Types of Physio Treatment

Acupuncture is a method of encouraging the body to promote natural healing, to reduce pain, swelling & muscle spasm and to improve function.

This is done by inserting needles and sometimes combining it with electrical stimulation at very precise acupuncture points around the body. The points used are chosen by the physiotherapist based on their experience and the presentation of your symptoms.

What to expect:

You can expect to feel no or only a very minor needle-like discomfort when the needle is inserted, and once the acupuncture point is reached you will feel a more generalised spreading, aching or numbing sensation. This is usually a pleasant sensation but it can be more intense, again depending on the presentation of your problem.

Typically the needles are left in for 10-30 minutes dependent on the presentation of your problem and may be further adjusted by the physiotherapist during the session. After this time the needles are removed with no or minimal discomfort.

At WSP we use Acupuncture to treat the signs and symptoms associated with DPI from a musculoskeletal viewpoint, utilising its effects on pain, swelling and function.

Acupuncture can be effective as the only treatment used, or as the support or adjunct to other medial treatment forms in many medical and surgical disorders. But by using acupuncture we can also influence other areas of the body:

• promotion of health and well-being
• prevention of illness
• treatment of various medical conditions

While we use acupuncture in its association with pain control, in the hands of a well-trained, predominantly Chinese Medicine practitioner it has much broader applications. The World Health Organization recognises the use of acupuncture in the treatment of a wide range of medical problems, including:

• Digestive disorders: gastritis and hyperacidity, spastic colon, constipation, diarrhea.
• Respiratory disorders: sinusitis, sore throat, bronchitis, asthma, recurrent chest infections.
• Neurological and muscular disorders: headaches, facial tics, neck pain, rib neuritis, frozen shoulder, tennis elbow, various forms of tendinitis, low back pain, sciatica, osteoarthritis.
• Urinary, menstrual, and reproductive problems.

Acupuncture is particularly useful in resolving physical problems related to tension and stress and emotional conditions. 

If you have questions about a specific illness or disorder not listed above, you can discuss this with your physiotherapist who may be able to suggest a suitable acupuncturist in your area.

A manipulation is a technique involving a controlled, small isolated thrust to a joint. The joint is usually placed at the end of its movement, and the manipulation gives an extra stretch to the soft tissues adjacent to the joint.

There is often a popping sound as a small suction pressure within the joint is released. This is normal and is similar to cracking your knuckles. The aim is to restore normal joint movement – which is a mixture of spin, roll and glide.

Manipulation is very technical and the experience and quality of the physiotherapist makes a difference. Assessing which joints need manipulation, the order and type of manipulation, is a learned skill. Willis Street Physiotherapy has very experienced Manipulative Physiotherapists.

Manipulation:

- Restores full range of motion

- Releases endorphins which are natural pain relievers

- Is less irritating than repeated movements into pain

- Unlocks stuck joints

- Relieves cervical headaches

- Reduces protective muscle spasm.

A mobilisation is a technique where a physiotherapist moves a joint repeatedly – either in small or large amplitudes; fast or slowly; firmly or gently; and for varying durations.

The aims of the technique are to:

- Relieve pain

- Restore full joint motion

- Release local muscle spasm

- Release endorphins (the body’s natural pain relievers)

- Restore a joint’s normal spin, roll and glide

- Stretch stiff non-bony structures around a joint

- Stimulate the area around the joint, increasing awareness and position sense of the joint

Mobilisation techniques differ from manipulation techniques, as they are slower and more repetitive. Manipulation will often only require a single thrust.

Trigger points have been found to be the sole source of around 75% of clinic patients’ pain. Myofascial Trigger Point Release is the main technique used by Willis Street Physiotherapy.

Trigger points frequently appear in many myofascial structures – including the skin, fascia, muscles, tendons, ligaments, joint capsules, periosteal tissue and scar tissue.

Trigger points in muscles will often cause shortening, pain and weakness.

Once located, they can be treated by a variety of methods including, light sustained pressure, deep sustained pressure, muscle energy techniques, proprioceptive neuromuscular facilitation, massage, pulsed ultrasound, ischemic compression or acupuncture. Depending on the position or size of the trigger point we may also use elbows to release them.

Once deactivated stretching and strengthening exercises are also needed to prevent their reoccurrence.

A trigger point can be felt as a tumor or band in the muscle, and can produce a twitch response when stimulated.

The pain cannot be explained by findings on neurological examination.

Trigger points are normally activated by a certain activity involving the muscles used in the motion, by chronically bad posture, bad mechanics, repetitive motion, structural deficiencies such as a lower limb length inequality or a small hemipelvis, or nutritional deficiencies.

The following conditions are frequently misdiagnosed as the cause of pain when trigger points are the true cause: arthritis, carpal tunnel syndrome, bursitis, tendinitis, angina pectoris and sciatic symptoms along with many other pain problems.

"I must be right. Never an aspirin. Never injured a day in my life. The whole country, the whole world, should be doing my exercises. They'd be happier."

- Joseph Hubertus Pilates, in 1965, age 86.

Joseph H. Pilates was born in Germany, in 1880. His father was a gymnast and his mother worked as a naturopath.  Pilates suffered from asthma, rickets and rheumatic fever, so he had reason to improve his life.

