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What is Frozen Shoulder? I Stages, Symptoms & Treatments

Shoulder Pain

Introduction

Frozen shoulder, also known as adhesive capsulitis, is a painful and debilitating condition that affects the shoulder joint. It is a condition that causes a gradual loss of movement in the shoulder joint. The shoulder joint is a ball and socket joint and it is one of the most mobile joints in the body. However with a frozen shoulder, the joint feels stuck and its movement is limited. The shoulder capsule thickens and becomes stiff and tight. Thick bands of tissue called adhesions develop and there will be less synovial fluid in the joint to lubricate the joint, which will make it painful and stiff to move.

Symptoms and Causes

Individuals experiencing frozen shoulder often find their daily activities compromised due to varying degrees of symptoms such as:

  • Dull and aching pain.
  • Stiffness and difficulty to move the shoulder joint.
  • Typically worse in the earlier phase of the condition.
  • Usually located over the outer shoulder area and sometimes the upper arm.

There is no known specific cause for frozen shoulders. It is most often caused by inflammation of the tissues surrounding the joint or immobilisation of the shoulder after an arm injury or inflammation of the muscles and tendons (such as rotator cuff tendinitis or bursitis).

The following are some of the risk factors for frozen shoulder:

  • People aged 40 and older, particularly women
  • History of immobility and injury/trauma to the shoulder
  • Stroke
  • Recovery from surgery
  • Systemic diseases such as diabetes, thyroid disorders, cardiovascular diseases and Parkinson’s disease.

 

Stages of Frozen Shoulder

For people who are suffering from this condition, symptoms may develop suddenly and have a slow recovery phase. Recovery may take up to 2 or 3 years. Frozen shoulder develops in three stages:

 Stage 1 – Freezing

Any movement of the shoulder causes pain, and the shoulder’s ability to move becomes limited. Typically at this stage, the patient will experience an increase in pain. The freezing stage lasts from 2 to 9 months

Stage 2 – Frozen

Painful symptoms may lessen during this stage however stiffness remains or increases. Using the shoulder for daily activities during this stage may be very difficult. The frozen stage lasts from 4 to 12 months.  

 Stage 3 – Thawing

Shoulder movements begin to improve. There will be a complete or near complete return to normal strength and motion. This thawing stage typically takes anywhere from 6 months to 2 years.

Physiotherapy Treatment for Frozen Shoulder

Fortunately, there are a range of effective physiotherapy treatments for frozen shoulders to alleviate symptoms and restore shoulder function. At Synapse Physiotherapy, we will be able to help address these symptoms and help you recover to full health. Undoubtedly, physiotherapy plays a crucial role in managing frozen shoulders. Here at Synapse Physiotherapy, we aim to reduce pain, increase range of motion, and enhance overall shoulder function. Our professionally trained physiotherapists employ a variety of techniques, exercises, and modalities to achieve these goals. The following are some of the treatment techniques and exercises that are carried out by our physiotherapists: 

1. Passive Range of Motion (PROM) Exercises:

Passive range of motion exercises involve a therapist gently moving the patient’s arm through various motions. This helps maintain flexibility and prevent further stiffness. PROM exercises are particularly beneficial in the painful and early stages of shoulder dysfunction.

 2. Active Range of Motion (AROM) Exercises:

As pain decreases and the shoulder begins to thaw, active range of motion exercises become crucial. Patients are encouraged to perform controlled movements on their own, gradually improving their ability to move the shoulder. These exercises are designed to restore strength and flexibility.

 3. Stretching Exercises: 

Stretching exercises target the muscles and connective tissues around the shoulder joint. Stretching helps improve flexibility and reduce stiffness. Therapists may incorporate techniques such as wall stretches, pendulum exercises, and towel stretches to address specific areas of tightness. 

4. Strengthening Exercises:

Strengthening the muscles surrounding the shoulder is essential for restoring function. Therapists design tailored exercise programs that focus on building strength in a progressive manner. Resistance bands, dumbbells, and bodyweight exercises may be utilised to target specific muscle groups. 

5. Joint Mobilisation:

Joint mobilisation involves the therapist gently moving the joint in specific directions to improve its mobility. This technique helps reduce stiffness and enhances the shoulder range of motion. It is often used in conjunction with other exercises to optimise results.

6. Heat and Cold Therapy:

Applying heat or cold to the affected shoulder can provide relief from pain and inflammation. Heat therapy helps relax muscles and increase blood flow, while cold therapy helps reduce swelling. Physios may recommend alternating between these modalities based on the individual’s needs.

7. Ultrasound Therapy:

Ultrasound therapy uses sound waves to stimulate deep tissues and promote healing. It can be effective in reducing pain and inflammation associated with frozen shoulders. Physios may incorporate ultrasound as part of a comprehensive treatment plan.

8. Electrical Stimulation:

Electrical stimulation, such as transcutaneous electrical nerve stimulation (TENS), can be employed to alleviate pain. By sending low-level electrical currents through the skin, this technique disrupts pain signals and provides relief. It is often used in combination with other therapeutic interventions.

9. Home Exercise Programs:

To ensure continuity of care, our physiotherapists will prescribe home exercise programs. They are designed to empower individuals to continue their rehabilitation independently. Consistent engagement with prescribed exercises contributes significantly to the success of physiotherapy treatment.

Frequently Asked Questions (FAQs) about Frozen Shoulder Treatment

1. What causes frozen shoulders, and who is at risk?

Frozen shoulders can develop from various factors, including inflammation of the tissues surrounding the joint, immobilization after injury, or underlying health conditions such as diabetes, stroke, or thyroid disorders. People aged 40 and older, particularly women, individuals with a history of shoulder immobility or trauma, and those recovering from surgery are at higher risk.

2. How long does it take to recover from a frozen shoulder with physiotherapy?

The recovery timeline for frozen shoulder varies depending on the severity of the condition and individual response to treatment. With consistent physiotherapy sessions and home exercises, significant improvement can be seen within a few weeks to months. However, complete recovery may take up to two to three years, especially in severe cases.

3. Is physiotherapy painful for frozen shoulder treatment?

Physiotherapy for frozen shoulder aims to alleviate pain and improve mobility, but some discomfort may be experienced during certain exercises or therapeutic modalities. However, the level of discomfort should be manageable and should not cause excessive pain. Your physiotherapist will adjust the treatment plan according to your tolerance levels.

4. Can frozen shoulder recur after treatment?

While frozen shoulder can recur in some cases, especially if underlying risk factors are not addressed, proper management and rehabilitation can significantly reduce the likelihood of recurrence. Following a comprehensive physiotherapy program, maintaining shoulder mobility through regular exercises, and addressing any contributing factors can help prevent recurrence.

5. Are there any precautions to take during frozen shoulder physiotherapy?

During frozen shoulder physiotherapy, it’s essential to communicate any discomfort or pain to your physiotherapist. They can adjust the intensity or technique of exercises accordingly. It’s also essential to follow the prescribed home exercise program diligently to maximize the benefits of treatment. Additionally, avoiding activities that exacerbate shoulder pain or stiffness can help facilitate recovery.

Conclusion

Frozen shoulders can be a challenging condition, but with the right physiotherapy interventions, individuals can experience significant improvement in pain and mobility. The key to successful treatment lies in early intervention and a tailored approach to address the specific needs of each patient. Whether through targeted exercises, modalities, or a combination of therapies, physiotherapy offers a path to improved mobility and restoring the joy of pain-free shoulder movement. If you suspect you have frozen shoulder symptoms, come to Synapse Physiotherapy for a consultation today with a qualified physiotherapist and take a crucial step towards a comprehensive and effective treatment plan to tackle frozen shoulder. 

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Top 3 Body Pain Problems in Malaysia: Physiotherapy Ampang

Muscle Pain, Shoulder Pain

Introduction

Lower Back Pain

Lower back pain (LBP) is a common complaint characterized by discomfort between the lower ribcage and buttocks. It can be acute, sub-acute, or chronic, impacting movement and quality of life. LBP can be specific or non-specific, with non-specific cases comprising the majority. Symptoms include dull or intense pain, often radiating to the legs, affecting mobility and causing sleep disturbances. Chronic LBP can lead to functional limitations and reduced productivity.

Neck Pain

Acute neck pain is prevalent and often resolves within weeks, while chronic neck pain persists beyond three months, with psychological stress playing a role in its development. Symptoms include stiffness, sharp pain, and radiating discomfort to the head, trunk, shoulders, and arms. Neck pain can be accompanied by numbness, tingling, weakness, and headaches, necessitating medical evaluation for proper management.

Knee Osteoarthritis

Knee osteoarthritis (OA) results from the gradual breakdown of articular cartilage, leading to pain, stiffness, and swelling in the knee joint. It can be primary or secondary, with symptoms worsening over time and affecting mobility. Risk factors include age, obesity, and occupational hazards, contributing to the high prevalence of knee OA in Malaysia’s elderly population.

Prevalence

Studies have highlighted the significant prevalence of musculoskeletal pain in Malaysia, particularly in the lower back, neck, and knee regions. Factors such as sedentary lifestyles, occupational hazards, obesity, and an aging population contribute to the high burden of these conditions in the country.

Role of Physiotherapy

Physiotherapy plays a crucial role in managing lower back pain, neck pain, and knee osteoarthritis by employing a comprehensive approach focused on pain management, functional improvement, and prevention of recurrent symptoms. Modalities such as heat and cold therapy, manual therapy techniques, and tailored exercise programs are utilized to alleviate pain, improve mobility, and enhance overall well-being.

Characteristics 

Chronic ankle instability is defined by enduring feelings of apprehension within the ankle, recurrent instances of the ankle giving way, and repeated ankle sprains persisting for a minimum of six months post-initial sprain. Patients with chronic ankle instability typically have a medical history characterized by repeated ankle sprains and significant inversion injuries, often impacting the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL), and/or the posterior talofibular ligament (PTFL). 

Symptoms indicative of chronic ankle instability encompass lateral ankle pain and ongoing swelling. As a result of these injuries, they tend to take specific precautions to avoid weight-bearing activities, strenuous exercises, and walking on uneven or rough surfaces.

 

Regarding impairments associated with chronic ankle instability, notable factors include heightened ligamentous laxity and proprioceptive deficits. These impairments contribute to limitations in various activities such as walking and jumping. Furthermore, in terms of participation, individuals with chronic ankle instability may find themselves ceasing participation in sports, withdrawing from or reducing occupational involvement, experiencing decreased exercise levels, and even altering the type of sport they engage in

 

Causes 

Chronic ankle instability is primarily attributed to two key factors: diminished proprioceptive abilities stemming from the loss of mechanoreceptors and weakened invertor and evertor muscle strength.

Following a lateral ankle sprain (LAS), not only are ligaments structurally compromised, but the mechanoreceptors within joint capsules, ligaments, and tendons surrounding the ankle complex also sustain damage. These mechanoreceptors play a vital role in relaying feedback about joint pressure and tension, aiding in the perception of joint movement and position. This sensory input is integrated with visual and vestibular cues, forming a complex control system responsible for regulating posture and coordination. When injury disrupts afferent input, it can lead to alterations in corrective muscular contractions, potentially contributing to functional impairments and chronic instability post-injury.

