What We Treat

My specialism really is musculoskeletal conditions (MSK) I have a bias towards neck and lower back problems as they tend to be the most difficult to assess and treat properly. I particularly enjoy working with work related conditions due to my post graduate degree in biomechanics and time working in different occupational health clinics. I have a qualification in acupuncture and use a Traditional Chinese Medicine approach to bio psychosocial condition and some long term conditions. I also enjoy working with hydrotherapy treatments and we have a small hydrotherapy type pool at the clinic here. This is ideal for some condition that respond to water based therapy and exercise like lower back pain, post-surgical rehabilitation etc. I have a wealth of experience in sports injuries as I worked at the Oval Cricket Ground home of Surrey County Cricket Club for more than ten years treating, sports and in particular injuries of a cricket nature. I work with orthopedic and spinal neuro surgeons who refer patients who have had a multitude of surgical interventions. This would tend to be for post-surgical rehabilitation following reconstruction or surgical repair.

Conditions we treat include:

• Arthritis
• Back pain
• Reduced mobility
• Sports injuries
• Whiplash and neck pain
• Hydrotherapy
• Rehabilitation
• Taping and Straping

ARTHRITIS

Arthritis is a very common condition that comes under the family of conditions known as Rheumatology. Rheumatologists refer patients to physiotherapists for their expert opinion on joint disease and management. Physiotherapists see patients with arthritic disease at any stage of the joint progression.

It may be at the early stage where the patients experience pain, crepitation, muscle weakness, or the joint giving way on weight bearing; i.e. knee, ankle etc. This may be the first time that they have requested a consultation. Physiotherapists are in an ideal position to educate patients as to the degree of disease progression, and it may be necessary for them to be referred back to their GP to get a referral to see a Rheumatologist.

In more severe cases, where the arthritic condition has not been assessed and diagnosed before, appropriate advice and maintenance can be offered by the physiotherapist while the patient is then referred to see an orthopaedic specialist.

In late stage joint disease patients may require joint replacements, usually hips and knees, by an orthopaedic surgeon. Patients are often referred back to the physiotherapist for post-surgical joint rehabilitation. The aim of the treatment for degenerative joint disease includes; proper assessment and diagnosis of the degree of the joint disease, pain management techniques, advice and education on preventing joint progression, and maintaining range of joint movements, maintaining and improving muscle power, and preventing swelling and effusion into the joint.

It may be necessary during the acute phase of the joint disease to prescribe a walking aid to maintain a patients mobility.

BACK PAIN

Many patients who present with a history of low back pain, would benefit from assessment and treatment by a physiotherapist. Put simply, there are two types of back problem that present in the clinic for the physiotherapist.

The first is the long-term degenerative low back disorder that shows signs of degenerative disease in the vertebral bodies and the facet joints. These are classically presented in the older age groups and in patients with weight issues. The second type is essentially the more acute injury which is related to recent injury or accidents at home or work, or is sport related. These are often linked to recent sudden signs and symptoms that may be related to a particular incident, for example, poor manual handling techniques, or poor spinal mechanics.

There is often evidence of poor posture and loss of core stability in the trunk, at the initial stage, which leads to a predisposition to further problems at a later stage. The main aims of physiotherapy treatment include: Assessment, diagnosis, identifying the extent of the injury, the anatomical areas involved, and drawing up a treatment plan.

Types of treatment often used include: Spinal manipulation, muscle strengthening programmes, postural awareness and advice, manual handling education, acupuncture for pain management if necessary, temporary immobilization of the spine with a spinal corset during the acute phase.

Physiotherapists often work with pain clinics and neurosurgeons in order to ensure that patients have the support that they require to recover from their back condition.

REDUCED MOBILITY

Physiotherapists are often required to assess and treat patients with problems related to disability and loss of mobility. Many illnesses and conditions can have a negative effect on a patients ability to mobilise safely. Increasingly, with age and degenerative conditions, or surgical interventions, it may be necessary to assist patients with balance and co-ordination, and difficulty with mobilisation (walking safely).

