Common Conditions We Treat

• Most common complaint in patients with associated neck pain
• Physiotherapy treatment aims to reduce pain and improve posture
• Treatment will focus on mobilising the upper cervical spine as research has indicated a close relationship between stiffness of the upper cervical spine and most types of headaches

Postural dysfunction

• Most common neck complaint usually involving tightness of neck muscles and restricted neck movement
• Often a result of suboptimal postures
• Treatment will focus on soft tissue manual therapy, joint mobilisations and postural modifications to improve pain and movement

Nerve root compression

• Commonly occurs at the levels of C5/6 and C6/7
• Likely to be a result of a disc bulge, prolapsed or herniated disc, osteophytic spurs
• Often associated with pins and needles or numbness and arm symptoms
• Physiotherapy aims to educate patients on optimal relieving positions as well as improve posture and symptom management

Whiplash

• Common result of a car accident due to impact forces causing sudden acceleration and deceleration of the head
• Muscles go into spasm to protect the neck
• Treatment will educate patients on optimal relieving positions, reduce pain and increase neck movement, increase quality of life and return to work/ sport
• Physiotherapy will also help identify whether nerves may be compressed as a result of the accident and treatment provided accordingly

Rotator cuff injury/ tendinopathy

• Supraspinatus and subscapularis are commonly affected often resulting from an impingement syndrome due to suboptimal shoulder biomechanics
• Pain often felt with overhead lifting and hand behind back movements
• Treatment will concentrate on improving shoulder biomechanics

Shoulder subluxation/ dislocation

• The shoulder is a common joint to dislocate
• Once acute precautions have been taken into consideration, physiotherapy aims to strengthen shoulder muscles globally to help support the joint structure
• If surgery was undertaken, physiotherapy is employed to strengthen the shoulder so that the patient is able to return to sport in full capacity
• Preventative exercises are also given

Subacromial bursitis

• Pain in the shoulder is often vague and occurs at end of range overhead lifting
• A result of suboptimal shoulder biomechanics
• Treatment will concentrate on improving shoulder biomechanics and improving rotator cuff strength

Frozen shoulder

• This is a self- limiting condition, generally lasting 2 years
• Physiotherapy aims to educate the patient on the phases that you can expect to go through throughout the condition as well as alleviate secondary complications from the condition

Fractured clavicle

• When the clavicle is broken, it is often allowed to heal on its own without further management. As a result, a step deformity develops causing tightness of neck muscles at the front
• Physiotherapy can help work on posture and reduce tightness of these neck muscles

Long head biceps tendinopathy

• This is a common condition especially with people who do a lot of lifting such as mothers
• Pain is usually felt at the front of the shoulder
• Treatment will involve rotator cuff strengthening, improving scapular stabilisation and eccentric biceps exercises

Tennis elbow

• Common injury in tennis players but also everyday workers
• Pain is commonly felt on the outside of the elbow with an insidious onset
• This is an overuse condition which can become difficult to treat when it becomes chronic
• Physiotherapy aims to reduce pain and increase strength through modification of aggravating activities and an eccentric elbow strengthening program

Golfers elbow

• This is the opposite to tennis elbow, it occurs on the inside of the elbow
• It is also an overuse condition
• Physiotherapy aims to reduce pain and increase strength through modification of aggravating activities and an eccentric elbow strengthening program

Carpal tunnel syndrome

• The carpal tunnel is located in the wrist and houses several tendons and vessels
• Through repetitive use inflammation may build up in the carpal tunnel which may cause impingement of the median nerve- which runs through the carpal tunnel
• Treatment will help offload the nerve through stretches and bracing
• Long term pathology may cause atrophy of hand muscles due to disuse and reduction of innervation from the median nerve- strengthening exercises can also be given

Repetitive strain injury (RSI)/ De Quervains tenosynovitis

• The tendons of the thumb can become inflamed due to overuse such as repetitive carrying and lifting of a baby/ toddler or typing
• Physiotherapy aims to provide adequate rest and bracing
• Patients may also be required to undergo cortisone injection or surgery – physiotherapy can help with post- operative management