 

Proprioception

Proprioception is defined as the sensory information relayed to the central nervous system by mechanoreceptors located in various tissues including joint capsules, ligaments, muscles, tendons, and skin. Trauma to tissues containing these mechanoreceptors can result in partial differentiation, leading to proprioceptive deficits that contribute to chronic ankle instability. Studies have shown postural control deficits during quiet standing following acute LAS and in individuals with chronic ankle instability.

 

Muscle Weakness

Additionally, researchers have identified weakness in the peroneal muscles as a contributing factor to chronic ankle instability. Deficits in evertor strength reduce the muscles’ ability to resist inversion and return the foot to a neutral position, potentially increasing susceptibility to inversion sprains. Notably, eccentric evertor weakness has been observed in patients with chronic ankle instability.

 

Management 

In contrast to acute ankle sprains, chronic ankle instability often necessitates surgical intervention. However, before resorting to surgery, non-surgical approaches are strongly advocated for patients with chronic ankle instability. Research indicates that repetitive ankle joint injuries lead to neuro-sensory, proprioceptive, and mechanical impairments. Therefore, exercises aimed at enhancing proprioception, balance, and functional capacity are typically incorporated into treatment protocols following an ankle joint injury, alongside muscle strengthening exercises.



Neuromuscular training

 

Neuromuscular training involves the unconscious activation of dynamic restraints, which prepare and respond to joint motion and loads, thereby maintaining and restoring functional joint stability. The primary objectives of neuromuscular training are twofold: first, to enhance lower limb postural control, and second, to rehabilitate active stability through targeted training methods.

 

Balance training 

Balance training can affect multiple joints and produce overall improvements. It significantly improves functionality, instability, and dynamic balance outcomes in people with chronic ankle instability

 

Mobilization 

Limited ankle dorsiflexion during jogging and walking presents a risk factor for recurrent sprains due to several factors. Firstly, insufficient dorsiflexion restricts the ankle joint’s ability to reach its closed-packed position during stance, compromising its stability. Secondly, individuals with limited dorsiflexion may have a tendency to lock the midfoot in supination, further compromising the ankle’s ability to adapt to uneven surfaces or sudden changes in terrain. Lastly, the lateral movement of the center of gravity caused by limited dorsiflexion increases the vulnerability of the ankle joint to supination and subsequent sprains, as the joint lacks the necessary flexibility to absorb and adapt to these forces effectively. Hence, mobilization with movement intervention will definitely benefit patients with chronic ankle instability by increasing dorsiflexion range of motion. 

 

Taping 

Physiotherapists will apply taping in order to improve patients’ perceptions of stability and decrease mechanical laxity. 

 

Strengthening exercise

 

Chronic ankle instability often leads to weakness in the muscles surrounding the ankle joint, including the peroneal muscles, which play a crucial role in stabilizing the ankle during movement. Strengthening exercises help to rebuild strength in these muscles, improving their ability to support and protect the ankle joint.

 

Associated lesions

Chronic ankle instability is often associated with lesions that evolve from contributory factors. They do not necessarily occur with chronic ankle instability, and if any, not all these lesions occur together. 



Sinus tarsi syndrome is frequently observed in specific populations such as basketball and volleyball players, dancers, overweight individuals, as well as those with flatfoot and hyperpronation deformities. This condition manifests as pain and tenderness in the sinus tarsi, located on the lateral side of the hindfoot. It can develop after a single severe ankle sprain or as a result of repetitive ankle injuries (Al-Kenani & Al-Mohrej, 2016).



Osteochondral defects (OCD) are injuries that affect the talus bone. These injuries can manifest as the blistering of cartilage layers, the formation of cyst-like lesions within the bone, or even fractures involving both bone and cartilage layers. OCD can be caused by a single traumatic event or recurrent trauma over time. Symptoms of OCD typically include swelling, instability in the ankle joint, and persistent pain that extends over a prolonged period (Al-Kenani & Al-Mohrej, 2016). 

 

Peroneal tendinopathy is chronic inflammation of the peroneal tendon resulting in weakness of the active ankle stabilizers. This happens when a person performs a repetitive activity that stresses the tendon over a long period. In addition, poor and rapid training and poor shoe wear may cause peroneal tendinosis. People who have a hindfoot varus posture are more likely to experience peroneal tendinosis (Al-Kenani & Al-Mohrej, 2016).

Frequently Asked Questions (FAQs)

1. How long does it take to see improvement with physiotherapy for lower back pain?

The timeframe for improvement varies depending on the severity and underlying cause of the pain. Generally, patients may experience relief within a few weeks of starting physiotherapy, with continued improvement over time.

2. Is physiotherapy effective for chronic neck pain?

Yes, physiotherapy can be effective in managing chronic neck pain by addressing underlying issues, improving mobility, and reducing pain intensity. However, the treatment approach may vary based on individual needs and response to therapy.

3. Can physiotherapy prevent the progression of knee osteoarthritis?

While physiotherapy cannot reverse the degenerative process of osteoarthritis, it can help manage symptoms, improve joint function, and delay disease progression. Through targeted exercises and lifestyle modifications, physiotherapy aims to optimize the quality of life for individuals with knee OA.

4. Are there any side effects associated with physiotherapy for musculoskeletal pain?

Physiotherapy is generally safe, with minimal side effects. However, some patients may experience temporary soreness or discomfort following certain treatments. These effects are usually transient and outweighed by the long-term benefits of therapy.

5. How can I find a qualified physiotherapist for my musculoskeletal pain in Ampang?

You can search online or ask for recommendations from your healthcare provider. Look for physiotherapy clinics like Synapse Physiotherapy that offer personalized care and have experienced professionals specializing in musculoskeletal rehabilitation.

Conclusion

In conclusion, musculoskeletal pain poses a significant challenge in Malaysia, affecting individuals’ daily lives and overall well-being. Physiotherapy offers a holistic approach to managing conditions like lower back pain, neck pain, and knee osteoarthritis, addressing pain, improving function, and enhancing quality of life. At Synapse Physiotherapy in Ampang, our team is dedicated to providing personalized care tailored to your specific needs, helping you achieve better musculoskeletal health and overall wellness. Don’t let pain hold you back; start your journey to recovery with physiotherapy today.

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Chronic Ankle Instability | Synapse Physiotherapy Near Me

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Introduction

Chronic ankle instability is a condition characterized by repeated ankle sprains, feelings of instability, and difficulty maintaining balance. This condition often results from previous ankle injuries that have not fully healed or have been inadequately rehabilitated. Physiotherapy plays a crucial role in the management of chronic ankle instability. If you are seeking physiotherapy for chronic ankle instability, it is essential to consult a qualified physiotherapist who can assess your condition and tailor a treatment plan to address your specific needs. You can search for “physiotherapy near me” to find practitioners in your area who specialize in the treatment and rehabilitation of ankle injuries.

Characteristics 

Chronic ankle instability is defined by enduring feelings of apprehension within the ankle, recurrent instances of the ankle giving way, and repeated ankle sprains persisting for a minimum of six months post-initial sprain. Patients with chronic ankle instability typically have a medical history characterized by repeated ankle sprains and significant inversion injuries, often impacting the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL), and/or the posterior talofibular ligament (PTFL). 

Symptoms indicative of chronic ankle instability encompass lateral ankle pain and ongoing swelling. As a result of these injuries, they tend to take specific precautions to avoid weight-bearing activities, strenuous exercises, and walking on uneven or rough surfaces.

 

Regarding impairments associated with chronic ankle instability, notable factors include heightened ligamentous laxity and proprioceptive deficits. These impairments contribute to limitations in various activities such as walking and jumping. Furthermore, in terms of participation, individuals with chronic ankle instability may find themselves ceasing participation in sports, withdrawing from or reducing occupational involvement, experiencing decreased exercise levels, and even altering the type of sport they engage in

 

Causes 

Chronic ankle instability is primarily attributed to two key factors: diminished proprioceptive abilities stemming from the loss of mechanoreceptors and weakened invertor and evertor muscle strength.

Following a lateral ankle sprain (LAS), not only are ligaments structurally compromised, but the mechanoreceptors within joint capsules, ligaments, and tendons surrounding the ankle complex also sustain damage. These mechanoreceptors play a vital role in relaying feedback about joint pressure and tension, aiding in the perception of joint movement and position. This sensory input is integrated with visual and vestibular cues, forming a complex control system responsible for regulating posture and coordination. When injury disrupts afferent input, it can lead to alterations in corrective muscular contractions, potentially contributing to functional impairments and chronic instability post-injury.

 

Proprioception

Proprioception is defined as the sensory information relayed to the central nervous system by mechanoreceptors located in various tissues including joint capsules, ligaments, muscles, tendons, and skin. Trauma to tissues containing these mechanoreceptors can result in partial differentiation, leading to proprioceptive deficits that contribute to chronic ankle instability. Studies have shown postural control deficits during quiet standing following acute LAS and in individuals with chronic ankle instability.

 

Muscle Weakness

Additionally, researchers have identified weakness in the peroneal muscles as a contributing factor to chronic ankle instability. Deficits in evertor strength reduce the muscles’ ability to resist inversion and return the foot to a neutral position, potentially increasing susceptibility to inversion sprains. Notably, eccentric evertor weakness has been observed in patients with chronic ankle instability.

 

Management 

In contrast to acute ankle sprains, chronic ankle instability often necessitates surgical intervention. However, before resorting to surgery, non-surgical approaches are strongly advocated for patients with chronic ankle instability. Research indicates that repetitive ankle joint injuries lead to neuro-sensory, proprioceptive, and mechanical impairments. Therefore, exercises aimed at enhancing proprioception, balance, and functional capacity are typically incorporated into treatment protocols following an ankle joint injury, alongside muscle strengthening exercises.



Neuromuscular training

 

Neuromuscular training involves the unconscious activation of dynamic restraints, which prepare and respond to joint motion and loads, thereby maintaining and restoring functional joint stability. The primary objectives of neuromuscular training are twofold: first, to enhance lower limb postural control, and second, to rehabilitate active stability through targeted training methods.

 

Balance training 

Balance training can affect multiple joints and produce overall improvements. It significantly improves functionality, instability, and dynamic balance outcomes in people with chronic ankle instability

 

Mobilization 

Limited ankle dorsiflexion during jogging and walking presents a risk factor for recurrent sprains due to several factors. Firstly, insufficient dorsiflexion restricts the ankle joint’s ability to reach its closed-packed position during stance, compromising its stability. Secondly, individuals with limited dorsiflexion may have a tendency to lock the midfoot in supination, further compromising the ankle’s ability to adapt to uneven surfaces or sudden changes in terrain. Lastly, the lateral movement of the center of gravity caused by limited dorsiflexion increases the vulnerability of the ankle joint to supination and subsequent sprains, as the joint lacks the necessary flexibility to absorb and adapt to these forces effectively. Hence, mobilization with movement intervention will definitely benefit patients with chronic ankle instability by increasing dorsiflexion range of motion. 