I have a post-graduate diploma in bio-mechanics, which enables me to break down the stages of standing, walking, running etc., and employ the techniques required in order to diagnose the phase of activity which has become problematic. With re-training and regular practice and exercise, it is possible to regain loss of function and facilitate safe mobility. It is necessary to review walking aids on a regular basis, so that when the patient activity improves, the appropriate walking aids are used at the right time.

It may be necessary to refer patients to clinics where their gait can be analysed. They may be asked to have further assessment with the use of a pedobarograph or pressure force plates. This is to understand where the mechanical pressure is falling during the gait cycle.

Physiotherapists often work with patients in a very tactile way in order to understand the subtle changes required in their gait to ensure safety and good mobility.

SPORTS INJURIES

Sports injuries are very commonplace and are often associated with the patients wishes to maintain fitness, and undertake activity. Put simply, sports injuries fall into two main categories; "overuse injury", which is often seen in conditions like Achilles tendonopathy or recurrent adductor strain, or supraspinatus injury to the shoulder. The second type is the more acute injury related to contact in sport, or over-exertion during particular activity resulting in ligament injury or muscle strain. This might include inversion ankle injury, hamstring tear, or subluxation of the patella.

During my career I have worked with professional football clubs, American football teams, and at Surrey County Cricket Club at the Oval for ten years. These unique clinical experiences have enabled me to gain insight into the wide range of presentation of sports injuries that are experienced by professional and amateur sportsmen alike.

The aim of physiotherapy treatment is to ensure appropriate diagnosis as soon as possible, provide advice at the right time, stabilize the injury, and ensure an effective rehabilitation programme is undertaken. The main intention is to get someone through the acute phase into the sub-acute phase and into the chronic stage as soon as possible, ensuring recovery of the injured area swiftly, without relapse of the initial injury. The aim is to minimise loss of muscle power and conditioning as this prolongs the final stage of recovery.

Physiotherapists often work with sports coaches and nutritionists to ensure that patients can return back to competitive sport as soon as possible.

WHIPLASH AND NECK PAIN

Whiplash is one of the most debilitating of injuries. The earlier the patient is assessed by a physiotherapist, the quicker they are likely to recover and respond to treatment.

Some of the neurological symptoms of whiplash are very frightening at the initial onset. These can include: headaches, blurred vision, sickness and nausea, disorientation, referred shoulder and hand pain, numbness, pins and needles, and loss of muscle power.

Early diagnosis is the key to good physiotherapy management. Often the deceleration forces can cause dislocation of the facet joints, and tearing or shearing of the longitudinal interspinous and facet ligaments. It is also possible to tear the outer parts of the discs of the neck, known as the annulus. In severe cases, it may be possible to fracture the spine, which causes instability. The most common presenting symptom is one of pain emanating from injured nerve roots, and loss of function of the brachial plexus (nerve network) from the neck into the arms.

The aim of treatment would be to reduce pain, restore function, normalise movement in the neck, and maintain normal range of movement. Typical treatment techniques would include: very gentle manipulation where required, neck traction techniques, advice on self-management, home exercise programme, and often, immobilization in a cervical collar.

Comprehensive physiotherapy intervention will help to reduce the symptoms, restore normal function, and enable patients to return to normal activities.

HYDROTHERAPY

Hydrotherapy is a treatment that is offered by physiotherapists for patients who require a treatment programme in a different environment rather than the physiotherapy department. There are some conditions that you cannot treat in the hydrotherapy pool. There are some previous medical conditions that it is necessary to seek advice before commencing hydrotherapy treatment programmes.

The history of hydrotherapy is a treatment protocol for physiotherapists, which is very long, steeped in history and has its roots in traditional physiotherapy. One of the most important aspects of hydrotherapy is the ability to use principles of floatation in order to allow patients to relax injured limbs while immersed in hot water, this then enables the effects of gravity which can make injured limbs feel very heavy and disabled to work in a different way. Physiotherapists in hydrotherapy pools often use floats and slings to provide buoyancy for an injured limb in order that they can help to move the limb that may have not been moved in that direction before or to strengthen a muscle which has been paralysed in order to stimulate the nerve and promote the muscle function.

