Comprehensive Assessment
To absolutely understand an injury a comprehensive subjective and objective examination are completed. The subjective examination involves a sequence of questions which provide a guide to the anatomical structures involved in an injury. In some cases more than one structure has been damaged during an accident. Understanding the exact cause or mechanism of injury is extremely helpful. The objective examination involves a sequence of physical tests ranging from passive range of motion, active range of motion, strength, special tests for ligament or tendons, through to a neurological examination to assess for possible nerve damage. Assessment and treatment are closely connected, so the effect that treatment has on an injury may assist in determining a differential diagnosis for an injury. Every treatment involves assessment and reassessment in order monitor progress.
Manual therapy and manipulation
These are a set of specific techniques used by a physiotherapist to mobilise or manipulate the spine and peripheral (limb) joints. The aim is to reduce pain, increase range of joint movement, reduce inflammation and induce relaxation. Manual therapy techniques include joint mobilisation, manipulation, manual traction, and specialised stretching (PPM).
Spinal Mobilisation: refers to passive movements within a joints normal range of movement, without cavitation or the popping sound inherent to manipulation. These are graded 1-5, with 1 being a tiny amount of movement and 5 being the most amount of movement. Typically a grade 5 mobilisation is considered to be a manipulation.
Spinal Manipulation: refers to passive movement of short amplitude and high-velocity which moves the joint beyond its normal range of movement. This is accompanied by cavitation or gapping of the joint that results in an intrasynovial vacuum phenomenon thought to involve gas separating from fluid. Research indicates that this often results in pain reduction.
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Soft tissue mobilisation
Techniques used by the physiotherapist to mobilise soft tissues for the purpose of modulating pain; increasing range of motion; reducing or eliminating soft tissue swelling, inflammation or restriction; inducing relaxation; improving contractile or non-contractile tissue extensibility; and improving pulmonary function. There are numerous techniques utilised, and the technique chosen will be specific to your needs. The physiotherapist may on occasions provide traditional massage, however this is not specifically within the realm of the treatment they will provide.
Electrotherapy
There are several treatment interventions available to physiotherapists which are electrical in nature: ultrasound, interferential and TENS are commonly utilised when necessary. They are particularly useful when the level of pain is such that soft tissue mobilisation is not practical. The indications for their application are varied. The physiotherapist will discuss the details of treatment with you in full, including the device, its physiological effect and indication for use.
Acupuncture
This is a form of treatment that utilises needles which can be inserted and manipulated at areas on the body with the aim of reducing pain. There are different types of acupuncture. Scientists are studying the mechanisms and efficacy of its therapeutic use. Researchers using the protocols of evidence-based medicine have found good evidence that acupuncture can be helpful in treating some conditions. While there is ongoing research into its efficiency, it is safe when administered by trained practitioners.
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Home programmes
A list of exercises or activities that you can do at home to support your rehabilitation programme will often be provided by your physiotherapist. In some cases the list of exercises may be generic in the sense that they are a general list of stretches or exercises that have a good track record of being helpful in situations similar to yours. In other cases the physiotherapist will prepare a group of exercises specific to your needs. It is imperative that you complete your prescribed exercises. It is typically an unreasonable expectation that an injury will clear up without any level of self management.
Biomechanical / Technical analysis
Some injuries require an in-depth assessment which may involve assessing an entire limb, the entire pelvic region and spine, or cervico shoulder complex. We sometimes refer to this as a BMX. It is a particularly useful tool when an athlete is struggling with multiple injuries that are plaguing one side of their body, or one limb. For example you might have a sprained calf, shin splints and a hamstring tear. Alternatively, you may have a recurrent tennis elbow injury which is interconnected with a shoulder girdle dysfunction. Muscle imbalance could be partly responsible for your symptoms. A comprehensive assessment will enable the physiotherapist to address numerous issues with an all- inclusive home programme which strategies to correct biomechanical faults.
Postural correction
Postural correction education is most commonly associated with Spinal Care, however it is not limited to the spine. The physiotherapist may consider postural correction when treating any injury. Spinal care is a generic term that describes no specific intervention, philosophy or methodology. It involves the provision of education which serves to promote a healthy fully functional spinal column. There are numerous techniques for assisting posture. The physiotherapist will endeavour to engage the technique that best serves your situation.
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Stretching & fitness programmes
As part of your treatment programme, your physiotherapist may prescribe a stretching or general fitness schedule. Please advise your physiotherapist if you would like assistance with a training programme. If you are a member of a local fitness centre, your physiotherapist should be able to provide you guidelines for developing and implementing a gym routine. Some of our physiotherapy staff have advanced experience in this area, and can be accessed if necessary.
At KCP our intention is to provide you with high-quality cutting edge training information which you can utilise not only as part of your rehabilitation programme, but in an on going capacity in the form of a well structure exercise routine.
Strapping / Splinting / Orthotics
Based on assessment, treatment and individual needs this incorporates the use of external devices which are applied to stabilise a moving joint. Most commonly used is strapping tape which your physiotherapist will apply in order to limit movement or provide a sense of stability to a joint. Your physiotherapist may recommend orthotic devices in order to improve foot posture. Alternatively your physiotherapist may on occasion organise a referral for you to see a podiatrist for a full foot assessment on the basis that you might require orthotics. Your physiotherapist can organise a brace for your damaged joint, utilising one of the many suppliers that we have available.
Core stability
The core is a group of muscles used to stabilize the thorax and the pelvis during dynamic movement and it also provides internal pressure to expel substances. The core is involved in most full-body functional movement. In addition, the core affects postural alignment. The core muscles assist in maintaining alignment of the spine, ribs, and pelvis during functional movement. Research shows a strong link between a lack of core stability and many injuries. Your physiotherapist will take research into account when considering whether or not core stability is important in the management of your injury.
Referral
At KCP, our physiotherapists have no hesitation in organising further tests or assessments with specialists if necessary.
If treatment is not progressing as planned, your physiotherapist may elect to refer you to a Radiology Clinic for an x-ray or ultrasound scan. An ultrasound scan is particularly useful for looking at tendon injuries, such as in your shoulder or achilles tendon. Alternatively, your physiotherapist might think that an MRI or CAT Scan is necessary to ascertain the full extent of the damage. In this case your physiotherapist would need to refer you to an Orthopaedic Specialist or Sports Physician for the necessary referral. An MRI and CAT scan are particularly useful for assessing stress fractures, superficial bone strain and spinal disc injury. Some fractures don’t show up on x-ray, so a bone scan may be necessary.