 

Taping 

Physiotherapists will apply taping in order to improve patients’ perceptions of stability and decrease mechanical laxity. 

 

Strengthening exercise

 

Chronic ankle instability often leads to weakness in the muscles surrounding the ankle joint, including the peroneal muscles, which play a crucial role in stabilizing the ankle during movement. Strengthening exercises help to rebuild strength in these muscles, improving their ability to support and protect the ankle joint.

 

Associated lesions

Chronic ankle instability is often associated with lesions that evolve from contributory factors. They do not necessarily occur with chronic ankle instability, and if any, not all these lesions occur together. 



Sinus tarsi syndrome is frequently observed in specific populations such as basketball and volleyball players, dancers, overweight individuals, as well as those with flatfoot and hyperpronation deformities. This condition manifests as pain and tenderness in the sinus tarsi, located on the lateral side of the hindfoot. It can develop after a single severe ankle sprain or as a result of repetitive ankle injuries (Al-Kenani & Al-Mohrej, 2016).



Osteochondral defects (OCD) are injuries that affect the talus bone. These injuries can manifest as the blistering of cartilage layers, the formation of cyst-like lesions within the bone, or even fractures involving both bone and cartilage layers. OCD can be caused by a single traumatic event or recurrent trauma over time. Symptoms of OCD typically include swelling, instability in the ankle joint, and persistent pain that extends over a prolonged period (Al-Kenani & Al-Mohrej, 2016). 

 

Peroneal tendinopathy is chronic inflammation of the peroneal tendon resulting in weakness of the active ankle stabilizers. This happens when a person performs a repetitive activity that stresses the tendon over a long period. In addition, poor and rapid training and poor shoe wear may cause peroneal tendinosis. People who have a hindfoot varus posture are more likely to experience peroneal tendinosis (Al-Kenani & Al-Mohrej, 2016).

Frequently Asked Questions (FAQs)

1. How long does physiotherapy treatment for chronic ankle instability typically last?

The duration of treatment varies depending on the severity of the condition and individual response to therapy. Generally, treatment may range from several weeks to several months, with regular sessions scheduled to monitor progress and adjust the treatment plan as needed.

2. Can chronic ankle instability lead to long-term complications if left untreated?

Yes, untreated chronic ankle instability can result in long-term complications such as recurrent sprains, joint degeneration, and decreased mobility. Seeking timely physiotherapy intervention is essential to prevent these complications and promote optimal recovery.

3. Are there specific exercises I can do at home to complement physiotherapy treatment for chronic ankle instability?

Yes, your physiotherapist can prescribe home exercise programs tailored to your needs and goals. These exercises may include strengthening, balance, and proprioception exercises to enhance your rehabilitation progress.

4. Is surgery necessary for all cases of chronic ankle instability?

No, surgery is typically considered as a last resort for cases of chronic ankle instability that do not respond to conservative treatments such as physiotherapy. Many individuals experience significant improvement with non-surgical approaches.

5. How can I find a qualified physiotherapist near me who specializes in treating chronic ankle instability?

You can search online or ask for recommendations from your primary care physician or orthopedic specialist. Look for physiotherapy clinics with experienced professionals who have expertise in treating ankle injuries and specialize in musculoskeletal rehabilitation.

Conclusion

 

In conclusion, chronic ankle instability is a condition that significantly impacts an individual’s quality of life and ability to engage in daily activities and sports. Physiotherapy plays a crucial role in the comprehensive management and treatment of chronic ankle instability. Through targeted exercises, manual therapy techniques, and education on injury prevention and proprioception enhancement, physiotherapy aims to address underlying biomechanical deficits, strengthen muscles around the ankle joint, improve balance and stability, and ultimately restore function and mobility. Synapse Physiotherapy provides specialized care and expertise in treating chronic ankle instability, offering personalized treatment plans tailored to individual needs and goals. Seeking physiotherapy at Synapse Physiotherapy can be instrumental in effectively managing chronic ankle instability, facilitating recovery, and promoting long-term ankle health and stability.

References

Al-Kenani, N., & Al-Mohrej, O. (2016). Chronic ankle instability: Current perspectives. Avicenna Journal of Medicine, 6(4), 103. https://doi.org/10.4103/2231-0770.191446

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Back Pain Treatment Malaysia: Can physiotherapy help? – Copy

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Introduction

Back pain is a pervasive and debilitating condition that affects people across various age groups and lifestyles. Whether caused by poor posture, muscle imbalances, injuries, or underlying medical conditions, its impact on quality of life can be profound. In recent years, back pain treatment via physiotherapy has emerged as a cornerstone in the management and alleviation of this common ailment in Malaysia.

Understanding the Landscape of Back Pain

Before delving into the role of physiotherapy, it’s crucial to understand the complexity of back pain, which stems from various causes including muscular imbalances, poor posture, and structural issues. Sedentary lifestyles and stress exacerbate this condition, highlighting the need for a holistic approach to treatment.

Anatomy and Function of the Spine

The spine’s intricate structure, comprising vertebrae, discs, ligaments, and muscles, allows for flexibility and weight distribution. Understanding spinal anatomy is essential in comprehending the mechanisms behind back pain.

Physiotherapy Assessment and Stratified Care

A thorough assessment by a physiotherapist is essential, involving a detailed examination of medical history and lifestyle to identify the root cause(s) of pain. Stratified care, targeting treatment based on individual characteristics, has shown effectiveness in managing low back pain.

Physiotherapy Treatment

Hands-On Healing

Manual therapy techniques like massage and joint mobilization provide immediate relief by relieving muscle tension and improving joint mobility.

Prescribing Therapeutic Exercises

Targeted exercises tailored to individual needs strengthen core muscles, improve flexibility, and correct imbalances contributing to back pain.

Postural Correction and Ergonomic Guidance

Educating patients on proper body mechanics and offering ergonomic advice empowers them to prevent future episodes of back pain.

Modalities for Pain Management

Utilizing modalities such as heat therapy, ultrasound, and electrical stimulation helps manage pain effectively, complementing other physiotherapy interventions.

Patient Education and Lifestyle Modification

Educating patients about lifestyle modifications including exercise routines, dietary choices, and stress management techniques fosters a proactive approach to recovery.

Continuous Monitoring and Adjustment

Regular monitoring of progress allows for necessary adjustments to treatment plans, ensuring sustained improvement.

Frequently Asked Questions (FAQs)

1. How many sessions of physiotherapy are typically needed to alleviate back pain?

The number of sessions varies depending on the severity and underlying cause of the back pain. Generally, a course of physiotherapy may range from several weeks to a few months, with regular sessions scheduled according to individual needs.

2. Are there any side effects associated with physiotherapy treatments for back pain?

Physiotherapy is generally safe, with minimal side effects. However, some patients may experience temporary soreness or discomfort following certain treatments such as manual therapy or therapeutic exercises. These effects usually subside quickly and are outweighed by the long-term benefits of treatment.

3. Can physiotherapy help with chronic back pain conditions?

Yes, physiotherapy can be effective in managing chronic back pain conditions by addressing underlying issues, improving mobility, and enhancing overall function. However, the treatment approach may vary depending on the individual’s specific condition and needs.

4. Is physiotherapy suitable for all age groups suffering from back pain?

Yes, physiotherapy is suitable for people of all age groups, from children to seniors, suffering from back pain. Treatment plans are customized to accommodate the unique needs and capabilities of each patient, ensuring safe and effective care.

5. What sets Synapse Physiotherapy apart from other clinics in Malaysia offering back pain treatment?

Synapse Physiotherapy stands out for its commitment to personalized care, evidence-based treatments, and holistic approach to healing. Our experienced physiotherapists prioritize patient well-being and work closely with individuals to achieve optimal outcomes in back pain management. Additionally, our clinic offers state-of-the-art facilities and a supportive environment conducive to recovery.

Conclusion

Physiotherapy offers a transformative pathway to healing for individuals grappling with back pain. Synapse Physiotherapy in Malaysia provides personalized treatments combining diagnostic precision, hands-on therapies, and holistic care. By focusing on improving physical function and overall well-being, physiotherapy offers a promising solution for those seeking relief from back pain.

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How to Choose The Best Physiotherapy? Synapse Insight

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Introduction

Physiotherapy involves treatment that restores, maintain and make the most of a patient’s mobility, function, and well-being. Physiotherapy also helps an individual through physical rehabilitation, injury prevention, health and fitness, with the individual themselves being actively involved in their own recovery. The best physiotherapy treatment approach you can take is a holistic approach, addressing both physical aspects of your well-being as well as your emotional, psychological, and social well-being. 

 

Embarking on a journey to restore and enhance your physical well-being through physiotherapy is a commendable decision. However, with various treatment options available, selecting the most suitable physiotherapy approach can be a daunting task. This article aims to provide a comprehensive guide to help individuals make informed decisions about choosing the best physiotherapy treatment tailored to their unique needs and conditions.

Understanding Your Needs:

 

Assessment and Diagnosis

 Before delving into treatment options, it’s crucial to undergo a thorough assessment by a qualified physiotherapist. This assessment helps identify the root cause of your condition, whether it’s a sports injury, chronic pain, post-surgical recovery, or a musculoskeletal issue. 

 

Setting Realistic Goals

Establish clear and realistic goals for your physiotherapy journey. Whether it’s pain reduction, improved mobility, enhanced athletic performance, or overall well-being, having specific objectives will guide the selection of the most appropriate treatment plan and meet the expectations of your goals. 

 

Exploring Different Physiotherapy Modalities:

 

Manual Therapy

Manual therapy involves hands-on techniques where the physiotherapist manipulates joints, muscles, and tissues. Techniques may include joint mobilisation, soft tissue massage, and manipulation. This approach is effective for conditions such as joint stiffness, muscle tightness, and certain types of injuries.

 

Exercise Prescription

Exercise is a fundamental component of physiotherapy. Based on your assessment, the physiotherapist will prescribe specific exercises to address your individual needs. This may include stretching, strengthening, and stability exercises tailored to your condition and goals.

 

Electrotherapy and Modalities

Some physiotherapy treatments incorporate the use of electrotherapy modalities such as ultrasound, electrical stimulation, and shockwave therapy. These techniques can be beneficial for pain management, tissue healing, and reducing inflammation.

 

Hydrotherapy

Conducted in a pool, hydrotherapy utilises the buoyancy of water to reduce stress on joints. It is particularly effective for conditions where weight-bearing exercises may be challenging, such as arthritis or post-surgical rehabilitation.

 

Specialised Technique

Depending on your condition, specialised techniques such as dry needling, acupuncture, or cupping may be incorporated into your treatment plan. These techniques can provide relief for specific musculoskeletal issues and are often used in conjunction with other physiotherapy modalities.



Considering Treatment Duration and Frequency:

 

Acute vs. Chronic Conditions

The duration and frequency of physiotherapy sessions can vary based on the nature of your condition. Acute injuries may require more frequent sessions initially, while chronic conditions may involve a more extended treatment plan with fewer sessions spread over time.

