemicals which tell the brain that damage has been caused and we feel pain! Next blood rushes to the area to fill any break in tissue and a clot forms as a barrier to infection. At this stage if swelling is not reduced then further damage occurs from excess pressure on already damaged tissues and those adjacent. Immediately after trauma is the time to apply R.I.C.E (Rest, Ice, Compression, Elevation). Of all these Compression is the most relevant at inital stages in relation to swelling and can reduce secondary tissue trauma immensely. Ice can be applied during this and after as an ongoing treatment. Due to the fact that muscle is pumped full of blood healing times are much shorter than for most other tissues because plenty of nutrition is available to fuel the healing process. The further stages of healing are specialising of tissue type to muscle then scar formation. If the correct directional stresses are placed on the scar while it is healing then the new tissue will be much stronger and able to withstand stretching without damage. A final point to make would be that muscle is predominantly made of protein and if the diet can tend towards this during healing with products which contain plenty of amino acids (the building blocks of protein) such as oily fish, cottage cheese, eggs, lean meat ,quinoa,(a cous cous like grain), then this will aid the production of good quality healing muscle tissue. These should also be eaten as part of a balanced diet!

Knowledge

Knowledge is power, especially from a patients perspective. It's very easy to do the wrong thing after injury and potentially leave yourself with a life long problem. Even a small amount of the right knowledge can empower a patient to take control of their rehab and regain full function. Most patients only spend a small percentage of recovery and healing time in the company of a medical team or clinician, so will not have someone there to hold their hand every step of the way. The majority of progress can be made in the interim, IF! the patient has been given the tools by the clinican to carry out ongoing progress. These include details on what to expect at each stage of healing, how an injury will react if they do the right and also the wrong thing, rough time scales (however these are very hard to establish between individuals and injuries) for return to function, progressive exercises and at which stage to progress them (these must be directed to gain the function the patient wishes to return to) and longterm advice. Many people may think that this may complicate issues and cause confusion, however a small amount of appropriate knowledge is infinitely more desireable than the confusion of no knowledge whatsoever!

Hyrotherapy

Water is a fantastic medium to rehabilitate any form of injury, whether a sprain, fracture, or stroke, there are unlimited applications. Water has unique properties which include buoyancy, rythmic wave patterns, therapeutic sound qualities, relaxation, easy progressive muscle resistance and flexibility exercises possible. From a muscular point of view, water allows the patient to exercise a weak injured muscle far earlier than possible on dry land due to it's supportive qualities. Injured athletes can return to cardiovascular training such as aquajogging as an early rehab technique, Stroke and neurological patients have found that the support given by the water greatly reduces muscle tone and spasm allowing normal movement patterns to be practised. Back pain can be reduced using the same techniques. In essence hydrotherapy is a very diverse and useful tool in the physiotherapy toolbox and there are more dedicated pools appearing all the time.

Headache

Headaches have many causes including tension, migraine, dehydration and food intolerance. As a physio the type we can help in general is cervical headache. This can be caused by a number of structures in the upper back and neck region. There are many trigger points in the muscles of this area and each has a specific pain referral pattern. This means that if you get spasm in a specific trigger point then the pain can be felt over a defined area of the upper back, neck and/or head. This specificity allows for accurate daignosis of a possible cause of the head pain. The symptoms may be linked to a certain repetitive activity possibly work or exercise related. Most often however poor posture is the main culprit. With more and more people leading sedentary home and working lives there seems to be a growing lack of awareness of how the body is moving and functioning (this could be linked to advancements in technology meaning that more and more tasks are being taken out of our hands). Many people I see who have extremely poor posture have no awareness of this and feel that they are upright, central and relaxed rather than slouched, twisted and full of tension. A mirror is a useful tool to self examine and to increase awareness. The brain loves repitition of movement patterns which helps it to lay down little connections in the subconcious mind allowing it to take care of little tasks like posture with out any concious thought. Posture should be brought in to the forefront of the mind to increase awareness. This one factor could reduce the number of headaches linked to tension dramatically. From a treatment point of view the inital advice would regard posture and neck exs to release tension. Manual therapy would involve spine mobilisation, trigger point release, acupressure, massage, traction, acupuncture and relaxation. Fantastic longterm reduction in cervical headaches can be achieved through these techniques.