He began studying ancient Greek and Roman physical regimens and gymnastics, body building and yoga, and by 14 years of age had so improved his physique that he posed for anatomical charts.

He came to believe that discomfort, pain or injury was the result of the ‘modern life-style’, bad posture and inefficient breathing. Over the years he devised a series of exercises and training techniques, and engineered the equipment he required to teach his methods.

His exercises involved specific, gentle controlled contraction of the deep postural or core muscles. These muscles help to support and control the spine so as to improve posture and stability. Recently these muscles have been studied and identified to provide scientific evidence which supports how Pilates Based Rehabilitation works. The muscles are the Pelvic Floor, Transversus Abdominus and Diaphragm.

We use Pilates Based Rehabilitation at Willis Street Physiotherapy because we believe that good posture and correct alignment are paramount to injury prevention. If you cannot sit, stand, walk, lift or handle correctly, you will be much more likely to get discomfort, pain or injury.

We can teach you a specific series of exercises to encourage good posture posture and reduce your chances of discomfort, pain and injury. We can advance these as necessary to return you to wellness as quickly as possible, better prepared to withstand the stresses of your hobby, job or sport.

Soft tissue is the superficial, and to a lesser extent deeper tissues, within the human body – such as the skin, fascia, muscles, tendons, nerves, ligaments and joint capsule.

Whenever a physiotherapist touches a person, it is a soft tissue technique.

There are a large number of soft-tissue techniques practiced by an equally large variety of practitioners.

At Willis Street Physiotherapy we combine soft-tissue techniques with mobilisation, manipulation, acupuncture, and specific exercises and rehabilitation. Importantly, we also spend a lot of time identifying potential everyday stresses and risks which will be contributing to the problem. We then ensure that we advise and teach individuals about their injury and ways of self-managing their problem.

There is no doubt, in our mind, that soft tissue treatments work only when they are used at the right time, in the right way and on the right thing.

For instance, to do any soft-tissue release but not give advice on how to sit, stand, lift and handle or run correctly, will only ensure that any benefit will only be short term. The cause of the problem has not been identified and it will return. To treat the soft-tissue but not address any joint dysfunction will also mean that the pain will return.

Soft tissue techniques should not be painful.

Variable amounts of force and different techniques are used to stimulate the tissue in order to achieve specific goals, such as to increase blood supply, restrict blood supply, reduce inflammatory waste products, stretch or relax tissue, break up scar tissue or desensitize and reduce pain.

When practiced by experienced physiotherapists and combined with other treatment techniques it can be a very effective means of reducing discomfort, pain or injury.

Strengthening is where the muscles and other soft tissues are put under strain, and respond by increasing their loading capacity.

Strengthening is important for:

- rehabilitation following an injury – it assists in soft tissue repair ensuring it’s strong and able to cope with the demands to be placed on it

- conditioning the body and its soft tissue to prevent injury – strengthening, protecting and enhancing the stability of associated joints

- enabling you to return to pre-injury levels of task fitness. 

Initially strength training is aimed at assisting the healing process and improving muscular performance.

As rehabilitation develops the training begins to become more functional - eg a builder with a lower back injury would start with abdominal or core conditioning, then do squats and lifting later to better simulate the day-to-day functional activities.

There are a number of methods used to strengthen.  Pilates-based core conditioning recognises that some muscle types are predominantly stability muscles and others moving muscles. A strong core improves the quality of limb movement and reduces loads to other parts of the body, thereby helping to prevent injury. These exercises are very subtle and do not necessarily require the use of any resistance. 

Resistance can be added by using free weights, machine weights, resistance bands, cable pulleys, body weight exercise e.g. pull-ups and press-ups, and environmental resistance e.g. swimming. The type of exercise and instruction will depend on the muscle, its function, and your stage of rehabilitation.

Stretching involves taking soft tissue (muscle, ligament, nerve, tendon, any non-bony structure) to the end of its available range and holding it there for any length of time. It’s a good way of assisting soft tissue repair and maintaining flexibility and tone.

Stretching can be static or dynamic.

Static stretching involves holding a stretch position for longer than 10 seconds – usually 30 seconds, depending on what you are trying to achieve.

Suffer from overuse injuries and want to know why.

- A warming up for an activity stretch would only need to be 20 seconds. The aim of this stretch would be to take the muscle through its available motion prior to doing the same during the activity.

- As part of your warm down, you could do a single stretch of the restricted area, lasting longer than a couple of minutes. They don’t have to be nasty, just so you feel local strain. 

- The key to gaining improved flexibility is long static stretches performed daily over months.

Dynamic stretching involves taking the muscle quickly into a stretch position and then off again. The aims of dynamic stretching are:

- to better simulate exercise conditions

- condition the soft tissues for higher and faster loads 

- facilitate stronger muscle contractions.

Generally dynamic stretching is performed in pre-exercise warm up.

A good warm up may look like:

- Gentle cycle/walk up steps (or run), 5-10 minutes

- Static stretches 20-30 seconds major muscle groups 

- Gradual increased tempo of the exercise about to complete, 5 minutes

- Dynamic stretching of key muscle groups 15-30 seconds each group 

- Gradual introduction of more exercise specific movements so as ready to go, 5-10 minutes.