 

Consistency is Key

Consistency plays a vital role in the success of physiotherapy treatment. Adhering to the prescribed exercises and attending regular sessions are essential for achieving optimal results. Discuss your availability and commitment level with your physiotherapist to create a realistic and sustainable treatment plan.

 

Considering Lifestyle and Preferences:

 

In-Clinic vs. Home-Based Exercises

Some physiotherapy plans may involve exercises that can be performed at home, while others may require in-clinic sessions. Consider your lifestyle, schedule, and personal preferences when choosing a treatment plan. A combination of both in-clinic and home-based exercises may offer flexibility and convenience.

 

Communication and Collaboration

Establish open communication with your physiotherapist. Share any concerns, preferences, or limitations you may have. A collaborative approach ensures that the treatment plan aligns with your expectations and is adjusted as needed based on your progress.



Financial Consideration

 

Cost-Benefit Analysis

While considering the cost of physiotherapy, weigh it against the potential benefits to your overall health and well-being. Investing in effective physiotherapy treatment can lead to long-term improvements in function and quality of life.

 

Seeking Second Opinions:

 

Consulting with Specialists

For complex or chronic conditions, seeking a second opinion from a physiotherapy specialist or another healthcare professional may provide valuable insights. A fresh perspective can offer alternative treatment options or confirm the appropriateness of the recommended approach.

Patient Testimonials and Reviews

Research patient testimonials and reviews about physiotherapy clinics and therapists. Positive feedback and success stories can provide confidence in your choice, while negative reviews may prompt further exploration or clarification.

Frequently Asked Questions (FAQs)

1. How can I determine the best physiotherapy treatment for my unique needs?

Start by undergoing a thorough assessment and diagnosis by a qualified physiotherapist to identify the root cause of your condition. Setting clear and realistic goals, whether for pain reduction, improved mobility, or overall well-being, will guide the selection of the most suitable treatment plan.

2. What are the different physiotherapy modalities, and how do I choose the right one for me?

Physiotherapy modalities include manual therapy, exercise prescription, electrotherapy, hydrotherapy, and specialized techniques like dry needling or acupuncture. Your physiotherapist will tailor a treatment plan based on your condition, combining various modalities for optimal results.

3. How do I determine the duration and frequency of physiotherapy sessions for my condition?

The duration and frequency depend on the nature of your condition. Acute injuries may require more frequent sessions initially, while chronic conditions may involve a more extended treatment plan with fewer sessions spread over time. Consistency in attending sessions and adhering to prescribed exercises is crucial for success.

4. Can I choose between in-clinic and home-based physiotherapy exercises?

Some physiotherapy plans may involve exercises for home use, while others require in-clinic sessions. Consider your lifestyle, schedule, and preferences when choosing a treatment plan. Discussing these factors openly with your physiotherapist can lead to a flexible and convenient approach.

Conclusion

 

Choosing the best physiotherapy treatment for yourself involves a thoughtful and individualised approach. By understanding your specific needs, exploring various treatment modalities, considering lifestyle factors, and weighing financial considerations, you can make informed decisions that align with your goals for recovery and overall well-being. Remember that physiotherapy is a collaborative process between you and your physiotherapist, and open communication is key to achieving the best possible outcomes on your path to recovery.

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What is Dry Needling? Physiotheraphy Near Me – Synapse

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What is dry needling

‘Dry needling’ involves the insertion of thin monofilament needles, akin to those used in acupuncture, without injection. This technique is commonly employed for the treatment of muscles, ligaments, tendons, subcutaneous fascia, scar tissue, peripheral nerves, and neurovascular bundles to manage various neuromusculoskeletal pain syndromes. Notably, the definition of dry needling has been refined by organisations such as the National Physical Therapy Association and several State Boards of Physical Therapy. According to their updated specifications, dry needling is specifically described as the insertion of needles into nodules within taut bands of muscle, more commonly known as ‘trigger points’ or ‘myofascial trigger points’ (MTrPs). If you’re seeking ‘physiotherapy near me,’ explore the benefits of dry needling with a qualified healthcare professional. This technique, when incorporated into physiotherapy, can be a valuable component in addressing musculoskeletal issues and pain syndromes effectively.

Mechanism of dry needling

 

The efficacy of dry needling in musculoskeletal conditions is evident through its immediate impact on pressure pain threshold, range of motion (ROM), muscle tone reduction, and pain alleviation. The proposed mechanisms of action encompass several intriguing aspects that contribute to its therapeutic effects.

One notable mechanism is the induction of a ‘local twitch response,’ an involuntary spinal reflex triggering localised muscle contractions within the needled area. This response not only influences the length and tension of muscle fibers but also stimulates mechanoreceptors like A Beta fibers, showcasing its multifaceted impact.

Furthermore, the impact on blood flow is a compelling facet. The sustained contraction of taut muscle bands in trigger points can induce local ischemia and hypoxia. Dry needling, in turn, prompts vasodilation in small blood vessels, enhancing muscle blood flow and oxygenation.

The neurophysiological effects of dry needling are equally intriguing, with documented local and central nervous responses. This prompts homeostasis at trigger points, resulting in decreased central and peripheral sensitisation to pain.

Lastly, the placebo effect should not be overlooked. The role of expectations in influencing pain perception is a critical aspect to consider when assessing the overall impact of dry needling.

Trigger point 

Trigger points, arising from an excessive release of acetylcholine at specific motor endplates, can be classified as Active or Latent myofascial trigger points. Active points may spontaneously cause local or referred pain, muscle weakness, restricted range of motion (ROM), and autonomic phenomena. In contrast, latent points remain asymptomatic unless stimulated, yet they can influence muscle activation patterns and contribute to limited ROM.

Both types induce allodynia at the trigger point site and hyperalgesia away from it when pressure is applied. The formation of trigger points involves the development of a taut band within the muscle, triggered by excessive acetylcholine release from the motor endplate. This process is coupled with the inhibition of acetylcholinesterase and an upregulation of nicotinic acetylcholine receptors.

Taut bands, initially a normal protective response to actual or potential muscle damage, often occur due to unaccustomed eccentric or concentric loading, sustained postures, and repetitive low-load stress. When sustained, these bands contribute to persistent pain.

Pain from trigger points is attributed to hypoxia and reduced blood flow, leading to decreased pH activating muscle nociceptors. This activation aims to restore homeostasis but ultimately causes peripheral sensitisation. Trigger points also play a role in central sensitisation, perpetuating nociceptive input into the dorsal horn, although the exact mechanism remains unclear. Understanding these mechanisms is crucial for the effective management and treatment of pain associated with trigger points.

Protocol

Executing Trigger Point Dry Needling (TDN) demands a meticulous and decisive protocol to ensure optimal efficiency and patient safety. Initiate the procedure with a thorough examination to pinpoint neuromuscular impairments, using a targeted approach. Prioritise patient safety by confirming the absence of contraindications before proceeding.

Obtain informed consent, providing a detailed disclosure of potential adverse effects linked to TDN. Uphold stringent adherence to clean needle technique and universal precautions, incorporating essential measures like wearing gloves, skin cleaning, and using single-use filiform needles to minimise infection risks.

Accurately identify the trigger point before engaging in direct needling, employing techniques such as piston motion at the practitioner’s discretion to elicit a twitch response. Swiftly and efficiently remove the needle, ensure proper disposal, and promptly assess the patient for any adverse effects.

Post-needling, reassess the patient’s neuromuscular impairments to gauge the immediate effects of the intervention. Conclude the procedure by introducing additional therapeutic interventions tailored to further diminish impairments and enhance overall function. This protocol underscores precision, clarity, and a commitment to achieving definitive outcomes in the TDN process. Strive for efficiency, maintaining a resolute stance throughout each step for the benefit of both practitioner and patient.

Indication

Dry needling is a therapeutic technique with diverse applications, particularly in addressing musculoskeletal conditions and pain syndromes. One key indication for the use of dry needling is in the management of Myofascial Pain Syndrome (MPS). This technique proves effective in targeting myofascial trigger points, which are hyperirritable spots in skeletal muscle associated with localised pain and dysfunction. By inserting thin monofilament needles precisely into these trigger points, dry needling aims to alleviate pain and improve muscle function.

Another significant indication for dry needling is in the treatment of muscle strains, both acute and chronic. The targeted insertion of needles helps promote muscle relaxation, enhance blood circulation to the affected area, and reduce muscle tone. This proves beneficial in facilitating the healing process and restoring optimal muscle function, making dry needling a valuable modality for individuals dealing with injuries resulting from overuse, trauma, or repetitive stress.

Precautions and contraindications 

Absolute contraindications to Trigger Point Dry Needling (TDN) necessitate a balanced approach, combining innovation and practicality for the safety of individuals seeking this therapeutic intervention. Patient consent denial stands as a fundamental contraindication, underscoring the importance of respecting autonomy. Practitioner incompetence due to inadequate knowledge or training is a significant obstacle, emphasising the need for proper education and training. State-of-the-art equipment is imperative for a safe and effective TDN procedure.

Specific scenarios, such as the first trimester of pregnancy, delicate areas like the scalp in infants, and sensitive regions like nipples, umbilicus, and external genitalia, are absolute contraindications due to their vulnerability. Uncontrolled anticoagulant usage and the presence of local infection, skin lesions, or active tumors require careful assessment. The occipital region with Arnold-Chiari malformation, cardiac pacemaker areas, and over surgical implants or in areas of laminectomy also necessitate cautious consideration.

Precautions include needle phobia, cognitive impairment, communication barriers, a history of pneumothorax, hyperalgesia, allodynia, compromised immune systems, metal allergies, abnormal bleeding tendencies, and vascular diseases.

Frequently Asked Questions (FAQs) - Dry Needling at Synapse Physiotherapy

1. What is dry needling, and how does it differ from acupuncture?

Dry needling involves the insertion of thin needles into muscles, ligaments, and other tissues to manage neuromusculoskeletal pain. Unlike acupuncture, dry needling focuses on trigger points and follows a Western medical philosophy. Acupuncture, rooted in Eastern traditions, targets specific points along meridians to restore the flow of life force or “qi.”

2. How does dry needling work on trigger points, and what are the benefits?

Dry needling induces a ‘local twitch response,’ triggering muscle contractions and impacting muscle fibers and mechanoreceptors. It also promotes vasodilation, improving blood flow and oxygenation. The neurophysiological effects contribute to reduced pain sensitivity. Benefits include increased pressure pain threshold, enhanced range of motion, reduced muscle tone, and immediate pain relief.

3. What conditions can dry needling address, and is it a standalone treatment?

Dry needling is effective for musculoskeletal conditions, especially Myofascial Pain Syndrome (MPS) and muscle strains (acute or chronic). It targets trigger points, alleviating pain and improving muscle function. While often used as a complementary therapy, its effectiveness makes it suitable as a standalone treatment, particularly when integrated into a holistic approach to musculoskeletal health.