Groin Strain

A phrase designed to bring tears to your eyes, no one wants a groin strain, very easy to occur and very hard to cure. Again they can vary from very mild where a few muscle fibres are strained to severe when large tears occur within the muscle or tendon. The classic cause is the side step in rugby, footslip when changing direction, icy or muddy ground. The main symptoms felt are severe burning in the groin area, abdominal pain, hip/knee and/or back pain. All these symptoms can occur separately or all at the same time. Proper history and assessment are vital to avoid confusion with back, hip and knee problems or treatment will not target the specific structures injured. Early intervention will speed up recovery immensely and as a physio this is the comment I make to all my patients whatever the complaint. Seek help as early as possible before secondary symptoms appear and other tissues become involved due to compensatory movements. Treatment consists of progressive stretches and strength exs, massage techniques, ultrasound and acupuncture. A secondary condition which can develop from groin strain is Gilmore's Groin, this normally occurs after repeated injury in the same area and is a development of symptoms into the abdominal muscles. More about this in a future blog

Gait analysis

Many problems of the lower limbs and back can be diagnosed by gait analysis. A seemingly simple thing like a fallen arch can be the underlying cause of chronic back pain. Every physiotherapy assessment of back or lower limb problem should involve, at some point, a gait assessment if there is any ambiguity regarding diagnosis because this can often highlight other possible causes. The assessment can look at standing posture initially to see if there are any asymmetries apparent throughout the skeletal system. This then leads onto gait analysis both from front and back and side which again can show any irregularities not immediately obvious at the standing assessment. Treatment can then be planned depending on this assessment. It is also useful to look into the patients everyday life to ascertain any aspects which may be contributing factors such as repetitive tasks involving fixed postures for example work environment or hobbies.

Fitness

There are many levels of fitness. If an individual states that they want to get fit what do they mean? Fit to live? fit to drop? fit to work? fit to run a marathon, fitness fanatic? Everybody has different concepts of what fitness is whether gained from the media, friends, life experience. As physiotherapists we have to bear this in mind when treating clients and be sure not to impose our concept of fitness onto them. To be fit can be a never ending quest with no goal at the end ither than to keep progessing or it may mean to climb a certain mountain, walk 100 metres to the local shop every day. A certainty however is that everyone can improve his or her fitness to some degree, all that is needed is confidence and knowledge.

Flexibility

Flexibility is a very important component in both joint and muscle function. Generally this is the first thing to be lost after any injury especially with immobilisation. There are a number of ways which can be used to increase flexibility, initially static stretching is the most commonly used because of the easy grading system from gentle to firm. At the other end of the scale is dynamic stretching using gentle balistic movements. This is particularly useful if used during a warm up pre exercise or sport as it reduces the chances of cooling down which is seen with static stretching. A technique commonly used by physiotherapists is contract relax where a muscle is isometrically contracted( without moving through a range) then relaxed and stretched. All muscles after contraction have a reciprocal relaxation which can be used to increase the length if the stretch is for long enough. Once flexibility is increased then strength exercises can be introduced.

Fracture

A fracture conjures up horrible pictures in most peoples minds of bone sticking through leg wounds and of screaming agony. While this, unfortunately, can certainly be the case there are a wide array of types and severity of fracture. From the gradual build up of the stress fracture with it's often dull throbbing pain, the greenstick snapping clean through of a bone to the twisting and shearing of the spiral fracture. Within this variety of types there are also grades from 1-5 which defines the extent and types of tissues involved. Obviously the more tissues involved the longer the healing process takes. No matter what type of fracture is experienced the initial reaction and care should follow the same rules. Immobilisation to remove the chance of the fracture ends causing further damage to surrounding tissues and also to help the initial rejoining (union) process to start to take place, elevation if possible to reduce swelling which in the case of most traumatic injuries is the greatest cause of damage after the initial injury. Compression depending on the type of injury again t0 reduce swelling and ice also to reduce swelling. The next obvious step is to move the casualty to expert medical care as soon as possible to assess the extent of the damage and ongoing care. On no account should any unqualified person try to move a suspected fracture site. This is espescially prevelant in the case of suspected spinal fracture because of the chance of paralysis and posssible life threatening damage being caused. Following treatment at hospital it is important to seek ongoing care and advice regarding timescales for exercises geared towards restoring full functional range of movement and strength. The mistake many people make is to assume that once a fracture is healed and out of plaster then normal life will resume straight away. The biggest shock is to see a stick thin limb appearing from the plaster and have the prospect of further ongoing work to get back to normal. A physiotherapist should always be consulted in this case, and there will be one near you wherever you live in Scotland