Hydrotherapy usually is undertaken for a series of treatment sessions, usually 6. The first session is usually spent getting used to the environment of the water, providing the right buoyancy for the injured limb, undertaking an assessment to understand what is possible and achievable in the time that is available.

A typical treatment program would include assisted movements that sometimes patients can control or ones that will be controlled by the therapist. Much time is spent ensuring that the patient is confident and involved in the treatment process. These movements include, for example, moving the shoulder underwater with the help of the therapist for conditions like frozen "shoulder". The buoyancy of the water and the lack of gravity make it possible for the shoulder to be moved in a much more comfortable way than if the patient was seen in a physiotherapy clinic.

In severe cases where somebody may have been in hospital for a long time and has become weak and unable to sit, stand or walk, because they are very unsteady, it is possible to rehabilitate and strengthen patients in the water so that they can regain confidence and they are able to then gain sufficient strength in their upper and lower limbs to be able to walk without assistance or with the aid of a walking frame.

One of the most common conditions treated in the hydrotherapy pool are patients who have undergone lower back injury or surgery following an injury or recent diagnosis of a lower back condition. A good assessment of the level of weakness and extent of disability will highlight where the main areas of weakness in the back or the neck may exist. A hydrotherapy program where the patients may be lying on their back in the water with floats and slings to support to maintain their buoyancy and also limit the effects of gravity on the body will allow the therapist and the patient to move the patients spine in a very specific and isolated way that they may not be able to undertake if they were in a physiotherapy department.

Because of this hydrotherapy is a uniquely valuable environment in which to work with patients who have undergone evasive surgery, have become progressively weakened or have low confidence. It provides an environment which they can begin to get some insight and understanding as to what has happened with their injured limbs and contribute to their overall recovery.

Often after hydrotherapy patients can be dehydrated and feel tired. This is normal, so they are encouraged to drink after treatment and try to rest. Treatment is usually undertaken weekly to ensure that the patients have suitable time to recover between physiotherapy sessions.

REHABILITATION AFTER A FRACTURE OR SOFT TSSUE INJURY

Physiotherapists are often expected to assess and organise a program of treatment for limbs following a break of the bone, a severe sprain of the ligament or a strain of a muscle. The treatment of these types of injuries are often done in conjunction with an orthopaedic consultant (a doctor who specialises in bones).

In the case of a bone break it is common for the limb to be immobilised in a plaster caste or splint for a period of time in order for the bone to have sufficient rest so that it may recover fully. Movement of the bone whilst broken may result in the bone not repairing fully and as a result there may be long term complications to that limb.

Once the splint or the plaster caste has been removed the bone will have fully recovered, but due to the immobility of the limb there may be weakness of the muscles, stiffness of the joints and some inactivity of the nerve. Circulation to that part of the limb may be slow. The aim of treatment therefore would be to regain the range of movement in the joint affected, strengthen the muscles that have become weakened and to stimulate the nerve endings that have been compromised. This is usually done by a physiotherapist using manipulation, ice, stretching, massage, ultra sound, amongst other technics that are used.

Typical ligament Sprains

Large joints in the body are made up of bones that are secured together by a complex ligament structures. These ligaments are responsible for stabilizing the joint whilst allowing as much movement as possible. Excessive forces and pressures on the joints can be through continuous activity or through sport and result in the ligaments becoming injured. This usually means they can be stretched or torn. The role of the physiotherapist in sprains would be to assess the extent of the injury and decide the best course of action for recovery. This may mean immobilising the limb for a period of time until the healing has started to take place, then applying physiotherapy techniques to ensure that the ligament begins to heal fully. This may include the use of ice, manipulations, graduated exercise, ultrasonics and the use of lasers. In my experience ligament injuries take longer to heal then muscle strains and have to be treated with a degree of caution because of the risk of subluxation or dislocation of the joint depending on the degree of ligament injury.