4. What is the protocol for Trigger Point Dry Needling (TDN), and what safety measures are in place?

The TDN protocol involves a thorough examination, confirming the absence of contraindications, obtaining informed consent, and adhering to clean needle technique. Accurate identification of trigger points and a swift, efficient needle removal process are crucial. Safety measures include stringent hygiene practices, wearing gloves, and using single-use filiform needles to minimize infection risks.

5. Who should consider dry needling, and how can I explore this at Synapse Physiotherapy?

Dry needling is suitable for individuals experiencing musculoskeletal pain, myofascial trigger points, or neuromuscular dysfunction. If you’re looking for “physiotherapy near me,” exploring dry needling with a skilled and professional physiotherapist at Synapse Physiotherapy is recommended. Tailored dry needling services are offered to address specific needs and enhance overall well-being.

Conclusion

Dry needling is a viable option for individuals dealing with musculoskeletal pain, myofascial trigger points, or neuromuscular dysfunction. Often employed as a complementary therapy alongside other rehabilitative approaches, the decision to utilise dry needling is made following a comprehensive assessment by a qualified healthcare professional, such as a physiotherapist. If you’re considering the benefits of dry needling, you are encouraged to explore this option with a skilled and professional physiotherapist. Synapse Physiotherapy provides tailored dry needling services to address your specific needs whenever required.

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Efficacy of Dry Needling vs Acupuncture in Pain Management

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What is dry needling

‘Dry needling’ refers to the insertion of thin monofilament needles, as used in the practice of acupuncture, without the use of injectate. Dry needling is typically used to treat muscles, ligaments, tendons, subcutaneous fascia, scar tissue, peripheral nerves, and neurovascular bundles for the management of a variety of neuromusculoskeletal pain syndromes.

National Physical Therapy Association and several State Boards of Physical Therapy\ have recently narrowed their definition of dry needling to insertion of needles into nodules within taut bands of muscle, more commonly referred to as ‘trigger points’ (TrPs) or ‘myofascial trigger points’ (MTrPs)(Dunning et al., 2014).

Differences between dry needling and acupuncture 

 

This question is frequently asked, what is the difference between dry needling and accupuncture. While both therapies utilise solid filament needles, their applications and goals differ significantly. The variations are apparent in the practitioner’s evaluative tools, assessment methods, needle application, and overall objectives. Acupuncture, deeply rooted in Eastern medical traditions and requiring expertise in traditional Chinese medicine (TCM), involves the insertion of needles into specific points along meridians, channels through which the life force or “qi” flows. TCM acupuncture aims to restore the normal flow of this life force.

On the other hand, dry needling (DN) follows a Western medical philosophy, focusing on a practitioner using a thin filiform needle to penetrate the skin and stimulate myofascial trigger points, as well as muscular and connective tissues. DN is primarily employed for managing neuromusculoskeletal pain and addressing movement impairments.






Trigger point 

 

Trigger points are believed to result from an excessive release of acetylcholine from specific motor endplates, categorising them into Active and Latent myofascial trigger points. Active trigger points have the potential to spontaneously initiate local or referred pain, leading to muscle weakness, restricted range of motion (ROM), and autonomic phenomena. In contrast, latent trigger points remain asymptomatic unless stimulated, yet they can influence muscle activation patterns and contribute to limited ROM.

Both active and latent trigger points induce allodynia at the trigger point site and hyperalgesia away from the trigger point when pressure is applied. The formation of trigger points arises from the development of a taut band within the muscle, triggered by an excessive release of acetylcholine from the motor end plate, coupled with the inhibition of acetylcholinesterase and an upregulation of nicotinic acetylcholine receptors.

Initially, taut bands emerge as a normal protective physiological response in the presence of actual or potential muscle damage, often occurring in response to unaccustomed eccentric or concentric loading, sustained postures, and repetitive low-load stress. However, when sustained, these bands contribute to persistent pain.

Pain resulting from trigger points is attributed to hypoxia and reduced blood flow within the trigger point, leading to decreased pH that activates muscle nociceptors in an attempt to restore homeostasis, ultimately causing peripheral sensitisation. Additionally, trigger points play a role in central sensitisation, though the exact mechanism remains unclear. Nonetheless, trigger points perpetuate nociceptive input into the dorsal horn, contributing to central sensitisation.

 

Mechanism of Dry Needling 

Dry needling has demonstrated immediate benefits for individuals with musculoskeletal conditions, showing increased pressure pain threshold, enhanced range of motion, reduced muscle tone, and diminished pain. The efficacy of dry needling is attributed to various mechanisms. Firstly, the procedure induces a ‘local twitch response,’ an involuntary spinal reflex causing localised contractions in the treated muscles, thereby altering the length and tension of muscle fibers and stimulating mechanoreceptors like A Beta fibers. Additionally, dry needling addresses ischemic conditions by promoting vasodilation in small blood vessels, enhancing muscle blood flow and oxygenation. The intervention is also believed to induce neurophysiological effects, prompting local and central nervous system responses that restore hemostasis at trigger point sites and reduce both central and peripheral sensitisation to pain. Moreover, dry needling exhibits remote effects, with evidence suggesting analgesic impacts on proximal Myofascial Trigger Points (MTrP) following needling of distal MTrP.



Contraindication

 

Absolute contraindications to Trigger Point Dry Needling (TDN) must be approached with a judicious blend of innovation and practicality to ensure the safety and well-being of individuals seeking this therapeutic intervention. Consent denial by the patient stands as a fundamental absolute contraindication, emphasising the necessity of respecting individual autonomy in healthcare decisions. Furthermore, inadequate knowledge or training on the part of the practitioner poses a significant obstacle, highlighting the importance of ensuring a practitioner’s competence through proper education and training. The imperative of uncompromised equipment underscores the need for state-of-the-art tools to guarantee a safe and effective TDN procedure.

Absolute contraindications extend to specific scenarios, such as avoiding TDN during the first trimester of pregnancy, acknowledging the need for caution and consideration of maternal and fetal well-being. Delicate areas like the scalp in infants and sensitive regions including nipples, umbilicus, and external genitalia are rightly safeguarded against TDN due to their vulnerability. Uncontrolled anticoagulant usage poses a potential risk, emphasising the necessity for careful assessment and management of bleeding tendencies.

Equally crucial is the prohibition of TDN over areas with local infection, skin lesions, or active tumors, recognising the potential for complications and the importance of prioritising the patient’s overall health. The occipital region with Arnold-Chiari malformation requires meticulous attention, acknowledging the unique anatomical considerations in such cases. Over a cardiac pacemaker remains an absolute contraindication, highlighting the need for prudence in avoiding potential interference with life-sustaining medical devices (D & David, 2016). 

Precautions 

Before undergoing Trigger Point Dry Needling (TDN), certain precautions should be carefully considered to ensure the safety and suitability of the procedure for individuals. Individuals with needle phobia or a strong aversion to needles may find TDN psychologically distressing. Those with significant cognitive impairment may face challenges in understanding the procedure, obtaining informed consent, or cooperating during the session. A communication barrier, such as a language difference, may impede effective communication during the procedure. A history of traumatic or spontaneous pneumothorax, hyperalgesia, or allodynia warrants caution, as does the presence of local skin lesions or infections. Patients with compromised immune systems, metal allergies, abnormal bleeding tendencies, or vascular diseases should approach TDN with care, and alternative approaches may need consideration. TDN over surgical implants or in areas of laminectomy requires cautious assessment due to potential risks(D & David, 2016).

 

Protocol 

When performing Trigger Point Dry Needling (TDN), adhere to a streamlined and decisive protocol for optimal efficiency and patient safety. Begin with a thorough examination to identify neuromuscular impairments, ensuring a targeted approach. Confirm the absence of contraindications before proceeding, emphasising the imperative of patient safety.

Secure informed consent from the patient, including a comprehensive disclosure of potential adverse effects associated with TDN. Maintain strict adherence to clean needle technique and universal precautions, incorporating essential measures such as wearing gloves, skin cleaning, and using single-use filiform needles to minimise infection risks.

Identify the trigger point accurately before proceeding with direct needling. Utilise various techniques at the practitioner’s discretion, such as piston motion, to elicit a twitch response. Swiftly and efficiently remove the needle, ensuring proper disposal, and promptly check the patient for any adverse effects.

Following needling, reevaluate the patient’s neuromuscular impairments to determine the immediate effects of the intervention. Conclude the procedure with a decisive introduction of additional therapeutic interventions, such as manual therapy, therapeutic exercises, or modalities, tailored to further reduce impairments and enhance overall function.

This protocol emphasises precision, clarity, and a commitment to achieving definitive outcomes in the TDN process. Strive for efficiency, maintaining a resolute stance throughout each step for the benefit of both practitioner and patient (D & David, 2016).

Frequently Asked Questions (FAQs)

1. What is the difference between dry needling and acupuncture?

Dry needling and acupuncture both involve the insertion of thin needles but differ in their applications and goals. Acupuncture, rooted in Eastern medicine, targets specific points along meridians to restore the flow of life force (“qi”). Dry needling, a Western approach, stimulates myofascial trigger points in muscles, ligaments, and tendons, focusing on neuromusculoskeletal pain management and movement impairments.

2. How does dry needling address trigger points, and what are the effects of trigger points on the body?

Dry needling targets myofascial trigger points, areas of muscle tension. Active trigger points can cause local or referred pain, muscle weakness, restricted range of motion, and autonomic phenomena. Both active and latent trigger points induce allodynia and hyperalgesia. Dry needling’s local twitch response alters muscle fibers, promoting vasodilation, inducing neurophysiological effects, and exhibiting remote impacts, enhancing pain relief and restoring homeostasis.

3. What is the mechanism behind dry needling, and what benefits does it offer for musculoskeletal conditions?

Dry needling’s mechanism includes inducing a local twitch response, promoting vasodilation, and initiating neurophysiological effects. Benefits for musculoskeletal conditions include increased pressure pain threshold, enhanced range of motion, reduced muscle tone, and diminished pain. Dry needling’s effects contribute to both local and central nervous system responses, reducing sensitization to pain and offering immediate relief.

4. Who can benefit from dry needling, and how can I explore these benefits at Synapse Physiotherapy?

Dry needling is suitable for individuals experiencing musculoskeletal pain, myofascial trigger points, or neuromuscular dysfunction. It is often used as a complementary therapy alongside other rehabilitative approaches. To explore the benefits of dry needling with a skilled and professional physiotherapist, you can schedule a session at Synapse Physiotherapy, where tailored dry needling services are offered to address specific needs.

Conclusion

Dry needling may be considered for individuals who are experiencing musculoskeletal pain, myofascial trigger points, or neuromuscular dysfunction. It is often utilised as a complementary therapy in conjunction with other rehabilitative approaches. The decision to use dry needling is typically based on a thorough assessment by a qualified healthcare professional, such as a physiotherapist. You are welcome to explore the benefits of dry needling with a skilled and professional physiotherapist. Synapse Physiotherapy offers tailored dry needling services to address your specific needs whenever you require them.

