'Physiotherapy': the treatment of disease, injury, or deformity by physical methods such as massage and exercise.
The Oxford English Dictionary
If you are a GP, please do not hesitate to ring me if you would like to discuss how we could develop a collaborative relationship to explore various treatment options that will enhance our patients' care, increase their clinical outcome measures and improve their quality of life.
I am frequently asked the questions:
'How does physiotherapy work to reduce pain and stiffness?' and,
'What does a physiotherapist do to regain movement and function?'
To illustrate this in more detail, I have complied a list of case studies for your perusal. These are actual patients on my clinic list whom I have recently treated, and who have kindly given me permission to demonstrate to you how physiotherapy has helped them.
Mrs. D is a 90-year-old lady who fell and fractured her R ankle in March 2010. As a result of her reduced mobility, she was moved into a residential care home. Prior to this, she was living independently in a bungalow. Mrs. D sustained a R CVA 17 years ago, which left her with a L hemiplegia, and unable to use her L arm. One of her friends was concerned that Mrs. D would lose her place in the residential care home if she were unable to maintain the set criteria of independence, and so she referred her to me.
During my first visit to Mrs. D at the residential home in August 2010, I discovered that she was a very pleasant, motivated and determined lady who wished to regain her independence when walking to and from the dining area. Upon the initial assessment, I ascertained what activities and movements Mrs. D could and could not do, her daily routine and what she wanted to achieve. The problem list I initially compiled was lengthy. Mrs. D complained that she was unable to sleep properly, and so she was frequently tired during the daytime. She needed assistance when walking to and from the dining area because her balance was reduced and she was afraid of falling again. She was also having difficulty transferring from lying to sitting to standing. Mrs. D walked with the aid of a R tripod walking stick. She reported that she was not confident in putting her full weight onto her R ankle. She also explained that she found it difficult to lift her L foot off the floor during the swing-through phase of gait.
In order for Mrs. D to regain her confidence when walking, I had to be certain that she felt safe and secure during each component of her gait pattern, as well as when she was performing any transfers. This meant that I needed to address any factors that restricted her independence. These included her tiredness, the limited movements in her L arm and leg, her level of abdominal control and the extent of her righting reactions following the CVA, any joint stiffness in her hips and knees, and the pain and swelling in her R ankle.
Mrs. D has been having weekly physiotherapy input for 7 weeks so far. Her treatment included advice on pacing her activities during the daytime, passive movements and stretches to her hips, knees and ankles, active exercises to improve her gluteal strength and core stability, postural control work, balance work in standing and most importantly, gait re-education. Particular attention was given to the sit to stand manoeuvres from her bed and as well as from her chair, to ensure that Mrs. D was able to do these safely and independently with both feet firmly grounded.
To date, Mrs. D is progressing well. I am very pleased to say that during our last session, Mrs. D exceeded my expectations. She was able to stand independently, transfer her weight safely and independently from side to side, reach upwards with her R arm and walk to and from the dining area independently. She does not need to use her R tripod walking stick for support when standing for short periods. The practical aspect of this achievement is that Mrs. D can now stand independently and use her R arm to put her clothes away and tidy up her room.
Miss K is a 45-year-old accountant who lives in London. On the 30th March 2010, she was hit by a car whilst crossing the road. Her injuries included:
-A fractured R orbital roof;
-A fractured transverse process of the R L5 lumbar vertebrae;
-Multiple fractures to the superior and inferior pelvic rami;
-A fracture to the R SIJ;
-A fracture to the proximal 1/3 of the R fibula;
-A 12cm open laceration over the L patella, which cut through the L distal quadriceps.
Miss K was initially admitted to hospital where she remained as an in-patient until the 8th of April 2010. She was initially put in a pelvic brace and was bed-bound for a few days. All the fractures were treated conservatively. The wound to her L quadriceps was surgically closed. Upon discharge from hospital, she was mobilising with 2 elbow crutches and needed assistance from one person to transfer from lying to sitting to standing, and when performing ADLs (activities of daily living). She was signed off work until August 2010.