Endorphins

Endorphins are chemicals produced by the body which make us feel good. They have been compared to the effect of opiates and are produced in reponse to certain stimulus such as exercise, acupuncture, acupressure and general massage, eating chocolate (dark) and sex to name but a few. Bet thats got your attention!! Endorphins are designed to elicit as a slight addictive response in the body and mind and make you want more of whatever causes their release. From a physiotherapy point of view we would focus on exercise, acupuncture and massage all of which have this pleasant side effect, which in exercise encourages you to continue, in acupuncture endorphins promote relaxation and a feeling of uphoria and similarly in massage. The effect can depend on the emotional state of the individual at the time in regard to the extent of the reaction

Exercise

Exercise can be of benefit in any situation from a lack of fitness, obesity, medical conditions (acute and chronic) and from a physiotherapy viewpoint injury rehabilitation. exercise covers a huge range of different levels of activity from simple one muscle/joint movements to whole body activites and sport and all inbetween. Everybody from the youngest child to the oldest grandparent can benefit from some increase in their level of activity and this can bring about massive lifestyle benefits. Physiotherapists prescribe exercises across the whole range of medical conditions and the programme will tend to be progressive and ultimately patient controlled through self motivation and time input. The best way to describe the physiotherapist role in exercise is as a facilitator to give the patient the knowledge to help themselves improve, heal and return to a reasonable standard of living.

Electrotherapy

Electrotherapy is an umbrella term covering a multitude of treatments. From a physiotherapy standpoint there are a number of modalities used to aid tissue healing a different levels and stages. Ultrasound, probably the most commonly used is designed to promote healing through use of high frequency sound waves and can be used from the acute through to the chronic stages. Depending on the levels used it can aid removal of damaged tissues throught the lymphatic system, increase blood flow, have a heating effect and work at different depths to target specific tissues. Interferential applies a variable low electric impulse to give pain relief, speed up healing, change blood flow and help break down bruises within the tissues, TENS is used mainly for pain relief especially at a longterm chronic level and on certain settings can stimulate muscular contraction (sometimes called faradism) which is very helpful in nerve damage or muscle wasting. Other lesser used modalities are pulsed shortwave diathermy and laser treatment. As with all treatments an experienced professional should be consulted .

Eye pain

Eye pain does not have to come from the eye itself and can be refered from any of the facial nerves, from the neck and from the muscles around the jaw and eye. Common causes can be poor posture, nervous or subconcious facial and neck twitches, lack of sleep, whiplash, general neck pain, tooth and gum problems/abcess and neural palsy or irritation. If there is a bimoechanical problem from the neck then treatments as simple as posture and increased body awareness, massage, exercises and acupuncture can help and solve this problem. so seek help from a professional don't suffer needlessly!

Early treatment

With any injury it is vital to seek treatment as soon as possible. This can prevent much longer duration of symptoms and reduce the need for longterm expensive physiotherapy treatment. Treatment can begin immediately after an injury occurs and if appropriately applied can reduce swelling considerably and therefore reduce the severity of the injury. It is a little known fact that the swelling itself can cause up to 50% of the damage experienced. So the advice is seek help fast!

Cervical Spine

The cervical spine consists of the seven vertebrae from the bottom of the skull to the shoulders where it joins with the thoracic spine. This is the area most commonly hurt in whiplash injuries, resulting in possible damage to the vertebrae and disks themselves, ligaments, muscles, tendons, and nerves. Many types of pain can radiate from this area causing a variety of symptoms including cervical or tension headaches, localised neck pain, upper back pain, referred arm pain including hand and fingers and neural symptoms such as numbness, tingling and pins/needles into the upper back, arm and hand. Early intervention and access to painkillers and physiotherapy is vital to ensure full recovery which can take between 6 months to 2 years depending on severity.