References

Dunning, J., Butts, R., Mourad, F., Young, I., Flannagan, S., & Perreault, T. (2014). Dry needling: a literature review with implications for clinical practice guidelines. Physical Therapy Reviews, 19(4), 252–265. https://doi.org/10.1179/108331913×13844245102034

 

D, J., & David, B. (2016). Orthopaedic Physical Therapy Secrets (3). Elsevier Mosby.

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Introducing aqua hydrotherapy treatment in KL | Synapse

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Introduction

Hydrotherapy, also known as aquatherapy, encompasses activities carried out in the water to aid in rehabilitation and recovery, particularly following intense training or significant injuries. This therapeutic approach has roots dating back thousands of years and involves engaging in exercises in warm water. Widely recognised as a favored treatment for individuals with neurologic and musculoskeletal conditions [3], hydrotherapy facilitates the practice of coordinated and balanced movements, providing an effective means for rehabilitation and recovery.



Physiotherapists frequently incorporate aqua hydrotherapy treatment into rehabilitation. Water provides a secure, low-risk, and supportive training environment, making it particularly advantageous for older individuals seeking to participate in fitness programs without concerns about falling. This contributes to high levels of client satisfaction and adherence to hydrotherapy exercises. Additionally, the therapeutic benefits are often amplified by the social atmosphere of the sessions.

Physical properties of water 

Water possesses various physical characteristics: encompassing mass, weight, density, relative density, buoyancy, hydrostatic pressure, surface tension, refraction, and reflection.The following are the physical properties laws of water that the physiotherapist should understand: 

 

Buoyancy 

Buoyancy is the upward force encountered, acting in opposition to gravity. In water, a submerged body undergoes the influence of two conflicting forces. Stable equilibrium is achieved when the weight of the floating body matches the weight of the displaced liquid, and the centers of buoyancy and gravity align in the same vertical line.

 

Hydrostatic pressure 

According to Pascal’s law, when a fluid is at rest, its pressure is evenly distributed on all parts of an immersed body at a specific depth. This pressure correlates with the fluid’s density and depth, leading to increased pressure. Consequently, exercises conducted beneath the water’s surface, where heightened pressure can be utilised, are more effective in reducing swelling.

The hydrostatic pressure exerted externally induces a peripheral decrease in Blood Pressure (BP) and a rise in BP in and around the heart. This dynamic can pose challenges for individuals with conditions such as Chronic Heart Failure (CHF) and Coronary Artery Disease (CAD), necessitating careful consideration. The depth of immersion directly influences the extent of changes in the mentioned factors.

 

Surface tension

When under tension, the surface of the fluid acts as a membrane. The key significance of this characteristic lies in its close correlation with the size of the object. Consequently, exerting force to move an object or body part above the water demands more effort compared to moving it below the surface. Devices such as floaters can be employed to facilitate these movements

 

Viscosity

Viscosity refers to the resistance to flow resulting from friction between the molecules of a liquid. This resistance is directly influenced by the viscosity of the liquid through which the movement occurs. Consequently, the crucial observation here is that resistance increases proportionally with the velocity of movement, as well as with the surface area of the item or body part in motion. 



Benefit 

Hydrotherapy creates a gravity-eliminated environment that enhances joint range of motion, further augmented by the stimulating effects of water flow providing sensory input.

Traditionally considered as a supplementary approach to exercise, hydrotherapy has gained broad acceptance in the treatment of acute painful conditions such as rheumatoid arthritis, complex regional pain syndrome, and postoperative pain.

 

 The advantages of water exercises encompass the elimination of gravity, the positive influence of buoyancy, increased muscle relaxation, and reduced joint compression.The buoyancy of water decreases the effective weight of the patient proportionally with increasing depth. An example would be standing in chest-deep water reduces weight-bearing loads to 40% of total body weight. By eliminating the effects of gravity through floating, water exercises may gradually introduce increased tissue loads by adjusting the therapy depth. Water viscosity provides resistance equal to the force exerted by the patient, with resistance varying according to the speed of movement.

 

Clinically, patients report reduced pain levels during passive and active range of motion, as well as strengthening exercises in water. Water exercises allow for closed kinetic chain activities when pain or weight-bearing precautions limit land-based therapy. Additionally, water exercise is often perceived as less strenuous compared to the same exercises performed on land. Studies have demonstrated sustained benefits, showing a reduction in pain and improved function in patients participating in hydrotherapy for up to three months after therapy initiation.

 

 Hydrostatic forces also have been demonstrated to enhance venous return, improve stroke volume and cardiac output, and induce reflexive bradycardia (Stanos et al.).

 

Contraindication

Hydrotherapy is contraindicated in the presence of the following conditions: severe organic deficiency, severe brain impairment, senile deterioration, individuals with multiple sclerosis, open wounds, active infection, altered sensation, hydrophobia, heat or cold intolerance, and poor balance.

 

Techniques in hydrotherapy 

WATSU method 

Also known as ‘water Shiatsu,’ WATSU® is a fusion of Aquatherapy and Shiatsu. It involves stretching the body in the comforting and buoyant environment of warm water. Beyond its physical benefits, WATSU® places significant emphasis on the mental aspect of therapy. This method induces a profound sense of relaxation and tranquility, alleviating muscle tension and promoting the stimulation of all body systems and organs by enhancing the flow of energy

 

Bad Ragaz Ring method 

The Bad Ragaz Ring technique is an aquatic treatment approach rooted in proprioceptive neuromuscular facilitation. Employing floating rings positioned at the neck, pelvis, knees, and/or ankles, this method supports the patient in a vertical supine position. Utilising water at a temperature of 33 degrees Celsius, the Bad Ragaz Ring technique involves resistive exercises that enhance both strength and mobility. It is essential for the patient not to exert significant force, allowing the therapist to apply the necessary pressure. For optimal results, the Bad Ragaz Ring technique should be integrated with complementary strategies aimed at enhancing engagement and exertion. One such approach is the Halliwick method.

 

Feldenkrais Method

This method promotes teaching individuals about the quality of their movements and how to move effortlessly with ease and efficiency.

 

Burdenko Method 

It is an integrated land-water therapy approach that develops balance, coordination, flexibility, endurance, speed, and strength using the same methods as professional athletes. The water-based therapy uses buoyant equipment to challenge the center of buoyancy in vertical positions, exercising with movement in multiple directions, and at multiple speeds ranging from slow to fast

 

Who needs aqua therapy? 

 

Hydrotherapy, the therapeutic use of water, offers a range of benefits that cater to various individuals. People grappling with musculoskeletal conditions, such as arthritis or joint pain, often find relief in the buoyancy of water, which reduces impact on joints during exercises. Rehabilitation patients recovering from surgery or injury can benefit from hydrotherapy, leveraging water’s support and resistance for a gradual and effective recovery of strength and mobility. Those dealing with chronic pain, including conditions like fibromyalgia or lower back pain, may experience alleviation as the warmth of water relaxes muscles. Athletes incorporate hydrotherapy, including ice baths and warm water immersion, for post-exercise muscle recovery and inflammation reduction. Hydrotherapy’s relaxing effects make it valuable for managing stress and anxiety. Individuals with circulatory problems may find improvement through contrast baths, while those with respiratory conditions can benefit from steam baths or saunas. Prenatal water activities and warm baths are recommended for pregnant women seeking relief, and elderly individuals appreciate the gentleness of hydrotherapy on aging joints

Frequently Asked Questions (FAQs)

1. What is Aqua Hydrotherapy, and how does it aid in rehabilitation and recovery?

Aqua Hydrotherapy, also known as hydrotherapy or aquatherapy, involves engaging in exercises in warm water to facilitate rehabilitation and recovery. At Synapse Physiotherapy, this therapeutic approach is designed to harness the benefits of buoyancy, hydrostatic pressure, and water’s physical properties for effective rehabilitation following intense training or significant injuries.

2. What are the physical properties of water and how do they contribute to Aqua Hydrotherapy?

Water possesses unique physical characteristics, including buoyancy, hydrostatic pressure, surface tension, and viscosity. These properties play a crucial role in Aqua Hydrotherapy, providing a gravity-eliminated environment that enhances joint range of motion, muscle relaxation, and sensory input. Understanding these properties allows physiotherapists to tailor treatments for maximum effectiveness.

3. What are the benefits of Aqua Hydrotherapy, and who can benefit from it?

Aqua Hydrotherapy offers a gravity-eliminated environment, positively influencing buoyancy, muscle relaxation, and joint compression. It benefits a diverse range of individuals, including those with musculoskeletal conditions like arthritis, postoperative pain, chronic pain (e.g., fibromyalgia), athletes for muscle recovery, and individuals with circulatory or respiratory conditions. It is also valuable for stress management and prenatal care.

Conclusion

In conclusion, hydrotherapy emerges as a versatile and beneficial approach for various health conditions, ranging from musculoskeletal issues to stress management. Recognising its efficacy, Synapse Physiotherapy proudly offers hydrotherapy services. Our dedicated therapists are well-equipped to guide you through personalised hydrotherapy sessions, ensuring a tailored approach to meet your specific needs and health goals. Whether you are seeking relief from pain, recovering from an injury, or simply aiming to enhance your overall well-being, our team is committed to providing expert guidance and support throughout your hydrotherapy journey. Trust in Synapse Physiotherapy to harness the healing power of water, promoting your physical and mental well-being through specialised and caring hydrotherapy services.

References

Stanos, Steven, et al. “Chapter 73 – PHYSICAL MEDICINE APPROACHES to PAIN MANAGEMENT.” ScienceDirect, W.B. Saunders, 1 Jan. 2009, www.sciencedirect.com/science/article/abs/pii/B9781416048367000730. Accessed 29 Jan. 2024.

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Sports Injury Clinic | About Synapse Physiotherapy

Leg Pain, Muscle Pain

Introduction

Sports injuries, which primarily occur during sports or exercise, extend beyond athletes to encompass individuals in various occupations. For example, factory workers may experience tennis elbow, painters can suffer from shoulder injuries, and gardeners may develop tendinitis, even if they aren’t engaged in traditional sports. Despite this broader scope, “sports injuries” predominantly pertain to those sustained by active individuals.



A sports injury clinic is a specialised medical facility dedicated to addressing the unique challenges posed by injuries related to sports and physical activity. Manned by a team of healthcare professionals, including physiotherapists, these clinics focus on the comprehensive management of sports-related injuries. Their objectives encompass accurate diagnosis through thorough examinations and diagnostic tests, followed by tailored treatment plans that may range from conservative measures like physical therapy to more invasive interventions such as surgery. Additionally, sports injury clinics play a pivotal role in rehabilitation, guiding individuals through structured programs aimed at restoring functionality and preventing the recurrence of injuries. Moreover, these clinics prioritise education on injury prevention strategies to empower athletes, fitness enthusiasts, and active individuals in minimising the risk of future injuries. Whether as standalone facilities or integral parts of larger medical institutions, sports injury clinics contribute significantly to the well-being of those engaged in physical activities by offering specialised care to facilitate recovery and promote long-term health.