Non-specific low back pain

• Most low back pain is non- specific, whether it is caused by lifting, sitting or standing for too long
• Physiotherapy will help settle any muscle spasm and mobilise joints to improve movement and return the patient back to sport/ work

Nerve root compression

• Commonly occurs at the levels of L3/4 and L4/5
• Likely to be a result of a disc bulge, prolapsed or herniated disc, osteophytic spurs
• Often associated with pins and needles or numbness and leg symptoms
• Physiotherapy aims to educate patients on optimal relieving positions as well as improve posture and symptom management

Spondylolythesis/ spondylosis

• Stable fractures of the lumbar spine
• Often occurs in adolescence and is an accidental finding on imaging later on in life

Sacroiliac joint pain

• Likely to occur due to hypermobility of pelvic joints
• This may result during pregnancy, after having a fall
• Physiotherapy treatment uses muscle energy technique and Mulligans treatment technique to help improve the articulation between pelvic joints

Scoliosis

• Scoliosis can be functional or structural
• Functional scoliosis may be corrected with physiotherapy treatment educating the patient of habits that cause an imbalance in the demands of back structures. It can also help strengthen weak muscles and loosen tighter muscles

Lumbar stenosis

• This is a degenerative condition which involves the narrowing of the spinal canal
• This condition may cause lower limb symptoms such as pins and needles or numbness
• Treatment will educate patients on relieving positions and discuss with patients management strategies

Adductor strain/ tendinopathy

• This is a common injury in soccer players
• It can be quite a difficult condition to manage if not treated timely as there is a risk that it may become chronic
• Treatment aims to reduce pain and improve strength with a graduated strengthening program, improve biomechanical faults and sporting technique to prevent recurrence

Greater trochanteric bursitis

• The greater trochanteric bursa is a sac of fluid which is located behind the greater trochanter (most prominent boney spot on the thigh bone)
• The job of the bursa is to reduce friction during movement
• If muscles are tight or lacking motor control and stabilisation, the bursa may become irritated and become inflamed
• Physiotherapy will help improve hip biomechanics and reduce muscular tightness to offload tension on the bursa

Hip labral tear

• The labrum is a lip around the socket of the hip
• It is sometimes torn as a result of femoro- acetabular impingement or due to high impact forces such as during a car accident
• Treatment will help strengthen the hip, if surgery is required physiotherapy can help provide post- operative care

Osteoarthritis

• Osteoarthritis is a degenerative condition of wear and tear due to the demands placed on the joint through time
• Physiotherapy can help strengthen muscles around the joint to help support the joint or help improve range of motion during times of flare up
• Physiotherapy can also help with post- operative management

Hamstring/ quadriceps strain or tear

• Muscle tears predominantly occur during eccentric contraction of the muscle
• Tears are graded into 3 grades with different prognosis for each
• Treatment will aim to minimise scar tissue build up, improve range and strength in the muscle and return the patient back to sport and functional capacity as soon as possible

Hamstring/ quadriceps muscle contusion

• This is also known as a corked thigh and commonly occurs in contact sports
• It is essentially a bruising in the muscle and return to sport timelines depend on the severity
• There is a small risk of developing myositis ossificans if not treated properly
• Treatment will involve soft tissue manual therapy to increase muscle metabolism as well as stretching and strengthening exercises

Anterior cruciate ligament tear/ ACL injury

• This is a very common injury that requires surgery if you want to continue with most sports
• A hamstring graft or LARS will be used for the reconstruction
• Physiotherapy aims to provide pre- operative strengthening as well as post- operative rehabilitation including improving range, strength and proprioception to return to sport as safely as possible
• The PEP program developed by Santa Monica University will be shown to you to prevent recurrence of injury

Posterior cruciate ligament tear/ PCL injury

• This is not common, usually occurs as a dashboard injury during car accidents or when the leg is pushed back on the thigh
• Most of the time surgery is not required and physiotherapy aims to provide strengthening and proprioceptive exercises to help return to sports

