Synapse Physiotherapy | Physio Center | Rehab Malaysia

Muscle Pain, Shoulder Pain


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.


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.


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



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 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.



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



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. 



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.


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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