Acute Injuries VS Chronic Injuries

Acute injuries are typically the result of sudden trauma to the tissue, with symptoms manifesting almost immediately. The key factor in such cases is that the force applied at the time of injury exceeds the inherent strength of the tissue, affecting muscles, tendons, ligaments, or bones. Acute injuries can be classified based on the site and type, encompassing various anatomical structures and conditions such as fractures, dislocations, sprains, or strains.

These acute injuries can be further categorised into direct and indirect injuries. Direct injuries involve external forces or blows, such as collisions in contact sports or being struck by an object, causing trauma to specific body parts. On the other hand, indirect injuries manifest either some distance from the impact site, as seen in falling on an outstretched hand leading to a dislocated shoulder, or result from internal forces generated by the performer’s actions, such as muscle strains due to overstretching or poor technique.

In contrast, chronic injuries, often referred to as overuse injuries, develop gradually over time due to prolonged and repetitive loading of tissues. Unlike acute injuries, symptoms emerge gradually, and individuals may initially experience little or no pain. Overuse injuries occur when repetitive microtrauma overwhelms the tissue’s capacity to repair itself. Factors such as inadequate rest, overtraining, improper biomechanics, and pre-existing vulnerabilities contribute to cumulative tissue damage surpassing a threshold, resulting in pain and dysfunction.

 

Physiotherapy Treatment 

 

At our Synapse Physiotherapy Center, we specialise in the treatment of both acute and chronic sports injuries. However, it’s important to note that the approach to treatment varies significantly depending on the type of injury you’ve experienced. For acute injuries, physiotherapists often initiate the R.I.C.E. protocol, incorporating rest, ice, compression, and elevation to manage initial inflammation. They employ pain management techniques, such as ultrasound or electrical stimulation, and gradually introduce range of motion exercises followed by targeted strengthening exercises to restore function. In chronic or overuse injuries, physiotherapists focus on identifying underlying causes, including biomechanical issues or muscle imbalances. Tailored exercise programs address weaknesses and imbalances, while manual therapy techniques alleviate pain and improve joint mobility. Education on proper training techniques and activity modifications is provided, and a gradual return-to-activity plan is implemented to prevent re-injury. Throughout the rehabilitation process, effective communication between the athlete and the physiotherapist is crucial for a comprehensive and successful recovery.

 

Common sport injury 

Ligament 

Acute ligament injuries are common occurrences in the realm of sports, often resulting from sudden and forceful movements that place excessive stress on the ligaments connecting bones within joints. One prevalent example is the Anterior Cruciate Ligament (ACL) injury, frequently observed in activities involving abrupt stops, directional changes, or awkward landings. Medial Collateral Ligament (MCL) sprains typically arise from direct impacts to the outer knee, prevalent in contact sports like football and hockey. Similarly, Lateral Collateral Ligament (LCL) injuries may occur with a blow to the inner knee. Posterior Cruciate Ligament (PCL) injuries, less frequent than ACL injuries, can result from direct blows or hyperextension. Ankle ligament sprains are commonplace in sports with rapid changes in direction, such as basketball. Additionally, shoulder ligament injuries, like Acromioclavicular Joint (AC Joint) sprains, often stem from falls or impacts, particularly in cycling or contact sports.

 

Fracture 

Fractures are not uncommon in the realm of sports injuries, and specific types are frequently observed due to the nature of athletic activities. Stress fractures, resulting from repetitive stress and overuse, are often seen in long-distance runners or athletes engaged in repetitive impact sports, commonly affecting weight-bearing bones like the tibia or metatarsals. Ankle fractures, on the other hand, are prevalent and typically caused by twisting, rolling, or direct impact during sports such as soccer or basketball. These fractures can involve the fibula, tibia, or foot bones.

Wrist fractures, arising from falls onto outstretched hands, are common in sports like skateboarding or gymnastics, potentially affecting the radius, ulna, or carpal bones. Femur fractures, involving the thigh bone, are usually a result of high-impact collisions or falls in sports like football or motor racing. Collarbone fractures, prevalent in contact sports like rugby or hockey, typically occur in the middle or outer third of the collarbone. Hand and finger fractures are seen in sports with direct trauma, such as basketball or martial arts, affecting the metacarpal bones or phalanges.

Tendon 

Tendinopathy, a prevalent condition in sports injuries, manifests as pain, swelling, and functional impairment of tendons subjected to repetitive stress, overuse, or acute trauma. Among the commonly encountered tendinopathies in sports, Achilles tendinopathy stands out, often attributed to overuse in activities like basketball or running, leading to pain and stiffness along the Achilles tendon. Patellar tendinopathy, colloquially known as Jumper’s Knee, results from repetitive jumping or forceful quadriceps contractions, prevalent in sports such as basketball, volleyball, or track and field, causing pain just below the kneecap, particularly exacerbated during jumping or running.

Tennis elbow, or lateral epicondylitis, is another common tendinopathy linked to repetitive gripping and wrist extension, seen in sports like tennis, golf, or activities requiring frequent forearm use, resulting in pain and tenderness on the outer part of the elbow. Its counterpart, golfer’s elbow or medial epicondylitis, arises from repetitive wrist flexion and gripping in sports like golf or racquet sports, causing pain on the inner part of the elbow.

Rotator cuff tendinopathy, associated with overhead arm movements in sports like swimming, baseball, or tennis, manifests as shoulder pain, particularly during overhead activities, along with weakness in the affected arm. Hamstring tendinopathy, caused by overuse or forceful contractions of the hamstring muscles, is prevalent in sports involving sprinting or kicking, resulting in pain in the back of the thigh, often aggravated during running or kicking.

Muscle

Muscle strains, characterised by the stretching or tearing of muscle fibers, are prevalent in sports and often result from abrupt or forceful movements, overexertion, or insufficient warm-up. One common type is the hamstring strain, occurring when the muscles at the back of the thigh experience overstretching or tearing, commonly seen in activities such as sprinting or sudden accelerations. Symptoms of a hamstring strain include pain, swelling, and, in more severe cases, bruising in the affected area.

Another frequently encountered muscle strain is the quadriceps strain, which occurs due to overexertion or sudden movements that strain the quadriceps muscles at the front of the thigh. This type of strain is common in sports that involve rapid changes in direction or powerful leg movements. Symptoms typically include localised pain, tenderness, and potential swelling in the quadriceps region.

Frequently Asked Questions (FAQs)

1. What is a sports injury clinic, and how does it differ from general healthcare facilities?

A sports injury clinic is a specialised medical facility dedicated to addressing injuries related to sports and physical activity. Synapse Physiotherapy, as a leading clinic in Malaysia, offers comprehensive care for sports injuries, focusing on accurate diagnosis, tailored treatment plans, and rehabilitation. Unlike general healthcare facilities, these clinics are staffed by professionals with expertise in sports-related injuries.

2. Who can benefit from services at Synapse Physiotherapy's Sports Injury Clinic?

While the term “sports injuries” might suggest only athletes, our clinic caters to a broader audience. Anyone engaged in physical activities, including sports enthusiasts and individuals with occupational strains (e.g., painters, gardeners), can benefit from our specialised care. The clinic addresses a wide range of injuries beyond traditional sports-related cases.

3. What is the difference between acute and chronic sports injuries?

Acute injuries result from sudden trauma, causing immediate symptoms, while chronic injuries develop gradually due to repetitive stress. At Synapse Physiotherapy, we treat both types of injuries, employing specific approaches such as the R.I.C.E. protocol for acute injuries and tailored exercise programs for chronic injuries.

4. What types of injuries are commonly treated at Synapse Physiotherapy's Sports Injury Clinic?

Our clinic handles various sports-related injuries, including ligament injuries (e.g., ACL, MCL), fractures (e.g., stress fractures, wrist fractures), tendon issues (e.g., Achilles tendinopathy, tennis elbow), and muscle strains (e.g., hamstring, quadriceps). We provide personalised rehabilitation programs, ensuring effective recovery for each injury type.

5. Why should I choose Synapse Physiotherapy for sports injury rehabilitation?

Synapse Physiotherapy offers specialised care designed for a diverse range of injuries, from common strains to complex conditions. Our professional team adheres to evidence-based practices, utilising cutting-edge techniques for personalised care and ongoing support. Choosing our clinic ensures a proactive approach to prevent worsening conditions and facilitates a safe return to an active and healthy lifestyle.

Conclusion

In Malaysia, physiotherapist plays a crucial role in sports injury rehabilitation, emphasising excellence in care. Physiotherapists at Synapse specialise in designing tailored rehabilitation programs for a range of injuries, from common strains to complex conditions, ensuring holistic recovery. The professional team at Synapse adheres to evidence-based practices, utilising cutting-edge techniques for personalised care and ongoing support. Seeking the expertise of a physiotherapist, especially at Synapse, is a proactive approach to prevent worsening conditions and expedite a safe return to physical activities. Physiotherapists are essential partners in sports injury rehabilitation, fostering resilience, preventing re-injuries, and promoting sustained well-being. Making an appointment with a professional physiotherapist is a wise decision for early intervention and an effective return to an active and healthy lifestyle.

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Scoliosis Chiropractor vs Physiotherapist | Synapse

Shoulder Pain

Introduction

Scoliosis is a complex deformity of the spine that manifests in three planes, involving curvature in the frontal plane, axial rotation in the horizontal plane, and deformities in the sagittal plane. The diagnosis is typically established by measuring the angle of curvature, known as the Cobb angle, which is considered significant if it reaches at least 10°. Adolescent idiopathic scoliosis (AIS) specifically refers to a three-dimensional spinal deformity that emerges during puberty in otherwise healthy children. While scoliosis can be diagnosed at any age, the majority of cases are identified during adolescence, typically between the ages of 10 and 18. As the most common pediatric deformity of the spine, scoliosis has a global incidence in the pediatric population ranging from 0.93% to 12%, according to estimates from the International Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT). Early detection and appropriate management are critical for addressing the challenges posed by scoliosis, emphasising the importance of ongoing research and effective treatment approaches in this field (Seleviciene et al., 2022). 

Classification

Idiopathic scoliosis 

Idiopathic scoliosis, constituting approximately 80% of all cases, is diagnosed when other potential causes of spinal curvature have been excluded. In the adult population, scoliosis has a prevalence of more than 8% among individuals over the age of 25, and this prevalence rises to 68% in those aged over 60 due to degenerative changes in the aging spine. Moreover, there is a 2.5% prevalence of scoliosis in the general population with a Cobb angle larger than 10 degrees. Adolescent idiopathic scoliosis, the most common type, typically emerges during puberty and accounts for around 90% of cases of idiopathic scoliosis in children.

This condition is further classified into distinct subgroups based on the age of onset. Infantile scoliosis, developing between the ages of 0 and 3 years, exhibits a prevalence of 1%. Juvenile scoliosis, occurring between the ages of 4 and 10 years, constitutes 10–15% of all idiopathic scoliosis cases in children. Notably, untreated curves in juvenile scoliosis can lead to serious cardiopulmonary complications, and surgical intervention becomes necessary in 95% of cases with curves measuring 30 degrees or more. Adolescent scoliosis, emerging between the ages of 11 and 18 years, is the most prevalent subgroup, representing approximately 90% of cases in children.