Medial collateral ligament tear

• This knee ligament is commonly injured when the knee is forced inwards
• Pain occurs on the inside of the knee
• Treatment will concentrate on improving range and knee strength as well as agility

Lateral collateral ligament

• This is not a common knee injury and often results from contact/ a blow to the inside of the knee
• Pain occurs on the outside of the knee
• Treatment will concentrate on improving range and knee strength as well as agility

Patellofemoral pain syndrome (PFPS)

• This is the most common knee injury which often results from maltracking of the knee cap due to suboptimal hip and knee biomechanics
• Treatment will aim to balance the tracking of the knee during knee flexion as well as correct biomechanical errors

Iliotibial band friction syndrome (ITBFS)

• This is a common injury among runners who train with downhill running
• The ITB is a taut band on the outside of the knee and in this condition is irritated within the 20- 30° of knee flexion
• Treatment will consist of soft tissue manual therapy as well as strengthening exercises and exercises to correct any biomechanical and running techniques

Meniscal tear

• The menisci are the knee’s cushion, they help to absorb forces and improve congruency of the knee
• If they are torn on the outer third, there is good capacity to heal as there is adequate blood supply. If they are torn in the middle 2/3, you are likely to require surgery
• Physiotherapy is often trialled initially involving knee stretches and strengthening exercises. If surgery is required, physiotherapy can provide pre- operative and post- operative management

Patella dislocation

• Can occur in twisting movements of the knee or due to a direct blow
• Physiotherapy aims to stabilise the knee cap by strengthening the quadriceps muscles
• If a second bout of dislocation occurs, surgical opinion is required
• Treatment will be required for post- operative management also

Fat pad impingement

• Commonly results from a hyperextension injury
• Nerve endings are concentrated in the fat pad and therefore this is a very painful condition
• Physiotherapy will help offload the fat pad to help with recovery as well as provide knee strengthening exercises

Patellar tendon tendinopathy

• This is an uncommon injury
• Treatment will concentrate on an eccentric strengthening program for the quadriceps as well as modification of aggravating factors to allow adequate relative rest

Osgood Schlatter

• Often occurs with children during a growth spurt where the bones grow faster than muscles
• Activity modification and quadriceps stretching is implemented

Medial tibial stress reaction/ fracture

• Often a result of prolonged running or increasing distance/ intensity of run too quickly
• Often occur in women with female triad presentation
• Initially, the condition begins as a reaction but if adequate rest is not administered, then a stress fracture may occur
• Physiotherapy will provide you with a CAM walker boot for management as well as teach you safe gradual progression strategies

Calf strain/ tear

• Often described as a gun shot
• Muscle tears predominantly occur during eccentric contraction of the muscle
• Tears are graded into 3 grades with different prognosis for each
• Treatment will aim to minimise scar tissue build up, improve range and strength in the muscle and return the patient back to sport and functional capacity as soon as possible

Achilles tendinopathy

• A very common condition as a result of overuse
• Treatment will constitute an eccentric ankle program

Plantar fasciitis

• Commonly occurs in middle aged people or those who are very active
• Pain is located in the sole of the foot, worse in the morning and eases with movement
• Treatment will help improve length of the plantar fascia and pain management strategies

Lateral ankle sprain (ATFL/CFL)

• The lateral ankle ligament is most commonly injured as the foot rolls inwards
• Treatment will consist of soft tissue manual therapy, joint mobilisation, ankle strengthening and proprioceptive work

Medial ankle sprain (deltoid ligament)

• This is a harder ligament to injure and therefore takes twice as long as the lateral ligaments to recover
• This often also means that higher forces are required to tear the deltoid ligament
• Treatment will consist of soft tissue manual therapy, joint mobilisation, ankle strengthening and proprioceptive work

Tibialis posterior tendinopathy

• The main role of the tibialis posterior is to provide adequate arch support
• Tendinopathy of the muscle often then results in a drop of the arch of the foot
• Predominantly occurs in middle aged women
• Physiotherapy aim to eccentrically strengthen tibialis posterior as well as provide adequate arch support