Miss K recuperated at her partner's residence in Nottingham. She came to see me for an initial assessment on the 4th June 2010. She was suffering from lower back pain, R hip pain, and stiffness in her L knee. She was still mobilising with 2 elbow crutches. Over the following 4 weeks, I set Miss K on an exercise programme to improve her core stability, weight-bearing strength, spinal mobility and gait. Utilising the gym studio, we repeatedly practised transferring from lying to sitting to standing thus slowly regaining her independence when doing these manoeuvres. We also used the mirrors in the studio as visual feedback to improve her postural and dynamic stability via a variety of challenging and progressive exercises. Miss K's exercise programme was coupled with acupuncture and manual therapy to reduce the muscle tightness in her quadriceps and to decrease the joint stiffness in her spine.
By July 2010, Miss K was able to attend weekly Pilates and Yoga classes at the YMCA gym. She continued her weekly physiotherapy sessions where hands-on treatment and acupuncture continued to reduce any residual muscular aches and pains.
Miss K returned to work in London on the 9th August 2010. She is now pain-free and was able to mobilise independently 5 months after the accident.
Mr. C is a 48-year-old gentleman who works as a recovery driver. He sustained a partial rupture of his R tendoachilles (TA) in March 2010 whilst he was stepping up into his van. The orthopaedic consultant made the decision to treat the injury conservatively, rather than surgically repair the TA. Mr. C was therefore placed in a series of below knee casts over a 3-month period, each one gradually allowing his ankle to return to the plantigrade position. Mr. C attended his first session with me on the 28th June 2010. He was due to start a phased return to work at the beginning of July 2010. He complained that there was a 'lump' over the back of his R TA and that he was still experiencing the occasional ache in this area. I observed that Mr. C was still walking with a limp as he was having difficulty executing the heel-strike and toe-off phases of gait. Mr. C also demonstrated decreased proprioception on the R leg in standing and was unable to hop on the R leg because of decreased strength in the R calf and residual tightness and pain along the TA.
Physiotherapy treatment included deep tissue massage to the R calf and TA to lengthen, soften and stretch any remaining scar tissue in this area, passive stretches to regain full ROM of the ankle, and graded home exercises to improve the weight-bearing strength on his R leg. Exercises included gait re-education, balance work, single and double leg squats, and controlled step-ups. Joint mobilisations were also performed on the talocrural and sub-talar joints to address any stiffness as a result of being in a cast for 3 months.
Mr. C returned to full work duties on the 19th July 2010 and is back to playing golf in his spare time. He is able to maintain his condition by continuing his home exercises and stretches.
Mr. P is a 34-year-old delivery driver who was involved in an RTC on the 2nd July 2010. His car was stationary when he was hit from behind by a van travelling at 40mph. Mr. P's car was shunted 15 feet forwards and ended up on the pavement. He was taken to A&E where X-rays were done to his C-spine, T-spine and both shoulders. He was diagnosed with Whiplash Associated Disorder (WAD II) and was signed off work for 3 weeks.
Mr. P's first session with me was on the 4th August 2010. He presented with neck pain that referred across the upper trapezius muscle fibres, cervicogenic headaches, hypomobility of the cervicothoracic (CT) junction and upper T-spine, and lower back pain (LBP). Prolonged sitting, standing and driving all aggravated his symptoms. He was unable to lift or carry any heavy items. He also explained that his sleep was disturbed because of flashbacks from the accident.
Mr. P was unable to take any more time off work and so had to fit his treatment sessions around his shifts. Physiotherapy treatment included advice on what he could do himself at home to ease his symptoms. This included the use of a heat pack and TENS machine, gentle neck exercises and relaxation advice.
A combination of manual techniques including massage and joint mobilisations were utilised to decrease Mr. P's pain and restore the movement in his neck and lower back. A comprehensive and graded home exercise programme was utilised to maintain the progress achieved after each session. Having regular physiotherapy treatment has allowed Mr. P to remain at work on full duties.
Please be advised that due to client confidentiality, anonymity is maintained in the above case studies.
I hope that the above case studies have provided a greater insight into how physiotherapy treatment and rehabilitation can be invaluable to people of all ages. There is nothing worse than being debilitated because of pain. I understand too well the fears and frustrations that my patients experience when they are not able to carry out the activities they need to do on a daily basis.
Physiotherapy is all about finding and implementing ways to put things right, whatever the problem may be. It is a process of reducing pain whilst improving strength, mobility and function. It helps people to feel better and to maintain their independence for longer.
Ring me on 07866-464385 to discuss how I can help you.