Biceps Tendonitis

Biceps Tendonitis is can be caused by either a minor or major tear left untreated or repetitive strain from overuse. The secret is to seek treatment early, to define the cause especially in overuse and to remove the aggravating factors to allow the tendon to heal. This process can be speeded up and helped with appropriate treatment consisting of ultrasound, acupuncture, graded massage, strapping and a progressive stretching and strengthening programme. a qualified physiotherapist should always be consulted in this case.

Bursitis

Bursitis can be defined as swelling over a joint. A bursa is a small gellified sac which lies between a muscle/tendon and bone providing a lubricated surface. This allows the muscle/tendon to slide effectively over the bony surface without wear or fraying. Overuse of a particular muscle either acutely or over time can irritate the bursa and cause it to swell producing a soft boggy lump over any joint or bony protruberance. There can be redness and swelling associated with it and acute pain which is aggravated by movement. The main causes are usually a sharp increase in training regime (mileage or intensity), a biomechanical deficiency such as leg length difference/ wrong footwear or equipment/ assymetrical muscle development, prolonged pressure on a bony surface. Treatment consists of ultrasound, ice, stretching, and specific exs.

Back Pain

Back pain is the single most common cause of absence at work and costs the country millions of pounds every year in lost man hours. In recent years more and more people are experiencing this crippling condition due to the changing nature of work and home lifestyles. In effect the human body is not designed to sit for prolonged periods of time and adapts to this lack of activity. The muscles meant to move and support the spine and joints get lazy and weak resulting in an inability to respond properly when we demand more from them. Hence the spasm and pain felt when trying to do even simple tasks such as pick a towel up from the floor. If nothing is done to restrengthen these muscles then the episodes of pain will inevitably become more severe, prolonged and frequent, leading to a chronic condition. Never was the phrase "get on your bike" more appropriate. The best way to prevent back pain developing is to increase the amount of exercise the body is exposed to, whether in a gym, up a mountain or on a running track. It is also essential to include an element of core stability training either with a gym ball, abdominal ex's or pilates for example. In other words use the muscles as they were meant to be used!

Acupunture

Acupuncture originated in China and is closely linked with traditional Chinese medicine. It has crossed into western culture and been integrated into western medicine being widely used within the NHS and the private sector. Amongst the many uses are Pain relief, general boost to health and wellbeing, decrease in blood pressure, treatment of tinitis, IBS, travel sickness and nausea, cessation of smoking, insomnia and in chinese medicine as an alternative to sedation and anaesthesia during major surgery. Acupuncture works on many levels but mainly as a pain relieving tool and aid to tissue healing in the physiotherapy profession. Main problems which can be treated include back, neck, muscle, joint and neural pain, muscle spasm, whiplash, nerve palsy, arthritis, sports injuries and many others. Safe sterile techniques are always used.

Arthritis

Arthritis is not the sole domain of the elderly, any joint which has been exposed to traumatic injury or consistant overload can develop arthritic changes. Arthritis can be categorised as traumatic (as above), osteo (genetic wear and tear), rheumatoid (genetic and inflammatory where the immune system attacks the joints) or viral which has a similar immune system component). Depending on the type, the treatment will vary. Whether joint strength both core stability or general exercises, pain relief (medication, acupuncture, TENS machine, heat or cold therapy, hydrotherapy, interferential or joint mobilisation) and flexibility/stretching exs (yoga, pilates). All the treatments mentioned above come under the physiotherapy remit. The main thing to bear in mind is that there can be something done and early intervention is certainly the best course of action. However, no matter what stage arthritis has progressed to you should seek the advice of a professional as each case has to be individually assessed.

Rannoch Physiotherapy

Rannoch Physiotherapy and Sports Injury Clinic is situated in Balbeggie, 5 miles from Perth on the main road linking Forfar, Blairgowrie, Coupar Angus and Perth, with free offroad parking. I cover all aspects of physiotherapy treatment including back and neck pain, joint and muscle strains, arthritis, rheumatism, pain management and specialise in sports injuries. My aim is to give you the knowledge to help yourself and prevent recurrence of any problem. Treatment can include manipulation, mobilisation, massage, acupuncture, ultrasound, progressive exercise and rehabiltation programmes and above all to help you understand your problem and stop it happening in the future.