Muscle Strains

Muscle strains are a condition that physiotherapist are asked to diagnose and treat. These can be due to a repetitive action that results in the overuse injury to the muscle and as a result fatigue in the muscle. The most common type of muscle injury however is usually one that is seen in the sports person, who has a high degree of physical fitness and has pushed themselves very hard and an injury has occurred as a result in the muscle. Typically this might be for instance in the hamstring muscle or in the adductors muscles in the leg. The skill of the physiotherapist lies in the assessment in diagnosing the type of tear in the muscle and its exact location. This information is relevant because it will affect the amount of time required for recovery from this injury. It is necessary sometimes to apply tapping or strapping to support the muscle during the early stages of the injury cycle in order to allow the muscle to recover fully. Once the condition has started to heal, physiotherapy treatment consists of the need to reduce the swelling and bruising to maximise strength of the muscle and to promote full return of function within the muscle. This treatment may consist of electrotherapy, nerve stimulation, pain reducing techniques and techniques to reduce the bruising and the swelling as soon as possible.

Physiotherapists because of their understanding or physiology and anatomy are in an ideal position to assess and treat these types of soft tissue injuries.

TAPING AND STRAPPING

It is possible that some medical conditions that present in the physiotherapy clinic are unstable and may require fixation in order to optimise healing. This decision is usually made with the physiotherapist and patient after consultation. This may be an opportunity to offer taping or straping.

Typically this may be, for instance an acute ankle sprain, which involves a weight bearing joint during the acute phase of the injury, which can be usually within the first week. The patient may need to be able to walk on the limb and this may be very difficult with a severe ankle sprain. The application of a taping or straping of the ankle joint can help to fixate the ankle joints and prevent re-occurrence or worsening of the injury during the optimal stage of healing. The straping may take the form of zinc oxide tape or adhesive plaster which will act in many ways like the function of the injured ligament which has been traumatized. The intention being to give the impression that the injured limb is still able to function, even though it has been badly injured.

The aim here is to help promote continued function, reduce swelling and oedema, maintain strength of the muscle around the injured site and allow optimum recover time while the ankle is resting.

In rare instances patients can develop allergy to the adhesive materials applied, physiotherapists usually will discuss any allergy with patients before application. These taping and strapping would usually be in place for about one week, in some cases they provide an opportunity for patients who participate in sport to continue to take part in their activities while experiencing a minor injury. The intention is never for someone who has a severe injury to mask the symptoms by taping and straping in order to take part in sport with a more severe injury.

Clear advice and instruction is given to the patients so that they are aware how they are to wear the taping and straping, when they are to remove it and what to look for if there are any complications to the application of the taping.

Tapings and straping are also used in conditions like dislocation and partial rupture of ligaments in the shoulder, knee pain around the knee cap. It is also used for conditions like overuse injuries in areas like Achilles tendon.

Taping and straping is occasionally used by physiotherapists to stimulate proprioception and to affect joint position and joint stability. For instance in conditions where patients find it difficult to hold and maintain the correct posture in sitting or standing, taping and straping can be applied to ensure that the lower end of the shoulder blade is placed in the correct position while undergoing rehabilitation of the lower back following injury.

One of the most common areas to find straping and taping would be in the wrist and hands. These are not necessary weight bearing limbs but by the nature of their increased range of movements the fingers, thumbs and the wrist are prone to instability and trauma. It is necessary to stabilise these joints whilst they undergo treatment and allow a chance to recover from injury. Taping and straping should be undertaken by a qualified professional at all times and if undertaken by a patient prior to taking part to a sporting event you should make sure that they are fully aware of the correct process of application of the taping and straping.

For more information on our services, and the conditions we treat, or to book an appointment please call
0795 638 5651 or email info@anthonyhegarty.co.uk