 

Congenital scoliosis 

Congenital scoliosis is a condition that results from embryological malformations affecting one or more vertebrae, and it can occur in any segment of the spine. The abnormalities in the vertebrae lead to curvature and other deformities of the spine, as one specific area of the spinal column tends to lengthen at a slower rate compared to the rest. The geometry and location of these abnormalities play a crucial role in determining the rate at which scoliosis progresses in magnitude as the child grows.

Unlike idiopathic scoliosis, congenital scoliosis is present at birth, as it arises from developmental issues during the embryonic stage. Due to its congenital nature, this form of scoliosis is typically detected at a younger age than idiopathic scoliosis. Early identification is facilitated by thorough examinations and imaging studies, allowing healthcare professionals to assess the extent of the malformations and plan appropriate management strategies.

 

Neuromuscular Scoliosis 

Secondary or non-idiopathic scoliosis encompasses cases where spinal curvature is a consequence of underlying neurological or muscular diseases. This category includes scoliosis associated with conditions such as cerebral palsy, spinal cord trauma, muscular dystrophy, spinal muscular atrophy, and spina bifida. Unlike idiopathic scoliosis, this type tends to progress more rapidly, often necessitating surgical intervention for effective management.

 

Characteristics 

 

Scoliosis presents clinically with a distinct curvature of the spine, forming an “S” or “C” shape when viewed from the front or back. This curvature leads to noticeable asymmetries, including one shoulder appearing higher than the other, uneven hips, and a tilted waistline. A characteristic feature, particularly in thoracic scoliosis, is the presence of a rib hump, observable when the individual bends forward. Clothing may not hang symmetrically, and postural changes such as leaning to one side can be apparent. While not always present, some individuals with scoliosis may experience back pain or discomfort. In adolescents, the condition may progress during growth spurts, emphasising the importance of regular monitoring

 

Examination and diagnosis 

Scoliosis is usually confirmed through a physical examination, an x-ray, spinal radiograph, CT scan or MRI. The curve is measured by the Cobb Method and is diagnosed in terms of severity by the number of degrees.

The Cobb angle, measured on X-rays, serves as a crucial parameter in defining the severity of scoliosis. A minimum angulation of 10 degrees is considered the threshold to diagnose scoliosis. When the curvature falls between 15 and 20 degrees, some studies suggest that specific treatment may not be immediately necessary, advocating regular check-ups to monitor progression until bone maturity. Physiotherapy including exercise sessions both at the clinic and through a home program is recommended. 

In the range of 20 to 40 degrees, orthopaedic doctors commonly prescribe back braces to impede further curvature development. The type of brace recommended depends on factors such as the patient’s lifestyle, discipline, and the severity of the curve. A scoliosis-intensive rehabilitation program must be introduced. 

When the curvature exceeds 40 to 50 degrees or more, surgery may be deemed necessary to correct the spinal deformity. Various surgical procedures exist, with spinal fusion being a recurrent choice. This procedure involves linking the vertebrae together, preventing further curvature progression. The decision to pursue surgery is typically influenced by the degree of the curvature, the impact on the individual’s quality of life, and the potential for continued progression.

 

Role of physiotherapist 

The role of a physical therapist in the management of scoliosis involves three crucial tasks: informing, advising, and instructing. It is imperative to provide the patient and/or parents with clear and comprehensive information about the individual’s specific situation. This includes explaining the nature of scoliosis, its potential progression, and the available treatment options. Some physical therapists may recommend braces, such as the Milwaukee brace, to prevent the worsening of scoliosis.

A significant focus for physical therapists is guiding patients in performing the correct exercises tailored to their condition. Numerous studies suggest that exercises can have beneficial effects on individuals with idiopathic scoliosis. Beyond physical interventions, physiotherapists also consider biopsychosocial factors. For adolescents with idiopathic scoliosis experiencing chronic low back pain, therapists may assess and address additional factors such as insomnia, depression, anxiety, stress, and daytime sleepiness. Recognizing and managing these contributing factors becomes crucial in providing comprehensive care for individuals with scoliosis, addressing both the physical and psychosocial aspects of their experience.

One of the best approaches for scoliosis management is to use physiotherapeutic scoliosis-specific exercises (PSSE).A PSSE physiotherapy methodology must be based on scientific evidence and customised for each patient.

The SOSORT emphasises that PSSE physiotherapy used for the treatment of Adolescent Idiopathic Scoliosis differs from nonspecific physiotherapy in that it aims at three-dimensional self-correction of posture, stabilisation of corrected posture, patient education, and the integration of corrective positions into daily activities. The frequency of PSSE physiotherapy varies from 2 to 7 days per week, depending on the complexity of the technique used, the need of the patients, and their ability to follow the prescribed program. Long-term outpatient programs typically occur two–four times a week if the patient is ready to cooperate. Typically, PSSE physiotherapy is only performed by professionally trained instructors, as physical exercises are chosen based on the type and severity of scoliosis in each patient, and the nature of the exercises themselves depends on the methodology applied.

 

The most well-known PSSE physiotherapy schools of thought is The Schroth Method. Schroth exercises serve as a targeted and non-invasive approach to address scoliosis by focusing on de-rotating, elongating, and stabilising the spine in three dimensions. These exercises, conducted through physical therapy, center around restoring muscular symmetry and aligning posture. By specifically targeting imbalances in muscle strength and tone, the exercises work towards achieving a more balanced and aligned spine. Integral to Schroth exercises is the incorporation of breathing techniques, directing breath into the concave side of the body. This emphasis aims to facilitate improved spinal alignment and enhanced muscular control. Additionally, Schroth exercises prioritise developing awareness of posture, enabling individuals to actively maintain correct spinal alignment in various daily activities.



Role of chiropractor 

Chiropractors may use spinal adjustments or manipulations to help improve spinal alignment and mobility. While chiropractic adjustments cannot reverse the curvature of scoliosis, they may help reduce discomfort, improve function, and enhance the overall health of the spine.

 

Differences between chiropractic and physiotherapy 

Chiropractors and physiotherapists approach the treatment of scoliosis from different perspectives, utilising distinct techniques and interventions. There are some key differences between chiropractic care and physiotherapy in treating scoliosis:

 

Philosophy and Approach:

Chiropractic care often focuses on spinal manipulation and adjustments to improve spinal alignment and function. Chiropractors believe that misalignments in the spine (subluxations) can affect overall health and well-being.

Physiotherapy employs a variety of techniques such as exercises, manual therapy, and modalities to improve movement, function, and overall physical well-being. Physiotherapists often focus on restoring mobility, strength, and flexibility while addressing pain and dysfunction.

 

Treatment Techniques:

Chiropractors primarily use spinal adjustments, mobilisations, and manipulations to address spinal misalignments and restore proper movement and function to the spine.

Physiotherapists utilise a broader range of treatment techniques including exercises, stretches, manual therapy (such as joint mobilisations and soft tissue techniques), modalities (such as ultrasound and electrical stimulation), and postural training to address muscle imbalances, improve mobility, and alleviate pain.

 

Emphasis on Exercise and Rehabilitation:

Physiotherapy places a strong emphasis on exercise and rehabilitation to strengthen muscles, improve flexibility, and promote proper movement patterns. Physiotherapists often design personalised exercise programs tailored to the individual needs and goals of the patient.

While chiropractors may incorporate exercise and rehabilitation into their treatment plans, the emphasis may not be as prominent as in physiotherapy.

 

Scope of Practice:

Chiropractors primarily focus on spinal health and musculoskeletal conditions, including scoliosis. They may use adjustments and manipulations to address spinal misalignments and related symptoms.

Physiotherapists have a broader scope of practice and can address a wide range of musculoskeletal, neurological, and cardiopulmonary conditions. They may use a variety of techniques to address functional limitations and promote overall physical well-being.

Frequently Asked Questions (FAQs)

1. What is scoliosis, and how is it diagnosed?

Scoliosis is a complex spinal deformity involving curvature in three planes. It is diagnosed by measuring the Cobb angle, with a significant angle considered as 10° or more. Diagnosis involves physical examination, X-rays, spinal radiographs, CT scans, or MRIs.

2. What are the different types of scoliosis, and how do they differ?

There are three main types of scoliosis: idiopathic scoliosis (80% of cases), congenital scoliosis (present at birth due to vertebrae abnormalities), and neuromuscular scoliosis (resulting from neurological or muscular conditions). Each type has distinct characteristics and may require different approaches to treatment.

3. What are the available treatment options for scoliosis, and when are they recommended?

Treatment options vary based on the severity of scoliosis. In mild cases (10-20 degrees), physiotherapy with specific exercises may be recommended. Bracing is commonly prescribed for curves between 20 and 40 degrees, while surgery becomes a consideration for curves exceeding 40 to 50 degrees or more. The type and frequency of treatment depend on individual factors.

4. How do physiotherapists contribute to scoliosis management, and what is the role of specific exercises?

Physiotherapists play a crucial role by providing information, advising, and instructing patients. They design personalized exercise programs, including Physiotherapeutic Scoliosis-Specific Exercises (PSSE) like the Schroth Method. These exercises focus on three-dimensional self-correction of posture, stabilizing corrected posture, and integrating corrective positions into daily activities.

5. What is the role of chiropractors in scoliosis treatment, and how does it differ from physiotherapy?

Chiropractors may use spinal adjustments to improve spinal alignment and mobility but cannot reverse scoliotic curvature. The difference lies in their approach; chiropractic care emphasizes spinal manipulation, while physiotherapy uses a broader range of techniques, exercises, and modalities to address muscle imbalances, improve mobility, and alleviate pain.

Conclusion

In conclusion, early detection and proactive management are paramount in addressing scoliosis, particularly among adolescents, with a heightened emphasis on females who are more prone to the condition. Regular postural check-ups and timely intervention play pivotal roles in preventing the progression of spinal curvature and mitigating potential complications such as low back pain. Seeking professional assessment and treatment from trained physiotherapists, such as those available at clinics like Synapse Physiotherapy, ensures individuals receive personalised care tailored to their unique needs. By initiating therapeutic exercises and interventions under the guidance of skilled practitioners, adolescents can embark on a path towards improved spinal health and overall well-being, thereby minimising the impact of scoliosis on their lives. Early intervention not only fosters better outcomes but also empowers individuals to actively manage their condition and embrace a healthier, more active lifestyle.

References

Seleviciene, V., Cesnaviciute, A., Strukcinskiene, B., Marcinowicz, L., Strazdiene, N., & Genowska, A. (2022). Physiotherapeutic Scoliosis-Specific Exercise Methodologies Used for Conservative Treatment of Adolescent Idiopathic Scoliosis, and Their Effectiveness: An Extended Literature Review of Current Research and Practice. International Journal of Environmental Research and Public Health, 19(15), 9240. https://doi.org/10.3390/ijerph19159240

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